Yea, we were hurting for money at the time, so we put a decent amount of effort into seeing if there was any similar pill they’d pay for, no dice. FWIW This randomly googled website claims 49% of large group health plans do not cover routine birth control.
Sadly, I now know something like this has happened once. Only once, to my knowledge, but if it happens once…
My acquaintance just had an emergency c-section with attending emergency hysterectomy due to uncontrolled bleeding. The insurance company (I’ll call them the christian blues), has decided that she obtained insurance under false pretenses. They claim that her usage of birth control indicated that she was aware of her “abnormal bleeding”, and should have disclosed her endometriosis (which she has never been diagnosed with). They’ve dropped her after 6 years of premiums, and are refusing to pay for the hysterectomy, emergency cesarean, and hospital bills.
I would have said no to this question yesterday.
I hate to be obvious, but in the absence of state law to the contrary, an Insurance company is a business, which can choose not to contract with you for any reason or no reason at all.
One a business level they are not obligated to sell you insurance any more than the bagel man is obligated to sell you bagels.
Agreed, it makes no sense. It also seems odd to disqualify someone for going to the doctor in the last 12 months, since I’d think going to the doctor in the last year shows that I’m taking care of myself. I mean, sure, I went for a cancer screening so that’s particularly true, but if I went even just to get some meds for my sore throat, I’d think that would show I was on top of my health.
Like I said, I get denied, but the lady who hasn’t had a pap smear in 15 years gets accepted? Makes no sense.
Sure, which I said in the OP is just as likely of a possibility. I was just curious if there was anything else out there.
Plus, in CA at least (it said this on my application), the health insurance company can’t deny you for having AIDS. So, obviously, there are exceptions to the free market idea of health care, implemented for necessary reasons.
OK, it looks weird, but either
(a) they are completely insane, or
(b) this does actually reflect their underwriting experience, i.e. newly-insureds who meet those two criteria do have a statistically significantly worse claims experience.
It may be, of course, that they are perfectly aware that within that group there are sub-groups who don’t present a claims risk, and that one of those may be women who visit the doctor to be prescribed oral contraceptives.
And it may be that rather than identify those sub-groups with increasingly detailed questions on their application form they rely on the appeals process to identify members of those sub-groups.
No only is it possible, but it was the standard when birth control first became available. I taught for a major metropolitan school system and had to pay full price for my birth control pills until I stopped using them in approximately 1987.
Even when I used them solely because of a polycystic syndrome (Stein-Leventhal) shortly after the pills first became available to the public in the early 1960s, I had to pay full price. Why? At the time it seemed almost like a sin tax just in case I had some fun because of them.
Well, there is at least one woman that had her policy canceled the day before cancer surgery because she had went and seen a dermatologist for acne (1st video).
The insurance policy which the University of Miami got for its graduate students for the year 1997-8 did not cover BCP for gynecological or other uses. The only gynecological procedure covered was voluntary interruption of pregnancy. Nothing. Else.
Getting that brochure made me so glad to be graduating in the summer of '97.
Just guessing, but I suspect most people who take medication long term have actual medical problems - aside from the pill and Accutane, I can’t think of any long-term prescriptions that wouldn’t indicate a medical problem. Antibiotics, etc are usually prescribed for a week or two , and pain relievers are usually prescribed for only a few weeks after an injury. They probably just automatically deny everyone, and let the humans sort out who’s on the pill and who’s taking four prescriptions for asthma and high blood pressure later.
Who said anything about long-term? The reasons given were simply going to a doctor and/or getting a prescription filled in the last year.
Somehow I wasn’t able to quote this part:
and the OP says
Those two combined seem to indicate that the problem is not that she had a prescription filled, but rather that the prescription she had filled was longer term than the 10 days or so a person might take antibiotics. " Medication management" and “maintenance” only make sense for longer term prescriptions. I’ve never been on the pill myself, but I’ve known people whose GYN follows my family practitioner’s policy (no more than six months on a prescription without a visit) and I’ve known people who had to have their BC prescription tweaked a few times. I know the girl on the phone said any prescription would lead to a denial. I also know that “girls on the phone” frequently don’t know all of the details- they don’t need to.