Regence BlueCross BlueShield Fights Free Prenatal Care for Diabetic Women

Supporters say the extra costs diabetic women face in pregnancy have led to some women quitting their jobs so they can qualify for Medicaid

February 8, 2013 -- Women with diabetes who get pregnant would have the medical costs of managing their condition covered at no extra cost under a House bill, but the measure provoked immediate opposition from Regence BlueCross BlueShield.

House Bill 2432 would not allow insurers to charge copayments and deductibles on medically necessary services, medications and supplies from conception to six weeks after giving birth.

“The prenatal care that is needed for diabetic women should be considered prenatal care,” said Rep. Sara Gelser, D-Corvallis, the bill’s chief sponsor. Some women diagnosed with diabetes have to spend hundreds of dollars out of pocket for special care, she said.

Dr. Lynn Bentson of Albany testified that those extra costs are so high that these women sometimes quit their jobs so they can qualify for the Oregon Health Plan, which offers such services for free.

But John Powell, who lobbies on behalf of Regence, said deductibles and copayments help manage costs. If patients don’t have to pay any additional charges, they could end up with the most expensive medicine, pumps and supplies to treat their diabetes. He also mentioned it’s often hard to tell exactly when a woman gets pregnant.

“A woman could go into the pharmacy and get drugs by just saying she’s pregnant,” Powell told legislators.

Sen. Elizabeth Steiner Hayward, D-Multnomah County, the bill’s chief sponsor in the Senate, said she was willing to negotiate with Regence to come up with amendments that would only require insurance companies to pay for the lowest-cost options. Steiner Hayward is a family physician at Oregon Health & Science University Hospital.

She also stressed the importance of diabetic women closely monitoring their blood sugar levels if they plan to get pregnant, adding that half of all pregnancies are unplanned.

Reeta Hill, a nurse and Bentsen’s patient, developed diabetes during her first pregnancy, and had to be very closely monitored during her second pregnancy. That meant she might have to check her blood sugar seven times a day, at 50¢ a strip, which added up fast. An insulin pump would have cost $6,000 out-of-pocket, so she made do with insulin injections six times a day.

“The only place I could save was cutting out office visits,” said Hill, who only saw Bentsen monthly rather than weekly which the doctor recommended.

Powell also argued that the copayments women now face for insulin, increased blood sugar testing and increased doctor’s visits will be offset by subsidies once the Affordable Care Act takes effect next year.

“These things are all going to change with the exchange,” Powell said. “I assume this is part of the essential benefits.”

Proposed rules in the Affordable Care Act require free screening for gestational diabetes, while maternity and newborn care fall under the essential benefits required of every insurance plan and could require a deductible or have copayments. Subsidies would help defer some of these costs, depending on income.

Health Committee Chairman Mitch Greenlick, D-Portland, said the bill may have fiscal implications because of its impact on the Oregon Educators Benefit Board, which provides coverage to public school teachers, administrators and university professionals.

If private health insurers are required to offer prenatal care for diabetic women for free, which would be required by House Bill 2432, the benefit board would have to absorb the same costs. Currently, the Public Employees Benefit Board, which covers state employees and their dependents, picks up those costs.

House Bill 2432 was tabled pending a fiscal report from the Joint Ways & Means Committee and to give the bill’s sponsors time to work out the disagreements with Regence.

Image for this story by Damien Cansse (CC BY-SA 2.0) via Flickr.

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