Their emphasis on cost control, most managed-care plans do not offer women a full range of reproductive health care. And many private insurers are cutting costs by eliminating services. Here, according to Eve Gartner, a senior staff attorney for the Center for Reproductive Law and Policy (CRLP), are some questions women should ask before signing up with an insurance plan:
What birth control devices, medications and procedures are covered?
Sometimes a device like an IUD or diaphragm is covered, but the office visit for insertion or fitting isn’t. Some plans don’t pay for oral contraceptives even though they do pay for other prescriptions, is abortion covered? If there isn’t a doctor in the plan to do it, where would I be referred? Managed-care plans often dictate which hospital you have to go to, no matter what the procedure. But not all hospitals perform abortions. For instance, CRLP has received reports of facilities that have merged with Catholic hospitals and now won’t perform the procedure. It has also seen cases of managed-care physicians who are so opposed to abortion that they refuse even to refer patients to a doctor who will perform one. In another example, a woman was referred to a facilitv more than 100 miles from her home, even though other abortion providers were closer.
How long can I stay in the hospital after a normal delivery of a baby? Would an epidural block (an anesthetic pain reliever) be paid for?
It is not uncommon for health-care plans to require women to leave within 24 hours of giving birth. And CRLP has gotten scattered reports of insurance companies not reimbursing the costs of epidurals, claiming they are not a “medical necessity.”
If coverage turns out to be less than promised, work through the plan’s grievance procedure. Concludes Gartner, “A threatening letter goes a long way.”