Can a woman be denied health insurance because she's taken birth control?

Factual Questions
1

General question that I’m curious about. The logical answer to me would be of course not, but I’m curious as to the legal standard for this.

Let’s say a young woman applies for a new health insurance policy and receives a denial letter. The two reasons listed for denial is that she’s visited a doctor in the last 12 months and taken a prescription for “maintenance” over the last 12 months. If she disclosed on her application that the visit and prescription were both related to birth control, is it something the company can legally use as a basis for a denial?

I might be totally off and maybe the company, being private, can deny on any basis they want. Just wondering!

2

it might be going out on a limb, but they might be able to claim ‘preexisting condition’ if the BC was taken to help with other problems, like endometriosis.

I can’t see them denying coverage based on using BC for it’s traditional usage because it saves the insurance company money in the long run if there’s no pregnancies to cover. Even if they’re zealots, the bottom line is still the most important thing.

3

Assuming, of course, that the new insurance policy covers BCP in the first place. Yes, not all policies do. I don’t know of any that refuse to cover Viagra and the like, but there are those who consider BCP optional and a “lifestyle choice” and won’t pay for them.

Assuming, of course, that you live in a large enough town where you’re not held hostage by a doctor and/or pharmacy who consider BCP abortion and refuse to prescribe/fill on moral grounds.

[/soapbox]

4

Wouldn’t this exclude a rather large percentage of their prospective clientele? I know they are bastards, but they can usually be counted on not to screw themselves out a big chunk of the paying public.

5

It comes down to “is she a bigger claims risk because she’s on birth control?”

If the answer, as I suspect, is “no” then the well-run, self-interested insurer will not reject her simply because she is on birth control.

They could, of course, be very stupid, and lump all drug maintenance regimes into a single category which is assumed to be associated with an increased claims risk(and, on average, is so associated). This simply means that they are failing to analyse risk properly; they are rejecting all people on drug maintenance regimes without considering whether the particular regime actually points to an increased claims risk.

There must be at least the possibility of a sex discrimination claim here. Rejecting people who routinely take the oral contraceptive pill is clearly going to adversely impact women, as a class, in a way that it does not adversely affect men, as a class. And if there is no objective justification for the rejection, how is that not indirect sex discrimination?

6

I don’t disagree with your thoughts on this, but there is a simple reason why Viagra is always covered and BCP is not always.

Erectile dysfunction is dysfunction - the body is not working the way it was intended, and so Viagra fits the clear definition of treatment for disease.

Fertility, on the other hand, is the natural functioning of the body and BCP is actually preventing the body from functioning “as intended.” They mostly choose to cover BCP for a variety of reasons (financial among them), but BCP does not fit the definition of a treatment for disease and so doesn’t get included automatically.

7

Viagra is a drug that RESTORES a normal function. This corrects a problem.

Giving birth is PREVENTING a normal funtion.

Your analogy is unapt.

8

I have over a dozen letters of denial from insurance companies and none of them state a reason other than “you do not meet the requirements”. This is from every insurer licensed in my state.

9

The less they say, the less you have to go on to mount a challenge. Still, presumably there is some factor which, rationally or irrationally, they rely on to support their decision to deny you insurance. Have you any reason to think that that reason is the fact that you are on birth control drugs?

10

I was on BCP to treat polycystic ovaries… and they denied me not because of the BCP, though. I had to wait a year at my current employer before their coverage would take effect. It sucked.

11

I hope no insurance company directors are reading this, no sense giving them new ideas, but I can see them denying coverage to women who have taken birth control if they smoke and are over 40. What they would probably do is insure the woman but have any cardiovascular problems be not covered for at least one year even if they are not related to the BC.
Related side note: we once had insurance that would pay for vasectomies but not birth control pills.

12

Well, I suppose it’s full disclosure time: obviously the question in the OP sprung to mind because it just happened to me.

I’m a 23 year old female with no preexisting health conditions, low BP, low cholesterol, normal blood sugar, I don’t smoke, I’ve never done drugs, etc.

I answered no to every question on the application (heart condition? No. Neurological disorder? No. Been to a psychiatrist in the last 5 years? No. AIDS? No.), except I answered truthfully that I had been to the doctor in the last 12 months and that I’d been on one prescription. I explained in the space provided that the visit was for an annual exam, but everything came back normal. I explained that the prescription was the pill, but I’m no longer taking it. (For what it’s worth, I went to the doctor at school- college, though I doubt this makes a difference. I did also disclose this on the application when it asked what doctor I’d seen).

The exact wording on the letter is this:

The only medication I’ve taken was the BC.

Anywho, I called the company in question and the girl on the phone said their computer system auto denies anyone who has 1: been to the doctor in the last 12 months 2: taken any prescription for any reason in the last 12 months. Her suggestion was that I appeal and then a real human will get assigned.

In my appeal, I’m going to point out that it was just BC, but this whole thing got me thinking about the legality of denying a woman based on prior BC usage. Or even the logic behind it.

Frankly, their policy just confuses me more, because it seems like they are denying people automatically that . . . actually took care of themselves. I get denied for going and getting a preventative, annual cancer screen, but the woman who hasn’t gotten a pap smear in 15 years gets accepted? It’s a strange, strange policy.

13

You could use the same argument against pain medications.

Pain IS a normal function.

Prescription strength Tylenol is PREVENTING that function.

14

And couldn’t you argue that if it is an older man taking something like Viagra (which I’m sure that is the bulk of their market) that they are actually going against a normal function? As you age, it is perfectly normal for your ability to have erections to decrease.

15

Look, I’m not saying it’s my argument. I’m not saying I agree with it. It’s the rationale used by the insurance companies.

But, I think even you would have to admit that intense pain may be normal functioning of the nervous system, but is not the normal functioning of the body as a whole. The pain is a symptom of an underlying problem. Furthermore, many sufferers of chronic pain are suffering from what is clearly a malfunction in the nervous system itself.

16

I’m not aware of BC being a denial reason but every company has their own underwriting criteria. I would think your appeal stands a good chance of success.

17

Well then Insurance companies are incredibly ignorant and need their ignorance fought. That argument is about creationist level ludicrous. Same kind of argument that arsenic produced from bacteria is healthy because it’s all natural.

I’d like to see the definition of normal they use. Having 20 kids isn’t the normal functioning of reproductive tracts, in the modern era. Not by a long shot. Humans are keyed to reproduction rates that assume high levels of child and infant mortality.

I assume in the interests of keeping fertility levels normal insurance companies want to do away with prenatal care, and put mothers on paleolithic diets, yea?

Also as pointed out being erect in your 80s isn’t normal.

18

I want to correct this misconception, Viagra and other ED medications are very rare to be covered by insurance. I have seen some policies that do cover it, but it is rare enough that I’m actually surprised when it happens. Viagra (and other ED meds) is the only medication I ask people who drop off a script how many they want.

Oh, and I have yet to see any insurance policy that doesn’t cover BCP, there might be restrictions on them (only certain types, or must get filled through mail order), but none that deny it off hand.

19

Wouldn’t this basically disqualify most of the sexually active females in the country? Plus, from a bottom line point of view, you’d think insurance companies would prefer to take woman who were using birthcontrol as opposed to those trying to become pregnant, as I suspect the latter is considerably more pricey then the former.

Really? My gf’s insurance doesn’t cover it, so it does happen anyways.

20

Well, as I said, I haven’t seen any, doesn’t mean it isn’t possible. Has she tried calling them to see if there is any particular type they will cover? It could be that they only cover one type, and no one has called to find out which it is.