Women are still paying for birth control. Why?

The Patient Protection and Affordable Care Act (ACA) requires nearly every health insurance plan to cover contraception at no cost to the patient (with limited exceptions for grandfathered plans, shortterm plans and plans offered by private employers with religious objections).

Despite the fact that this requirement has been on the books for nearly 15 years, studies and surveys continue to show that large numbers of women are still paying for their birth control.

But why? A big part of the problem is that those paying out of pocket for contraceptive pills and devices are unaware of the requirement that these items be covered by insurance without a copayment. Since many patients do not understand the scope of the ACA's protections, it is harder to catch insurance violations.

Insurance violations are particularly acute when it comes to brand-name contraceptives, which many people do not know are included in the ACA's coverage requirement. As long as the patient and their doctor have decided that the brand-name contraceptive is "medically appropriate," it must be covered at no cost to the patient, the same as generic contraceptives.

In order to obtain this coverage, an insurance company may require a patient to apply for an exception, but federal law requires that the exceptions process must be "easily accessible, transparent, and sufficiently expedient" and may not be "unduly burdensome" on a patient or their doctor. Despite this, insurance companies sometimes create complicated processes or fail to fully explain the required processes, confusing patients who may believe that there is no way to get the medication covered. This is not acceptable.

I recently had a constituent write to me to tell me that she was being charged a co-payment for her brand-name birth control, seemingly in violation of the ACA. When I took the complaint to her insurance company, it turned out there was a "coding error" that impacted not just my constituent, but many women. This widespread issue had been going on for more than a year, and no one else had reported it. The insurance company reimbursed my constituent for her past payments and corrected the error going forward. But it made me think: What about the many women who do not catch and report these errors?

I recently wrote to the Bureau of Insurance, the entity charged with overseeing insurance companies in Virginia, asking them to do more to ensure that insurance companies are complying with ACA requirements. Lawmakers must also pass state and federal legislation to empower women and doctors with the information they need to advocate for coverage by requiring that insurance companies provide patients and providers directly with information about the process for obtaining approval for a contraceptive after coverage has been denied. Finally, each of us must do our part to educate our friends, family and other women in our lives about the ACA birth control coverage provision so we can all advocate for ourselves.

If you or someone you know is being erroneously charged for contraceptives, you should reach out to your insurance company and advise others in the same situation to do the same. If the insurance company does not fix the issue, you can file a complaint with the entity that oversees insurance in your locality: the Bureau of Insurance in Virginia, the Maryland Insurance Administration in Maryland, and the D.C. Department of Insurance, Securities and Banking in Washington, D.C. You can also contact your state legislator for assistance.

With reproductive rights under attack across the country, it is more important than ever to protect access to contraceptives. Copayments and other charges can be prohibitive for many who need contraceptive care.

Barriers to birth control are not just bad for women, but for society in general. Birth control is linked to many benefits, including fewer unplanned pregnancies, more educational and economic opportunities for young women, and improved maternal and infant health. These benefits are exactly why we have a federal law protecting no-cost contraceptives. Insurance companies must follow the law and fully cover birth control with no out-of-pocket costs, and we must all hold them to account.

Contact state Sen. Barbara Favola, D-Arlington, at district31@senate. virginia.gov.