Sat. Apr 1st, 2023
12 Audit Finds Oregon Insurers Did Not Pay Full Cost of Eligible Reproductive Services – Oregon Capital Chronicle

Under the law, which took full effect in 2019, Oregonians are guaranteed free sexual and reproductive health insurance, including abortion. But state officials said Wednesday that at least 12 insurers are billing consumers anyway.

The Consumer and Business Services Division released a report of violations by 12 health insurers covering approximately one million people in Oregon.The audit dives into the details initially outlined report Published last summer.

Audit finds companies that cover people through individual and group markets have failed comply with the law, Reproductive Health Equity Act. They claimed copays, applied payments to deductibles that had to be paid before insurance coverage started, or failed to cover mandatory benefits that should have been free.

In some cases, insurers have denied claims outright or failed to resolve consumer complaints, the agency said in a statement.

The states are Aetna Life Insurance Co., BridgeSpan Health Co., Cigna Health and Life Insurance Co., HealthNet Health Plan of Oregon, Kaiser Foundation Health Plan of the Northwest, Moda Health Plan, PacificSource Health Plans, Providence Health Plan, Oregon. of Regence BlueCross BlueShield, Samaritan Health Plans, UnitedHealthcare Insurance Co., and UnitedHealthcare of Oregon.

“RHEA is a critical tool in the state’s efforts to remove barriers to reproductive health care,” said Andrew Stolfi, state insurance commissioner and commissioner, in a statement. “Like all legislation, our insurers had an obligation to implement each aspect of his RHEA across all systems in a complete and timely manner. We regret that this did not happen.”

The department said it would continue to work on the issue, including customer refunds. The State Access to Reproductive Health and Care Workgroup has invited Democratic House Speaker Dan Dunn to analyze how Oregon can protect abortion access after the Supreme Court overturned Roe v. Wade. Layfield called up last summer. Recommended in December Aggressive state enforcement of indemnification obligations.

The Reproductive Health Equity Act passed by Congress in 2017 covers annual health checks, contraception, abortion, cancer and sexually transmitted disease screening, breastfeeding support, and other services.does not apply to all insurance companies, however. Corporate insurance plans covering 1.5 million people and Medicare are exempt. Auditors didn’t check the compliance of the Medicaid insurance company that covers her one in three of her Oregonians, but that insurance is free.

The provider billed the insurance company, but sometimes the insurance company did not cover all of the billed amount. That’s when the consumer was charged, said Mark Peterson, spokesman for the Department of Consumer and Business Services. However, in some cases providers may accept lower rates.

“Rather than pass the cost on to the consumer, I’ve heard anecdotal evidence that some providers have spent that cost,” Peterson told the Capital Chronicle.

The audit examined claims from January 1, 2019 to December 31, 2020, the first two years of the law’s full implementation. According to the department’s data, 12 companies insure about 900,000 people through individual and group coverage.

According to the ministry, all 12 insurers failed to pay the full cost of all services or supplies in accordance with the law. or did not allow 12 months replenishment.

Three other insurers (Cigna, HealthNet, Kaiser, and Samaritan) were unable to resolve all consumer complaints or produce documentation demonstrating that they had adequately addressed complaints and appeals. It also failed to demonstrate that the employee handling the complaint was aware of the requirements under the law, the ministry said.

Two companies, Heath Net and Moda, did not publicly respond to their findings. Others have submitted answers. Kaiser, pacific sauce When United Healthcare of Oregon Kaiser said it agreed with the findings of the investigation and also detailed the steps it has taken to comply with the law.

SignaOn the other hand, he said he “disagrees with certain factual findings in the report.” Samaritansaid it has insured 2,000 people covered by the law and countered that it failed to keep the necessary records.

Aetna filed the longest and most detailed objection to the findings. 17 page letter.

“Rather than provide specific examples of allegations that Etna has handled in violation of the RHEA during the review period, the Final Report instead makes general statements, substantiated by data actually submitted by Etna. It draws inferences from unsupported hypothetical scenarios,” it wrote.

providence responded that the differences with the findings were “narrow and limited,” and called on the agency to be more explicit about compensation requirements under the law. That sentiment was echoed by PacificSource.

“Since the passage of the Reproductive Health Equity Act in 2017, the department has not attempted to pre-set the standards to be applied in this review report.” pacific sauce Said.

Regence When bridge spanOwned by Cambia Health Solutions.

“We have read the legal requirements and have implemented the RHEA Act in good faith with the best intentions of complying with it,” they said in their response letter. “When the law is silent or vague, and in the absence of additional state regulation or guidance, we will follow federal regulations and preventive care requirements for women in the Affordable Care Act (ACA). I have fully implemented her RHEA legislation relying on the guidance.”

The company’s list of recommendations included reviewing policies and procedures, training employees, and monitoring complaints. The ministry said it would issue guidance and remediation plans to help businesses comply with the law. The company said it will continue to monitor companies, request compliance data submissions, and determine consumer penalties and reparations.

“We will continue to monitor each insurer until they are fully RHEA compliant and consumers are fully harmed by these failures,” Stolfi said.

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