I don’t know much about insurance. I am still covered under my parents’ plan because I am in school and am financially dependent on them. So this may be a stupid question, I just really don’t know the answer.
My insurance recently changed. My old coverage covered my birth control, it was 7 bucks a month. I go this month to get my pills refilled and I am told my insurance refuses to cover it and it will cost 40 bucks a month.
Does my insurance refuse to cover it for ethical reasons? They cover my mom’s pills because she is taking them as hormone therapy for menopause. If they are denying coverage on ethics, how is that fair? I went on it to not get pregnant becuase I was in a serious relationship at the time, but now I continue to take it because it lighens my period, makes it predictable (I never used to know when I was due to get it, frustrating the crap out of me), and pretty much eliminates physical PMS symptoms (cramps, backaches, headaches, etc). I happen to think it’s total BS that they refuse to cover it because of what it is.
If I decide to continue taking it, my yearly price is going from $87 to $480. Not a small difference. I make $480 in a good month! My mom told me to use my rent account to pay for it this month, then we’ll think about it. I didn’t get it today because I wasn’t sure I could afford it and didn’t talk to my mom until after I left the pharmacy.
The only reason they do it is to save money. They get away with it because it is usually optional in the most direct sense and, when it is medically necessary, they cover it just like they would any other prescription.
Well, let’s crunch the numbers. When my daughter was born the hospital and doctor bills were well over $30,000. That’s 62 years worth of birth control at $480 a year.
Obviously those insurance companies know something I don’t…
I had to get something signed by my gynecologist for my insurance company stating that she prescribed me birth control for medical (non-birth-controlling) reasons before they’d pay. They paid with no problem after that. And this was heavy-duty, UAW-sponsored insurance, too.
My new insurance company will pay for the pills. Some companies are more into paying for preventative measures than paying for the possible outcomes, others are not. I never assumed it was an ethical thing.
You beat me to it. You would think that the long term profits and savings by not covering birth control would be slammed in a bad way by the cost of unintended pregnancies.
My first thoughts were that birth control is cheaper then creating a child, and it would seem that a insurance company would be looking at their bottom line.
Then I thought that wow a company actually standing up for morals over the allmighty dollar.
Then I thought that this can’t actually be, so it must be something else.
Which I concluded was that the risk of the creation of another person was less then the cost of birth control, when you factor in other birth control (i.e. condoms) that would be used instead of the pill, and the chance of pregnacy.
This incident first happened on Friday when I dropped the prescription off and the pharmacist told me they had to contact my doc and the insurance company. I found out the rest today.
I talked to my doctor today, and she seemed as incredulous and I was because insurance will pay for having a baby and 4 days in the hospital, but not for the preventative measures. Seems cheaper to just pay for the pills.
I would be more pissed if I were currently in a sexual relationship or even forsaw one in the near future - I always practice safe sex with condoms even while on the pill, but I like the extra protection. Besides a disease, the last thing I want is a baby.
I think kanicbird has it right. All of you are making two erroneous assumptions:
That not having access to prescription birth control equates with having no birth control at all, and
That being on prescription birth control will prevent unwanted pregnancy.
As to the first point, there are a ton of OTC birth control methods that people will turn to it the pill isn’t available–in fact, a lot of people, myself included, use OTC methods as a safety net for the pill. This is a direct consequence of the second point: the birth control pill fails due to improper usage. My dumb cousin has four children and two miscarriages, every single one conceived while she was on the pill.
Apparently they’ve done the math, and the cost of covering the pill is higher than the cost of not covering it.
Ooh, ooh, another possibility-- new insurance arrangement doesn’t cover THAT particular pill, and has another equivalent picked out but your doctor will have to figure out what the special one is that the insurance company-pharm company arrangement covers (I’ve had this happen twice-- some agreement with drug companies changed or my insurance changed and I had to switch to the closest covered brand).
Check this out (see p. 18 of .pdf for Missouri info) - I don’t know whether your parents are also in Missouri, but the National Women’s Law Center seems to think that in most cases, Missouri law requires that insurance plans provide coverage of contraceptives at the same level as any other prescription (provided the plan has prescription coverage at all).
If this info doesn’t help you, check with your school’s health center and/or the nearest Planned Parenthood health center. Both typically provide referalls and/or contraceptive prescriptions on a sliding-scale basis.
