Health insurers failing to comply with Oregon law requiring free reproductive health care, state audit finds – Oregon Capital Chronicle

Oregon’s governor, lawmakers and state agency officials have often touted the state’s reproductive rights law as one of the most comprehensive and fair in the nation.

But there’s a problem: Many insurers providing coverage to more than a million Oregonians aren’t following the regulations.

That’s one of the findings of an audit commissioned by the state Department of Consumer and Business Services, which regulates the insurance industry. Released Tuesday, the report said investigators found extensive evidence of violations of the Reproductive Health Equity Act, which was passed by the Legislature in 2017 and took effect in 2019. The law requires insurers to provide free coverage for reproductive health care, including screenings, abortions and contraceptives – even to undocumented immigrants.

The violations mean Oregonians have paid, at least in part, for supposedly free reproductive services. The report did not specify how many Oregonians were affected.

The law applies to commercial insurers, including individual plans and large and small groups. The only exceptions to the law are religious insurers, such as Providence Health Plan, which are exempt from the law.

The audit reviewed applications from January 1, 2019 to December 31, 2020. The department launched the audit when its work on a legislative report in June 2020 revealed that requirements were not fully met.

The agency found “variations in coverage and indications of potential widespread non-compliance with the law,” particularly failure to pay for some services in full, according to the report.

Supporters of reproductive rights were angered but not shocked by the report.

“It’s incredibly disappointing and incredibly unsurprising,” Sen. Elizabeth Steiner Hayward, D-Portland and physician at Oregon Health & Science University, told the Capital Chronicle. While acknowledging that “it is difficult to reorganize when new requirements are put in place”, she said insurers have had almost three years to adapt to the law.

“What baffles me is this: All of these things are things that ultimately save insurance companies money,” Steiner Hayward said. “It is cheaper to provide contraception than to care for a pregnant person. It’s also smarter because people who get pregnant when they plan are more likely to have healthy babies.

By law, insurers must cover free abortions, anemia screenings, contraception, pregnancy screening, sterilization and screening for sexually transmitted diseases. The law also requires coverage for undocumented immigrants.

Abortion bans could be coming

The report comes as reproductive rights activists and anti-abortion groups — as well as the public — await a U.S. Supreme Court ruling that could overturn Roe v. Wade, which was decided in 1973, and a later decision – Planned Parenthood v. Casey – who supported Roe in 1992.

The department prepares reports on each company’s violations. Mark Peterson, acting director of communications for the consumer and business services department, said he had received few complaints about consumer coverage.

The report did not name the insurance companies, but Peterson told the Capital Chronicle they were: Aetna, Inc., Cigna, Health Net Health Plan of Oregon, Kaiser Foundation Health Plan of the Northwest, Moda Health Plan, Inc., PacificSource Health Plans, Providence Health Plan, Regence BlueCross BlueShield of Oregon, Samaritan Health Plans, Inc., UnitedHealthcare Insurance Co., UnitedHealthcare of Oregon, Inc., and BridgeSpan Health Co. Their commercial health plans cover 1,042,661 inhabitants of Oregon, or a quarter of the population.

“Not all violations were found at all insurers,” the department said.

Details of each insurer’s breaches will be released after the companies have had a chance to review them, the agency said.

Range of violations

The audit found that insurers were not paying for the services they were required to cover for free and mishandled claims and were applying inaccurate cost-sharing allocations between patients and insurers.

“Some insurers have not provided coverage for certain benefits until 2020 or later, including preventative services covered by the Affordable Care Act,” the report said. ACA covers annual wellness checks and other preventative services, including mammograms, cervical cancer screenings, and prenatal care.

The report says insurers require in some cases at least partial payment for abortions, anemia screening, contraception, pregnancy screening, sterilization and screening for sexually transmitted diseases.

An Do, executive director of Planned Parenthood Advocates of Oregon, said the report was an important first step.

“It’s important now, more than ever, that we have elected officials and agencies who stand up to insurers and hold companies accountable for wrongdoing,” Do said in a statement to the Capital Chronicle. “Every Oregonian who has been forced to pay out of pocket for sexual and reproductive health services — in violation of state law — deserves reimbursement, and insurers should be held accountable.

State lawmakers also welcomed the report.

State Representative Dan Rayfield, D-Corvallis and Speaker of the House, told the Capital Chronicle that insurance companies must comply with the law.

“It is unacceptable for any Oregonian to have paid out of pocket for these essential health care services or been otherwise affected to access health care. I appreciate the law enforcement work that DCBS does and hope they continue to use their full authority to protect reproductive health services for all Oregonians,” he said. -he declares.

State Rep. Rob Nosse, the new chair of the House Health Care Committee, said “this review is vital in light of what we know to come regarding reproductive health and abortion services in the states. United to Protect Oregonians.”

Lawmakers and attorneys said they were eagerly awaiting the company’s reports, which the department is finalizing.

Leave a Comment