By Ashley Mayo, Strategic Engagement Fellow

August 1st, 2012 was a big day for American women. That day, we gained access to a number of preventive services- including well-woman visits, contraception, breastfeeding supplies, and more – without cost sharing. This means thanks to the Affordable Care Act, the insurance that women pay for has to start covering the things we need.

It may not sound like a huge victory, but access to affordable preventive care can make a real difference in a woman’s life. A recent study showed that in 2010, 32% of American women with insurance went without needed care because of cost. Since their plans now cover important preventive care, women with insurance can take greater control of their health and focus more on achieving their goals, without that barrier. 

For all this good news, there are still some challenges as this new requirement for insurers.  Many women have tried to access these services and found they still have to pay a copay. If this has happened to you, there are several explanations:

1) Your insurance plan may not have been renewed yet. All new plans will be required to cover certain women’s preventive services without cost-sharing beginning August 1, 2012. Because most plan changes take effect at the beginning of a new plan year, the requirements will be in effect for many plans on January 1, 2013.

2) Your plan may be “grandfathered.” Health plans that existed before the health care law (March 2010) are considered “grandfathered” with benefits as they were, including charges for copays. They don’t have to follow the new preventive services coverage rules until they make “significant changes” such as increasing deductibles or cutting benefits. However, it is expected that most plans will change with Obamacare’s full implementation in January 2014.

3) The service may not have been labeled as “preventive” when the provider billed your insurance company. CCHI and its national partners are currently investigating claims that some providers are coding preventive services as “diagnostic” in some cases, or where the test results resulted in an “abnormal” finding. Services coded as diagnostic may require a copay.

The good news is that you can do something about this. If your insurer isn’t covering these 8 preventive services without cost-sharing, call them and ask why! Check out The National Women’s Law Center’s handy guide to calling your insurance company (complete with flow chart!) for help with what to say and how to get answers.

If you find out your plan does cover preventive services, make sure to ask your provider to code them appropriately, as preventive, when making an appointment so you don’t end up with an unnecessary copay.

Finally, if you believe your health plan has not implemented the contraceptive coverage (or other women’s preventive service coverage) requirement appropriately, please contact the National Women’s Law Center at 1-866-PILL4US or via email at [email protected].

It’s easy! At CCHI, we called our insurer and have since gotten copay free coverage of the full range of women’s preventive services. You have a right to these services too. Make your voice heard and take control of your health today!

Check out our fact sheet on women’s preventive care for more information!

Translate »