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12 Oregon insurers fail to pay full cost of eligible reproductive services, audits find

Three insurers did not pay for eligible contraceptives or allow 12-month refills, and three did not resolve consumer complaints.
Some state lawmakers have suggested restricting access to the intrauterine device known as IUD; many reproductive health advocates fear the overturning of Roe v. Wade would embolden those efforts. | REPRODUCTIVE HEALTH SUPPLIES COALITION/UNSPLASH
February 7, 2023

This article was originally published in Oregon Capital Chronicle.

Oregonians have been guaranteed free reproductive health care coverage, including for abortions, under a law that went into full effect in 2019. But at least a dozen insurance companies have charged consumers anyway, state officials said Wednesday.

The Department of Consumer and Business Services released reports on violations by 12 health insurers that cover nearly 1 million Oregonians. The audits dive into details first outlined in a report issued last summer.

The audits found that the companies, which cover people through individual and group markets, have failed to comply with the law, the Reproductive Health Equity Act. They charged copays, applied payments to deductibles that have to be paid before insurance coverage kicks in or failed to cover mandated benefits that are supposed to be free.

In some instances, the insurers denied claims altogether or failed to resolve consumer complaints, the department said in a statement.

The state found violations by Aetna Life Insurance Co., BridgeSpan Health Co., Cigna Health and Life Insurance Co., HealthNet Health Plan of Oregon, Kaiser Foundation Health Plan of the Northwest, Moda Health Plan, PacificSource Health Plans, Providence Health Plan, Regence BlueCross BlueShield of Oregon, Samaritan Health Plans, UnitedHealthcare Insurance Co., and UnitedHealthcare of Oregon.

“RHEA is a critically important tool in the state’s effort to remove barriers to reproductive health care,” Andrew Stolfi, the state insurance commissioner and department director, said in a statement. “As with every law, our insurers had an obligation to fully and timely implement each aspect of RHEA across all of their systems. It is disappointing to see that this did not happen.” 


Consumer help

Consumers who believe they have not received the services or benefits owed under the law should contact their insurer or the department’s advocacy line at 888-877-4894 or go here

For a list of benefits under the act, go here.


The department said it would continue working on the issue, including customer refunds. The state’s Reproductive Health and Access to Care workgroup, which Democratic House Speaker Dan Rayfield convened last summer to analyze how Oregon could protect abortion access after the U.S. Supreme Court overturned Roe v. Wade, recommended in December that the state proactively enforce coverage mandates. 

The Reproductive Health Equity Act, passed by the Legislature in 2017, covers annual wellness visits, birth control, abortions, cancer and sexually transmitted infection screenings, breastfeeding support and other services. It does not apply to all insurers, however. Company insurance plans and Medicare, which cover 1.5 million people, are exempt. Auditors did not look at compliance among Medicaid insurers, which cover one in three Oregonians, but that insurance is free.

Providers charged the insurance companies but sometimes the insurer did not cover all of the money invoiced. That’s when consumers were charged, said Mark Peterson, a spokesman for the Department of Consumer and Business Services. In some cases, though, providers accepted a lower rate.

“We heard anecdotal evidence that some providers ate that cost rather than pass it on to consumers, Peterson told the Capital Chronicle.

The audits looked at claims from Jan. 1, 2019 through Dec. 31, 2020, the first two years the law was fully in effect. Through individual and group coverage, 12 companies insure about 900,000 people, department data show.

All 12 insurers failed to pay the full cost of all services or supplies according to the law, the department said. Three of them – Aetna, BridgeSpan and Regence – did not cover certain types of prescription contraceptives or did not allow 12-month refills.

Three other insurers – Cigna, HealthNet, Kaiser and Samaritan – failed either to resolve all consumer complaints or produce documentation showing they had properly responded to complaints and appeals. They also failed to demonstrate that employees handling complaints were aware of the requirements under the act, the department said.

Two companies – Heath Net and Moda – did not respond publicly to the findings. The others filed a response. Kaiser, PacificSource and UnitedHealthcare of Oregon said they agreed with the findings, and Kaiser even detailed actions it has taken to comply with the law.

Cigna, on the other hand, said it “disagrees with certain factual findings in the report,” and Samaritan, which said it insures 2,000 people covered by the act, disputed that it had failed to retain required records.

Aetna submitted the longest and most detailed objection to the findings in a 17-page letter.

“Rather than provide specific examples of claims that Aetna processed during the examination period in violation of RHEA, the final report instead makes general statements and draws inferences from hypothetical scenarios that are not supported by the data that Aetna actually submitted,” it wrote.

Providence said in its response that its differences with the findings were “narrow and limited,” and called for the department to make the coverage requirements under the act more clear. That sentiment was echoed by PacificSource.

“Since the passage of the Reproductive Health Equity Act in 2017, the division never attempted to set out in advance the standards applied to us in this examination report,” PacificSource said.

Regence and Bridgespan, which are owned by Cambia Health Solutions, called on the department to enact a rule that explains the requirements of the act.

“We have implemented the RHEA statute in good faith and with best intentions to comply with the statutory requirements as we read them,” they said in their response letters. “When the statute was silent or ambiguous, in the absence of additional state regulations and guidance, we relied upon federal regulations and guidance pursuant to the Affordable Care Act (ACA) women’s preventive care requirements to fully implement the RHEA statute.” 

A list of company recommendations included reviewing policies and procedures, training employees and monitoring complaints. The department said it will issue guidance to help companies comply with the law along with corrective plans. It said it will continue to monitor the companies, require data submission on compliance and determine penalties and restitution for consumers.

“We will continue to monitor each insurer until they fully comply with RHEA and make whole any consumer harmed by these failures,” Stolfi said.

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