introduction
This webpage provides contact information and other details about paying compensation for contraceptive services claims, including contact information and what to do if you don’t receive a refund but feel you owe a refund.
Contraceptiveve Notice regarding compensation for service damages
Recently, three major insurance companies serving Vermonters Blue Cross Blue Shield of Vermont, MVP Healthcare, and Cigna Healthcare announced that their members would not be eligible for contraceptive services covered as no cost-sharing. It announced it would distribute refund checks to all policyholders who were charged for the cost. 8 VSA § 4099c.
Under the Affordable Care Act (ACA), health plans are required to provide contraceptive services and supplies to consumers free of charge, including a full range of contraception, counseling, treatment of complications, and other related services. there is. Contraception may include options such as insertion and removal of an intrauterine device (IUD), prescribed emergency contraception, oral contraceptives, and sterilization procedures such as tubal ligation.
DFR examined compliance with its obligations by auditing health insurance medical claims and identifying claims for contraceptive-related medical services. The department found that BCBSVT, MVP, and Cigna violated laws prohibiting members from paying for contraceptive services during the audit period (extended to December 31, 2021), but on behalf of carriers, It was determined that there was no intention to violate the obligation. The Market Conduct team said all insurers were cooperative, accommodating requests and agreed to work with the team on a solution.
The Department found that many claims applied member cost-sharing for mandated services. The investigation revealed that these claims were mishandled due to coding, different interpretations of obligations, and system limitations. The main categories of claims processed at your expense are:
- Sterilization for women: various ancillary services.
- Pregnancy tests related to contraceptive services.
- A visit to the office for contraceptives.
- Ultrasound examinations related to contraceptive services: Ultrasound examinations are frequently performed in conjunction with IUDs, often to ensure accurate placement, detect complications related to the IUD, or during removal procedures. It is done for.
- Sexually Transmitted Infection (STI) Testing: Doctors routinely test for STIs before performing contraceptive services or prescribing contraceptive pills.
- Male sterilization (a requirement unique to Vermont).
The DFR Market Conduct Division’s investigation excluded prescription contraceptive claims. If you believe you were incorrectly billed for the cost of prescription contraceptive drugs or devices, contact your health insurance company or employee benefits specialist.
Member Support and Insurance Company Statement
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blue cross blue shield of vermont
“Blue Cross VT is committed to providing contraceptive care at no out-of-pocket cost to our members. The Department of Financial Regulation (DFR) recently provided additional guidance regarding coverage of contraceptive care. Since 2017, we have been working to ensure that all members who have paid out-of-pocket for these services are reimbursed. We are working with DFR to proactively identify individuals who are owed refunds. Identified members will receive a check from Blue Cross VT at the earliest possible date.”
contact: BCBSVT Customer Service 800-247-2583
Monday to Friday • 7 a.m. to 6 p.m. • Visit BCBSVT Contact Us. - Signa
“At Cigna Healthcare, we are proud to offer no-cost coverage of contraceptive care to our customers in Vermont. We appreciate the Financial Regulatory Authority’s cooperative approach to making repayments possible. Those customers do not need to do anything and will immediately receive a check from Cigna Healthcare for the amount owed.”
contact: Please call the number listed on the back of your insurance card, or Please contact Cigna. - MVP Healthcare
“MVP is committed to providing our members with critical free access to contraceptive services that comply with state and federal requirements. Affected members will receive a letter with additional information regarding cost-sharing reimbursement. You should receive it from MVP within a few days.”
contact: Past and present MVP members may contact the MVP Customer Care Center at 800-348-8515 (TTY 711).
Monday to Friday • 8 a.m. to 6 p.m. • or completed Customer care contact form.
Note: This settlement only affects individuals whose health insurance is provided by MVP Health Care, Cigna, or Blue Cross Blue Shield of Vermont. People with other insurance companies should contact their insurance company or employer benefits representative.
background
In late 2021, the Department began investigating potential issues surrounding health insurance coverage of contraceptive services. Department staff audited contraceptive claims for all health plans under DFR jurisdiction and offered or managed by BCBSVT, MVP, and Cigna. The claims were retrospectively audited from October 1, 2017, the effective date of Vermont’s mandate, to December 31, 2021. The department reviewed more than 250,000 medical claims, including more than 500,000 billing statements, and found that 16,000 had cost sharing applied. In addition, the company is seeking damages totaling more than $1.5 million for more than 9,000 members.
Because Vermont’s law is based on the ACA, health plans under the state’s jurisdiction may not be eligible for voluntary male sterilization (to the extent that high-deductible health plans do not disqualify them from health savings account eligibility). ) and cover 12 months’ supply. Dispensing prescribed contraceptives at no cost to members – Health plans and health insurance issuers that require members to pay for contraceptive services are not complying with both federal and state laws. .
Corrective action: After multiple meetings between the ministry and insurance companies, BCBSVT, MVP Health Care, and Cigna have implemented or plan to implement several measures to correct these issues. .
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