When President Obama passed the Affordable Care Act (affectionately known as Obamacare) in 2010, it changed the world of medical insurance drastically for women. Women routinely paid more for their health insurance, and many healthcare providers did not provide treatment for many “pre-existing conditions” that affect woman. These included being pregnant, giving birth with a Caesarean section or seeking out treatment after a sexual assault.
Although the Affordable Care Act eliminated these overt discriminations, recent research shows that unclear insurance documentation may mean women must pay more or are denied necessary services.
A new study by the National Women’s Law Center examined 109 different insurers in 16 different states during 2014 or 2015 to see the most common exclusions. Although these exclusions may also affect men, the group focused on policy exclusions that would primarily affect women.
Health insurance plans usually includes a general summary of benefits and coverage, which explains whether the plan covers 13 specific services. This section is usually made clear to the reader. But this leaves it unclear as to whether the plan’s coverage includes other services. Exclusions from other services may be tucked away in the additional material which is over a hundred pages long. Exclusions are also typically written in insurance jargon, making it difficult for potential customers to understand them.
The National Women’s Law Center found that six policy exclusions were most common among the insurers. In 42% of cases, insurance companies would not cover conditions that resulted from other operations if the insurance company did not cover the initial operation.
27% of plans also failed to cover ongoing therapy to maintain a stable condition for a chronic disease or other condition. 15% of the insurance agencies studied only covered genetic testing if required to do so by law. This exclusion particularly affects women who may have genetic mutations linked to breast cancer or ovarian cancer. If women have mutations in the BRCA gene doctors often recommend that they undergo more frequent screenings. But insurance companies may not cover these screenings. However mutations in other genes do not receive the same frequent monitoring.
Fetal reduction procedures also commonly affect women, doctors recommend them to protect maternal health or the baby. Yet the study found that only 15% of the 109 health insurance groups covered such a procedure.
Unless required specifically to do so by law, up to 10% of plans do not cover preventive services like mastectomies and removing ovaries and fallopian tubes, which can be life-saving procedures for women with family histories of genetic mutations or personal health problems. Care options also excluded treatment for self-inflicted conditions 11% of the time. This is particularly dangerous because, nationally, more women attempt suicide and more women survive suicide attempts.
Some health insurance providers deny that the issues of the study are problems. Still, the study’s authors call for more transparency in the wording of insurance agreements. It’s imperative that women clearly understand what they’re agreeing to when they sign health insurance agreements.
On a preventative policy level, lawmakers at both the federal and state levels could ban health insurance companies from making certain exclusions. Lawmakers or insurance companies could also change page limits in the “benefits and coverage” section to include more conditions.