12 Oregon Insurance Companies Failing to Pay Full Cost for Qualified Reproductive Services, Audits Find – Oregon Capital Chronicle

Oregonians got free reproductive healthcare coverage, including abortions, under a law that took full effect in 2019. But at least a dozen insurance companies charged consumers anyway, state officials said Wednesday. .

The Department of Consumer and Business Services released reports of abuses by 12 health insurance companies covering nearly 1 million Oregonians. The audits delve into the details first described in a report released last summer.

The reviews found that companies, covering people through individual and group markets, failed to do so comply with the lawReproductive Health Equity Act. They charge co-premiums, apply payments to deductibles that must be paid before insurance coverage begins or fail to cover mandatory benefits that are supposed to be free.

In some cases, the ministry said in a statement, insurance companies have rejected claims outright or failed to resolve consumer complaints.

The state found violations by Aetna Life Insurance Co. BridgeSpan Health Co., Ltd. Cigna Health and Life Insurance Co., Ltd. HealthNet Health Plan of Oregon Kaiser Foundation Health Plan of the Northwest Moda Health Plan PacificSource Health Plans Providence Health Plan Regence BlueCross BlueShield of Oregon Samaritan Health Plans UnitedHealthcare Insurance Co. and UnitedHealthcare of Oregon.

“RHEA is an incredibly important tool in the state’s efforts to remove barriers to reproductive health care,” Andrew Stollvie, the state’s insurance commissioner and department director, said in a statement. “As with every law, our insurers had an obligation to fully and timely implement every aspect of RHEA across all of their systems. It is disappointing to see that this did not happen.”

Management said it will continue to work on the issue, including refunds to customers. The State Working Group on Reproductive Health and Access to Care, convened last summer by Democratic House Speaker Dan Rayfield to analyze how Oregon can protect access to abortion after the US Supreme Court overturned Roe v. Wade, Recommended in December That the state proactively enforce coverage mandates.

The Reproductive Health Equity Act, passed by the legislature in 2017, covers annual wellness visits, birth control, abortion, screening for cancer and sexually transmitted diseases, breastfeeding support, and other services. not apply to All insurance companies, However. The company’s insurance plans and Medicare, which covers 1.5 million people, are exempt. The auditors did not look at compliance among insurance companies for Medicaid, which covers one in three Oregonians, but that insurance is free.

Providers charge insurance companies, but sometimes the insurance company doesn’t cover all of the money billed. Mark Peterson, a spokesperson for the Department of Consumer and Business Services, said this is when consumers were charged. In some cases, though, service providers have agreed to a lower rate.

Peterson told the Capital Chronicle: “We’ve heard anecdotal evidence that some service providers have ingested this cost rather than passing it on to consumers.

The audits considered claims from January 1, 2019 through December 31, 2020, the first two years the law was in full force. The department’s data shows that with individual and group coverage, 12 companies insure about 900,000 people.

The ministry said all 12 insurance companies failed to pay the full cost of all services or supplies in accordance with the law. Three of them — Aetna, BridgeSpan and Regence — didn’t cover certain types of prescription contraceptives or didn’t allow 12-month refills.

Three other insurers — Cigna, HealthNet, Kaiser and Samaritan — have either failed to resolve all consumer complaints or provide documentation showing that they have properly responded to complaints and appeals. The department said they also failed to demonstrate that staff dealing with complaints were aware of the requirements set out in the law.

Two companies – Heathnet and Moda – have not responded publicly to the findings. Others have provided a response. KaiserAnd pacificsource And United Health Care of Oregon They said they agreed with the findings, and Kaiser even detailed the measures it took to comply with the law.

Cignaon the other hand, said that it “does not agree with some of the factual findings in the report”, and Samaritanwhich said it insures 2,000 people covered by the law, contested that it had failed to keep the required records.

Aetna filed the longest and most detailed objection to the findings in a 17 page letter.

“Instead of providing specific examples of allegations that Aetna addressed during the examination period in violation of RHEA, the final report instead presents general data and draws conclusions from hypothetical scenarios that are not supported by data actually provided by Aetna,” it wrote.

Providence In its response, she said her disagreements with the findings were “narrow and limited,” and called on the department to make the coverage requirements under the law clearer. PacificSource echoed this sentiment.

“Since the passage of the Reproductive Health Equity Act in 2017, the department has never attempted to pre-specify the standards that apply to us in this screening report.” pacificsource He said.

regens And BridgespanCambia Health Solutions, which is owned by Cambia Health Solutions, called on the administration to enact a rule explaining the requirements of the law.

“We have implemented the RHEA in good faith and with the best intentions to comply with legal requirements as we read them,” they said in their reply messages. “When the law was silent or ambiguous, in the absence of additional state regulations and guidance, we relied on federal regulations and guidance in accordance with the preventive care requirements of the Affordable Care Act (ACA) to fully implement RHEA.”

The company’s list of recommendations included reviewing policies and procedures, training employees, and monitoring complaints. The department said it will issue directives to help companies comply with the law, along with corrective plans. It said it would continue to monitor the companies, requesting they provide data on compliance and determining penalties and reimbursements for consumers.

“We will continue to monitor each insurer until they are fully compliant with RHEA and no consumer is harmed by these failures,” said Stolvey.

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