Oregon insurers failed to comply with a state law mandating reproductive health coverage and illegally denied claims or restricted coverage for abortions, contraceptives and screenings for pregnant women, state regulators found.
The 38-page report released Tuesday examined Oregon insurers’ compliance with the Reproductive Health Equity Act, which the Legislature passed in 2017. The law requires health insurers to cover reproductive health and sexual health services without cost-sharing.
Financial regulators at the Oregon Department of Consumer and Business Service launched the review two years ago after spotting indications of widespread noncompliance.
The audit’s findings included:
- Out of 12 abortion claims examined, five of them were not properly covered.
- Most insurers failed to program anemia screenings with no cost-sharing in their systems for processing claims.
- Insurers denied coverage of contraceptives without providing alternatives.
Other violations included failure to fully cover pregnancy screenings and inadequate coverage of tests for sexually transmitted infections.
In general, insurers failed to put processes in place to fully cover the services, misinterpreted the requirements of the law, or failed to update their claims-processing systems to ensure the law was followed.
The report doesn’t identify specific insurers. It said the problem was “marketwide,” but noted that not every violation was discovered for every insurer.
Providence Health Plan, an Oregon insurer, issued a statement to The Lund Report saying the findings show opportunities to collaborate with regulators.
“We are committed to providing access to the highest quality healthcare to every member we serve. In keeping with this commitment, we made a good faith effort to implement the Reproductive Health Equity Act using the information available regarding compliance and claim processing.
“Based on the findings of this preliminary report, there is clear opportunity for both insurers and the Division of Financial Regulation to better collaborate in service to members and communities. We look forward to that collaboration.”
In a prepared statement AHIP, the trade association formerly known as America's Health Insurance Plans, said health insurers are committed to providing access to women’s health services.
“While health insurance providers have dedicated great time and resources to complying with the market conduct exam, they have also had considerable concerns about the lack of clarity and standardization in the process, which we believe has led to a lack of clarity and reliability in the resulting data,” it said. “This first market conduct exam provided valuable insight into the clarity needed to meet expectations for implementing the law, as well as data and analyses required. We will continue to work with DCBS to improve processes to demonstrate compliance.”
State financial auditors are working on more detailed reports that will include insurer-level information about violations. That process will include an opportunity for insurers to review and comment on the findings.
You can reach Ben Botkin at [email protected] or via Twitter @BenBotkin1.
