Tag Archives: HHS

Diagnosis: Female?

16 Aug

Lots of people are talking about the decision on the part of HHS that all forms of contraception be covered for all insured men and women for “free” as basic preventive services under health reform. This decision came not a minute too soon. Recently I found myself having to call in a prior authorization for birth control for one of my patients. At first I figured it was just that the insurance didn’t pay for the birth control patch, Ortho-Evra, but did pay for other methods. However, it turned out to be more complicated. The entire conversation took a half hour and went more or less as follows:

Me: This is Dr. Pro Choice. I’m calling to get a prior authorization for ortho-evra for my patient.

Customer Service Associate: OK, let me look into that for you…(5 minutes of terrible muzak later) I’m showing we don’t cover that medication.

Me: Right, that’s why I’m calling. Can you tell me why you don’t cover that medication?

CSA: Let me look into that for you… (5 minutes of even worse muzak later) We don’t cover any contraceptive methods.

Me: What? Are you sure?

CSA: Yes Ma’am, this plan that your patient signed up for does not cover contraceptive methods.

Me: (after a moment of disbelief) So how can I get this for my patient? She can’t afford it on her own. She has Medicaid.

CSA: You can make an application.

Me: Great, let’s do that.

CSA: What is the diagnosis?

Me: Diagnosis?

CSA: Yes, what is the diagnosis?

Me: (long pause) Female?

CSA: That is not an accepted diagnosis

Me: Human? Able to get pregnant? Sexually active?

CSA: Those are not accepted either.

Me: Umm, OK, menorrhagia [not the real reason but a ‘real’ diagnosis].

[1 minute on hold]

CSA: Your request has been approved.

I wish I could say I made this up, but it happened just a few weeks before this decision came from HHS. There IS no diagnosis code justifying contraception as a way to avoid pregnancy, because diagnosis codes are built around illness. Avoiding pregnancy usually isn’t about already being sick, it’s about preventing something from happening. So birth control clearly belongs in the list of preventive services.

I fear politics will get in the way of the HHS ruling that all contraceptive services be covered free of charge under all insurers starting next year, but if not, women with private or public insurance will not have to pay for their birth control. This is a huge step for all women, and a small step for doctors like me who will no longer have to have conversations such as the one above.

Free Birth Control?! Implausible. Well, maybe.

21 Jul

This post is part of the Birth Control Blog Carnival sponsored by the National Women’s Law Center and Planned Parenthood.

Birth control should be free for women. We’ve all heard that every dollar spent on family planning saves four. Economically, it is a no brainer. Politically, it becomes a bit more complicated as, heaven forbid, a politician endorses happy and safe sex lives. Personally, I would like stop spending 35 bucks a month on pills. That money could easily be reallocated to Chinese food or shoes, still fueling our ailing economy. The problem is there are many other players between me and my pink round pill pack. In fact, there are so many that I’m not going to list them all here (think insurers, pharmaceutical firms, pharmacists, pharmacies, etc). So how can we make birth control free?

Just on Tuesday an advisory panel from the Institute of Medicine (IOM) recommended eight women’s health preventive services be added to the government mandated list of services provided and paid for by health insurance companies at no cost to patients. Included in the list was the following: “a fuller range of contraceptive education, counseling, methods, and services so that women can better avoid unwanted pregnancies and space their pregnancies to promote optimal birth outcomes.”

So now birth control will be “free” (if by free you mean still paying an arm and a leg to health insurers who will end-up economically benefiting from paying for your said “free” birth control)? Right? Well, not quite. IOM made the recommendation to yet another government body, Health and Human Services (HHS). The big kahuna if you will. Now HHS needs to decide if these recommendations will actually be included on the no cost consumer list.

All said this is probably not going to change overnight. If it does, Chinese takeout for all! But in the interim, as a public health nerd, I have to ponder if free birth control is even a good idea. Hear me out.

I want you to imagine two shopping bags. One full of free swag from an event you paid to attend, the other a brand new purchase of totally your own choosing. Think about the contents of each, number of items, colors, shapes, perhaps even smells. Okay. Now you only get to keep one, which one do you take?

The purchased one, right? Unless of course your free swag bag is from the Oscars, I imagine it contains flyers, shampoo samples, and, if you’re lucky, a few granola bars. I cannot imagine getting a new pair of shoes or hot General Tso’s chicken for free, and I’m pretty sure neither can you. That’s the problem. Although birth control should be free for women and society would benefit on a multitude of levels from it being so, women might not take the same stock in their birth control if it’s handed to them. It might not seem as valuable, and then possibly effective, or useful, and that is exactly what we want to try and avoid.

Not convinced? Neither am I. Most women, most of the time, don’t want babies. I watched a documentary this week where a woman walked three hours in the blistering African sun just to see if contraception had arrived at her “local” clinic. Women everywhere really want this stuff. They will go to great lengths to get it whether it is walking miles or listening to Michael Bolton on hold for three hours. What really sold me on women’s value of even free birth control was asking friends this question: what is the best part about going to the gyno? I know, I know, it is all awful. I too have seen the Vagina Monologues 12 times. But there is one good thing. Free samples! Everyone uses those free birth control samples and they get so excited. It’s a little surprise win for suffering the fate of the duck lips. Everyone who I talked to, in my very limited and skewed but loving sample, agreed that they actually use them. That in fact they end up using them more correctly and consistently because they are just sitting around their apartment and there is no need to go to the pharmacy once a month (but that is another battle altogether).

So women use free birth control. We’ve seen it in action. Maybe getting it for “free” from insurers would *gasp* encourage women to use birth control more consistently and correctly. Maybe that could make for happier, healthier families, women and sex lives. Maybe.