Sanders calls out 3 payers over birth control coverage, urges investigation

Sen. Bernie Sanders is asking the Government Accountability Office to investigate why some payers are charging members for birth control, which violates the ACA.

The ACA requires most health plans to fully cover all contraception methods approved by the FDA.

In a June 17 letter, Mr. Sanders cited a recent state investigation in Vermont that found BCBS Vermont, MVP Health Care, and Cigna Healthcare violated state and federal law by failing to cover contraceptives for members at no cost. 

The investigation found that between 2017 and 2021, the three payers charged members $1.5 million for contraceptives that should have been free.

A federal investigation in October 2022 found that insurers nationwide have excluded or imposed cost-sharing on at least 34 contraceptive products. Between 2015 and 2021, a majority of payers denied an average of 40% or more of exception requests for birth control products, with one insurer denying more than 80% of requests annually.

"It is completely unacceptable that plans consistently defy mandated coverage and that there is little enforcement or accountability. This is costing Americans millions in unnecessary health care fees," Mr. Sanders wrote.

In the letter, he requested that the GAO address the following questions:

1. How do states and federal agencies oversee group and individual health plans for compliance with ACA’s mandate that contraceptives be covered without patient cost sharing? 

2. How do the Department of Health and Human Services, Department of Labor, and Department of the Treasury oversee compliance with the ACA mandate, and what, if any, barriers do the agencies face in carrying out their enforcement and oversight responsibilities? 

3. What is known about the extent to which group and individual health plans comply with the ACA contraceptive coverage mandate?

"Blue Cross and Blue Shield of Vermont values access and protection of contraceptive care for our members," the company told Becker's in a statement. "This investigation focused on a newly expanded, Vermont-specific no-cost-share contraceptive statute and found inconsistencies by all participating insurers. The Vermont Department of Financial Regulation stated that: "the claims inappropriately processed to include cost-share to the member were generally the result of incorrect coding, differing interpretations of the mandate, and system limitations. Blue Cross and Blue Shield of Vermont corrected the errors to our systems, provided restitution, and is now in full compliance with both federal and state requirements."

"MVP Health Care shares Sen. Sanders' concerns about cost-sharing barriers and the importance of no-cost access to contraceptive coverage and services," a spokesperson for the company told Becker's. "We are deeply committed to compliance with both Vermont and federal laws concerning reproductive rights and vital preventive services for our customers. In 2021, MVP worked collaboratively with Vermont regulators to identify coding errors, claims processing limitations, and differing statutory interpretations related to Vermont state laws which go beyond the ACA contraceptive mandate. MVP's systems have since been updated to rectify the administrative processing errors and affected members were informed on how to seek restitution, including with interest, for any incurred costs due to the errors."

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