There are other exceptions similar to this. Wellbutrin is sometimes prescribed as an aid to smoking cessation, but insurance companies don’t normally recognize that as a legitmate use and won’t cover it. capybara also makes a good point, insurance companies have a formulary of drugs they will pay for and if your prescription specefies a brand not covered the doctor must provide justification for that particular brand, or rewrite the scrip for one on the formulary.
Most insurance companies will have their formulary posted on their web site, so you can do the research to show your doctor.
The doctor can also write the scrip to indicate that the BC pills are being used for a medical reason that is covered by insurance.
Part of the rationale for not covering birth control is that, while in the long run it does save money, it doesn’t do so in the short run. And given that folks in the child-bearing age change their health care coverage on average every 3 years or so, the company that expends the bucks to cover the BCPs is unlikely the one to be reaping the benefits of lack of childnessness as time goes by.
I’d definitely call and find out if it’s just that particular pill that’s not covered. Or, check online. Lots of insurance companies have their formularies (lists of drugs that are covered, tiers, quantity limitations, etc.) available. That way, if they DO cover other types of BCPs, you can be prepared with a list next time you talk to your doctor.
I just had this happen to me…I changed jobs, and my new insurance doesn’t cover Yasmin, but they do cover several others that are available in generic form, and I guess there’s one that’s comparable (that’s the reason that was listed for Yasmin not being covered, a comparable generic is available). I’m sad, I was really happy with Yasmin. Luckily I got three months’ worth a week before I left the old job, so I’ve got a couple months to get in to the doctor.
I’m on a generic for Mircette. I can’t imagine how much Mircette costs!
I’m wondering if my doc could write it for PMS symptom help instead - because it’s why I take it now (and for the last 1.5 years).
I don’t want to go to Planned Parenthood because they make you get your pap smears done there. I like and trust my doctor. I don’t want to go to someone else. And insurance covers it at my doc, I think I have to cough up like 100 bucks to get it done at Planned Parenthood.
I don’t understand it. The same companies that refuse coverage for birth control do provide coverage for Viagra. Why the double-standard??? (my guess is not suitable for a GQ thread).
I do know that back when I used oral contraceptives, the cost wasn’t covered. But it was also only 10 bucks a month (this was back in the age of the dinosaurs).
I don’t have a cite and my google-fu is weak today but a few years back, the District of Columbia was talking about passing a law mandating coverage for contraceptives similar to the one Eva Luna cites in Missouri. There was a big to-do from some Catholic organizations (Georgetown University perhaps? or maybe the Archdiocese itself) threatening to terminate health coverage entirely rather than comply. Since I can’t find a cite for it, I can’t comment on the outcome but this was some time in the past decade.
I’d definitely appeal this with the insurer, especially since you’re using it for medical reasons now.
I’ve heard this argument ad nauseam. ED drugs are prescribed for a medical condition, if BC drugs are prescribed for a medical condition, they are normally covered, but not simply for BC. This is a choice, for which there are other options. Now if you could show me where insurance companies cover the cost of condoms, you might have a point.
Quick question, have you checked the retail price of your BC? Its possible that your new company is covering that particular brand at a higher copay level. ($40 is a fairly common brand name drug copay)
Or has been mentioned, that particular one just might not be on your insurance companies formulary. Basically I’m saying it sounds like you need to do a little more checking, just because they don’t cover that one drug doesn’t mean they have a blanket restriction on covering BC.
The health insurance at my place of work does NOT cover birth control, because they’re a faith-based insurance and hospital company, specifically of the Catholic faith. I don’t agree with it (both the faith-based insurance thing, and the not allowing me cheaper methods to control my out-of-whack hormones), but I deal with it by not using the insurance entirely. I signed up for a sliding-scale program at my local clinic instead and I go in there and get a shot for $20 every three months. Since I don’t go to the doctor for anything else unless it’s life-threatening, it’s pretty much worth it to me - $20 every three months as opposed to $150 every month for insurance, plus copays and such.
There’s one specific insurance company I’m thinking of, but there are other ones out there. So sometimes it IS a moral standpoint. Well, “Moral.” We could argue that all we want, but the point is, if your parents wound up with a faith-based insurance company, that would explain why you’re not getting the pills. Like everyone else said, check the formulary, but if they have a “St.” or anything religious-sounding in the name, you may not have a lot of luck with that.
Anyway, when you’ve gotten that taken care of, talk to your doctor - regulating periods is a valid medical reason for using birth control pills, especially if yours were out of control, so he might be willing to write a script for it just based on that, since that’s all you were using them for anyway.