Advertising

Originally published August 15, 2011 at 11:53 AM | Page modified August 15, 2011 at 9:46 PM

Regence BlueShield fined by state for denying IUD-removal coverage

A West Seattle woman's complaint has prompted the state insurance commissioner to fine Regence BlueShield $100,000 for denying contraceptive services to nearly 1,000 women. The fine comes in addition to nearly $150,000 Regence already spent reimbursing the women, whose claims were illegally denied over eight years.

Seattle Times health reporter

quotes For all the troglydytes whining about this, do you even realize this was NOT "birt... Read more
quotes And by what authority does the government claim the right to mandate a private entity's... Read more
quotes It also doesn't make sense to deny coverage for IUD removal. It can be medically... Read more

advertising

She was a busy mom of a toddler and a full-time employee who worked in a cubicle surrounded by men.

There were a lot of reasons why a 36-year-old West Seattle woman wasn't about to make a call from work to talk about her problem: That her health insurer wouldn't pay to have her intrauterine device (IUD) removed so she could try to get pregnant.

Still, she was peeved, so she persisted — and won.

Her complaint early last year to the state Office of the Insurance Commissioner, the lone protest among 984 women whose claims were illegally denied over eight years, triggered an investigation that required Regence BlueShield to reimburse the women a total of nearly $150,000.

On Monday, the insurance commissioner took an additional step, fining the company another $100,000 and requiring it to pay 8 percent interest to the women on the illegally denied claims.

"We wanted to make sure they understood and other companies understood that they had a duty to do due diligence when there's a new law," said Stephanie Marquis, spokeswoman for the insurance commissioner's office.

The West Seattle woman, who asked that her name be withheld because she thinks her employer might be unhappy at the publicity, said Monday she received $78 from the settlement.

The reimbursement covered only the amount that should have been paid by her husband's Regence plan, which also covered her. She works for a self-insured company, so her plan isn't subject to state insurance regulations.

It's little compensation for the reams of paperwork she went through, appealing denials from Regence, both for her own insurance plan and her husband's. When both appeals were denied, too, she used the insurance commissioner's online complaint form, filling it out at night after her 3-year-old was tucked into bed.

The woman was determined that the cumbersome process would not stop her. An ardent supporter of reproductive rights who moved to Washington more than a decade ago, she was heartened to find that coverage of contraceptives had many vocal advocates.

First, a federal judge ruled in 2001 that Bartell Drugs, a self-insured company, must provide its employees with coverage for contraception because not to do so would discriminate against female employees.

Then, the state passed a rule, effective in 2002, requiring health insurers to cover contraceptive services just like any other outpatient service.

"I was really proud of living in a state like this which protects rights for women," said the woman.

And she was irritated by Regence's denials and the cumbersome appeals process. First of all, she said, people with comprehensive insurance like hers typically have full-time jobs and so are busy. And IUDs are often used by women who've already had children, she said, so they're doubly busy.

"This is why nobody else complained," she said.

Having an IUD removed isn't usually terribly expensive, maybe a couple hundred dollars, she said. "It's easier to just pay it, so you can move on to something more important — like sleep."

The state rule on contraceptive coverage says that any insurance plan providing general, comprehensive coverage of prescription drugs and devices must also cover Food and Drug Administration-approved contraceptives and devices, including dispensing, administration and removal in the same way it covers other outpatient services.

Regence had originally maintained that removal of an IUD was not medically necessary.

Both Regence and the Office of the Insurance Commissioner said they were alerted to the improper denial of the claims by the West Seattle woman's complaint.

"There's an important lesson here," state Insurance Commissioner Mike Kreidler said in a news release. "If you believe you've been unjustly denied coverage, don't just accept it; call us ... One woman's call to our office resulted in coverage for nearly a thousand other women."

For the West Seattle woman, the result was a lot of satisfaction.

Oh, yeah, and a baby girl, now just 6 months old.

Carol M. Ostrom: 206-464-2249 or costrom@seattletimes.com

News where, when and how you want it

Email Icon




Advertising