Ensuring birth control is insured

By TOM GRAHAM
WASHINGTON POST
"I'm stuck in birth-control limbo right now," Carolyn Henry wrote in an e-mail. Because she takes medicine that interferes with birth-control pills, Henry said, her gynecologist suggested an IUD, or intrauterine device.
That sounded fine to Henry, who described herself as "fairly young, married ... not ready for kids." So she proceeded to arrange for an IUD insertion.
A systems analyst for BAE Systems who lives in Alexandria, Va., Henry said BAE's benefits staff told her that her Aetna policy would pay for the insertion, but that Aetna would not cover the $400 IUD itself. For that, she had to go to Medco Health, which administers BAE's drug benefits plan. She did so -- only to be told that although birth-control pills are covered, IUDs are not.
"It's just boggling my mind," Henry said.
In response to an inquiry by The System, BAE said there had been a misunderstanding. Although IUDs are not mentioned in a summary of Aetna's coverage, said John Measall, a BAE spokesman, the plan would include both the insertion and the device itself: "We're directing our medical plan administrators to cover this procedure."
As for Henry, he said, "I think her best course of action is to go to someone in human resources" at BAE and insist that her procedure is covered through Aetna.
Henry's case, while seemingly headed for resolution, touches on the thorny topic of contraceptive parity.
Varying requirements
According to the nonprofit National Women's Law Center, some states require insurance plans that cover prescription drugs in general to include birth-control pills and contraceptive devices such as IUDs.
Many women are not guaranteed such parity, either because they work in other states or because they're enrolled in large, so-called self-insured health plans that are not subject to state insurance laws.
And according to NWLC vice president Judith Appelbaum, federal law does not require self-insured plans to cover birth control as they do other drugs. (Federal workers, however, do have parity protection, she said.)
What to do
So what could a person like Henry do if her self-insured employer refused to pay for an IUD? One option would be to raise the issue of sex discrimination.
Appelbaum noted that in 2000, the Equal Employment Opportunity Commission declared "it is illegal for employers with 15 or more employees to offer their employees a health plan that covers prescription drugs in general but not prescription contraceptives."
"The EEOC was very explicit," said Appelbaum, in ruling that a company "has to cover the full range of contraceptive options," including IUDs.
"We actually do get a steady stream of inquiries" from women contending the EEOC rule is being violated, she said. "It seems as if the coverage gap is narrowing," she said, but "not every employer is meeting its obligation."