Q: Beneath the Affordable Care Act, I authorize for contraceptive casework as allotment of my bloom plan at no added cost. My bloom allowance provider Blue Cross Blue Shield has accepted that actuality to me. Yet Express Scripts, a abstracted aggregation my Blue plan uses for decree coverage, insists that my Blue plan doesn’t action a aught co-pay for me. What’s activity on? I’ve alleged and alleged and called. Where can I book a complaint adjoin Express Scripts?
A: You’re absolutely appropriate in principle. Beneath Obamacare, women accept been advantaged to a ambit of antitoxin casework for added than a year, including bearing ascendancy articles and services, all at no added costs. Your bloom plan premiums awning those costs in full.
“Starting a year ago, women of all walks of activity began to get both bearing ascendancy and important well-women checkups at no amount for the aboriginal time,” said Cecile Richards, admiral of Planned Parenthood, recently. “This is the big adventure of the Affordable Care Act—the steady, celebrated advance for women.”
However, not every accurate contraceptive is covered beneath the law. The Affordable Care Act requires aloof one anatomy or cast of anniversary of the 15 or so bearing ascendancy methods—pills, rings, IUDs, implants, patch, injections and so on—to be covered.
So it seems to me that you accept a simple problem. The accurate anatomy or cast of bearing ascendancy you are application is not on your Blue Cross plan’s accustomed list. For example, your brand-name pill—or alike your specific generic—may not be included.
As aboveboard as that botheration sounds, you’re acquirements how catchy the band-aid can be.
In a rational world, you’d anticipate you could alarm Express Scripts and acquisition out what specific us or added anatomy of bearing ascendancy is covered.
However, about third-party providers like Express Scripts are set up to do is acquaint you whether the exact us or anatomy you’re allurement about ancestor up as accustomed on its computer screen. If it does, great! You’re covered; Express Scripts fills your decree at no added cost. But aback it does not—as in your case—Express Scripts aloof tells you that you’re out of luck.
Before you attending for a lawyer, go aback to Blue Cross and get a administrator to accord you the abounding account of the contraceptive articles and casework your bloom plan covers, including cast names and dosages if applicable. Blue Cross should advice array this out for you.
Then allocution to your doctor. Ask whether there is an accustomed artefact or account that would be safe and able for you. Chances are, you’ll accept several options, at no added cost. And if you accept appropriate medical needs, your doctor should appetite to advice you seek a abandonment for your accurate contraceptive from Blue Cross.
If you’re still accepting trouble, go to the Civic Women’s Law Center website at nwlc.org. That non-profit women’s advancement accumulation has an accomplished “toolkit” for women who are denied the antitoxin casework they deserve, including anatomy belletrist for academic appeals and waivers.
Studies done afore the ACA became law accept accurate that bearing ascendancy has been cher for women—and the nation. Half of all women of changeable age said they didn’t use bearing ascendancy because of the costs, which can ascend to $1,000 or added a year for IUDs and implants, the best able forms of contraception. And the aerial costs, in turn, accord to the nation’s 1.6 actor adventitious pregnancies a year at an estimated amount of $12.5 billion in accessible assistance.
Over time, the ACA’s bearing ascendancy allowances should abate the cardinal of adventitious pregnancies and the cesspool on the civic budget.
Published: October 24, 2013 — 9:38 AM EDT | Updated: October 24, 2013 — 11:34 AM EDT
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