Politics & Policy

Total Confusion on Elective-Abortion Coverage

Explaining Obamacare at a fair in Miami, December 2013 (Joe Raedle/Getty Images)
Asked if plans cover abortion, insurance agents give every answer in the book — except a straight one.

Now ten months since the rollout of Obamacare, with about three months to go until the next enrollment period begins, we’re seeing a shift in how insurance companies delimit and describe their coverage of elective abortion. Unlike the pervasive, confused silence on the issue of elective-abortion coverage reported last October by the Charlotte Lozier Institute, insurance companies now are seemingly able to answer the question, “Do your individual plans offered on the exchange cover elective abortion?” The only problem: Those answers keep changing depending on who’s talking.

To begin at the beginning, CLI selected New York’s health-insurance exchange as a starting point to identify which individual plans include or exclude elective abortion — or “interruption of pregnancy,” as it is also termed in the state’s insurance lingo. Via the exchange’s web chat, CLI recently asked a representative whether the multi-state plans offered in New York cover elective abortion. The representative replied, “This information is not in my portal.” But she did provide a helpful URL to the directory of all the insurance companies in question, so that CLI could contact each directly.

And down the rabbit hole we went.

Our findings include these exceptional instances of readily given and yet inconsistent replies to the question of whether elective abortion is covered:

‐United Healthcare’s plans in New York In sum: No, none do; and, yes, all do.

One agent contacted by phone on July 7 said that none of their plans covers elective abortion. Another representative informed CLI by phone on July 22 that all United Healthcare plans on the New York exchange cover elective abortion, quoting the plan as permitting “one procedure per member per calendar year.”

‐Empire BlueCross BlueShield’s plans in New York In sum: Yes, all do cover elective abortion, including the multi-state plans (MSPs). (But, under the terms of Obamacare, at least one MSP in each state must exclude coverage of elective abortion.) And, no, none do.

Two licensed agents contacted by phone on July 1 and 2 stated, “All of [Empire’s plans on the New York exchange] cover elective abortion.” When asked if the MSPs offered on the exchange do as well, both emphatically confirmed this twice, one declaring that the “benefits do not change” according to whether the plan is an MSP or not.

The Office of Personnel Management (OPM), on the other hand, states: “As required by the Affordable Care Act, MSP insurers in each State must offer at least one plan that does not include elective abortion services.” CLI sent a letter to Empire BlueCross BlueShield on July 10 requesting clarification; we still await a reply.

Two live-chat agents contacted on July 22 informed CLI that no elective abortions are covered, one explaining that “it will be considered” only if it is medically necessary.” When asked for the definition of medical necessity, the agent responded: “health-care services or supplies needed to prevent, diagnose, or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine.” The agent then apologized that there wasn’t a plan document online stating this. She added: “I know that information because that is what the direct-sales team has been told.” The second live-chat agent likewise stated, “None of our plans cover elective abortion.”

CLI also looked at individual-marketplace plans in Vermont, a state that lacks legislation banning elective abortion in the exchange and that does not currently participate in the Multi-State Plan Program — which means that all plans in Vermont are free to cover elective abortion. (It is also on the fast track to being the first state with a single-payer system.)

MVP’s plans in Vermont ​ In sum: No, none do; no, you need authorization; yes, all do, and you do not need authorization; yes, all do again; sorry, really, none do.

A live-chat agent informed CLI on July 16 that elective abortion is not covered. We were inexplicably disconnected after asking for a plan document stating this.

#page#In a follow-up phone conversation that same day, a representative stated that only “medically necessary” abortions are covered. When asked to define what constitutes medical necessity, she replied: “Authorization is required — the reason for it, and whether the doctor sees a need — on a case-by-case basis.” She explained that the doctor submits records and authorization, and these go to “MVP’s authorization department and medical board for review.”

Another live-chat agent notified CLI on July 17 that “all [MVP’s] individual plans cover [elective abortion]” just as their New York plans do. After touting his status as a “13-year veteran rep,” he said: “ . . .  ‘Medically necessary’ just means that you’re having the service because you want to, and it [has] nothing to do with anything cosmetic or experimental. Most everything in the insurance world starts out with ‘medically necessary.’ It’s legal jargon.” He went on to explain: “You’d have to be worried if you were working for a church or religious group, some of them are allowed to exclude abortion coverage, it gets complicated. But all the individual plans cover it.”

A third live-chat agent clarified on July 21, saying, “Yes, these plans cover elective abortion based on Federal Health Care Reform.” When asked about the language of “medically necessary” as mentioned in an MVP Member Handbook in New York State, she corrected herself, saying, “No, actually I am very sorry, elective termination of pregnancy is not covered in Vermont for Vermont Health Connect policies.” After being asked for a plan document that would state this exclusion, she replied: “I am unable to locate a document [containing this exclusion] that is on the MVP website. You can use this chat as verification that elective termination of pregnancy is not covered in Vermont.” Upon being asked further if there might be a hard-copy document stating this exclusion, and if she could mail it, she responded: “I checked on that for you while trying to locate a document online for you, and I was advised that you can copy this chat as verification.”

Besides these conflicting accounts, CLI received the following wide array of responses from New York marketplace insurance companies after requesting a plan document confirming the inclusion or exclusion:

‐Can’t e-mail any specific plan document because “so many [plan] files were transferred to the exchange,” and the company website now has “limited information.” — Independent Health

‐Plan documents are “legal documents” and therefore are “not available to be mailed to non-members.” — Emblem Health

‐Not able to e-mail a sample plan document, but can send via snail mail, and should arrive within 10 to14 days from request on July 3. CLI subsequently received plan documents, but there was no information on abortion coverage. — Capital District Physicians’ Health Plan and Healthfirst New York

‐Abortion information is “only in Member Contracts, and I cannot send these to non-members.” — Oscar

The bottom line? The ongoing clamor for transparency in health-insurance exchanges under Obamacare is fully warranted. Of the 300-plus plans offered by the 18 insurance companies on New York’s individual marketplace that CLI inspected, virtually no company listed any “interruption of pregnancy” information in its Summary of Benefits and Coverage. There was one exception: the Catholic-run Fidelis Care, which excludes it.

To be fair, a few companies do provide this information online, but only in Member Handbooks, Member Guides, or Member Contracts, which are not necessarily located in the same place online as the accompanying plan, if they are available for viewing pre-purchase at all.

If a woman’s “right to choose” is so essential, why wouldn’t her “choices” be clearly stated on each plan’s Summary of Benefits and Coverage? If the plan covers elective abortion, it could easily specify that in its Services You May Need section. If it does not offer this coverage, it could state that in its Excluded Services section. Why not make it as simple to view a plan’s abortion-coverage rules as it is to assess contraception coverage? BlueShield of Northeastern New York’s benefits layout, for instance, shows its contraception coverage directly on its website: “Generic oral contraceptives — covered in full.” Whether one identifies oneself as “pro-life” or “pro-choice,” this “yes, no, maybe” guessing game about abortion coverage is utterly unacceptable.

— Genevieve C. Plaster is a research assistant at the Charlotte Lozier Institute, the education and research arm of the Susan B. Anthony List.

EDITOR’S NOTE: This article has been amended since its initial posting.​

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