Unfair Insurance or Employer?

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lilder

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My husband and I will be taking NFP classes soon, the NaPro Technology ones. They are a bit costly (the total for a year for us will be around $300). When setting up the appointments, the instuctor mentioned some insurances covered the classes. So I called our insurance company, United Healthcare, to see what was covered. First I was told no infertility treatments were covered, then I explained this would be used to prevent pregnancy. I was told that only hormone contraceptives and devices were covered. I asked who I could talk to about this or where I could file a complaint. They told me it was my employers decision about what was covered in my policy.

I called my employer, Adminsitaff. They told me it was the insurance company that decides. That NFP was not covered in their policy, but it was just the package and not something they specifically denied. They could not tell me if NFP was covered in another package that they did not subscribe to.

I was told if there was a “pressing medical need” I could appeal to United Healthcare. If they found it to be “medically necessary” they might cover it.

Here are my questions:
1.) Do I appeal? It is not a medical reason that I want NFP over “the pill” so I doubt they’d pay.

2.) Do I complain? I think this is VERY unfair. I would not be so upset if they didn’t cover “the pill” and other stuff, if they said no to it all. But I feel discriminated against because of my wanting to follow church teachings.

3.) Who do I complain to? Insurance company or employer? Both?

Thanks for the (name removed by moderator)ut (and for listening to my rant),
🙂 Lilder
 
I think it makes sense to write a respectful letter to your insurer asking them to consider covering the classes. Point out to them, as you have here, that there is an apparent inequity in covering birth control while not covering other family planning options. You might also point out that for religious reasons birth control is not an option for your family. I think that at the least they will respond and better explain their position so you know what you are dealing with.
 
I can’t answer your direct question, but if you can’t get it covered would like to suggest taking the course from the Couple to Couple league. It usually only costs about $75.00, the cost of the packet they give you. Since the teachers are volunteers there is no charge for their time.

For info on Couple to Couple league and contacts in your area go to this page:
Link
 
Point out to the insurer, that NFP is more effective and cheaper than medical contraceptives.

Unfortunately most make their decisions based on finances and not morality.
 
T.A.Stobie:
Point out to the insurer, that NFP is more effective and cheaper than medical contraceptives.

Unfortunately most make their decisions based on finances and not morality.
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I ran into the same problem…and my employer at that time was a major Catholic university (go figure!) I appealed, but it’s not a “medical” procedure per se, so they wouldn’t cover it. In reviewing the coverage, it was pretty clear that the only way any of it would be covered is if the organization or person providing the course was a licensed medical professional, clinical social worker or psychiatric professional.

My solution was to call the local Catholic hospitals and I found a course that was free at a Daughters of Charity hospital. They did ask for donations to offset the material costs, but most people in the room could never have afforded even the $75 mentioned above, so if there had been an actual number, the message wouldn’t have gotten out.

Of course I got pregnant anyway…but at least it wasn’t as quick as the earlier pregnancies had been. Some of us are just fertile no matter what we do. 😃 It bears mentioning that it was statistically impossible for me to conceive my oldest son…his dad and I were both using contraception and it was day 29 of my cycle. So just know that if God wants you to get pregnant, not even pills, diaphragms and condoms are going to prevent it. Some things you just have to accept as divine providence.
 
loyola rambler:
They did ask for donations to offset the material costs, but most people in the room could never have afforded even the $75 mentioned above, so if there had been an actual number, the message wouldn’t have gotten out.
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When I mentioned the $75 I assumed the person that was above could afford the $75. In my area if you truely can not afford the $75, you can usually find someone willing to donate the money. If you can not afford the $75 for the Couple to Couple League course, contact the teachers and they will probably be able to help out by suggesting sources (i.e. the local parish, pregnancy centers, or even private donations.)

There is probably ways to cut the cost of the course down also, because like I said the $75 pays for all the materials and a one year membership in the Couple to Couple League. In the end the only thing you need to have is the Basil Thermometer. Everything else in the case of a real need could be borrowed.

The materials include:
the book
the thermometer
blank charts
handout
1 year membership in Couple to Couple League

Man, I’m sounding like an advertisement here. 😉
 
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lilder:
My husband and I will be taking NFP classes soon, the NaPro Technology ones. They are a bit costly (the total for a year for us will be around $300). When setting up the appointments, the instuctor mentioned some insurances covered the classes. So I called our insurance company, United Healthcare, to see what was covered. First I was told no infertility treatments were covered, then I explained this would be used to prevent pregnancy. I was told that only hormone contraceptives and devices were covered. I asked who I could talk to about this or where I could file a complaint. They told me it was my employers decision about what was covered in my policy.

I called my employer, Adminsitaff. They told me it was the insurance company that decides. That NFP was not covered in their policy, but it was just the package and not something they specifically denied. They could not tell me if NFP was covered in another package that they did not subscribe to.

I was told if there was a “pressing medical need” I could appeal to United Healthcare. If they found it to be “medically necessary” they might cover it.

Here are my questions:
1.) Do I appeal? It is not a medical reason that I want NFP over “the pill” so I doubt they’d pay.

2.) Do I complain? I think this is VERY unfair. I would not be so upset if they didn’t cover “the pill” and other stuff, if they said no to it all. But I feel discriminated against because of my wanting to follow church teachings.

3.) Who do I complain to? Insurance company or employer? Both?

Thanks for the (name removed by moderator)ut (and for listening to my rant),
🙂 Lilder
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Since Catholic organizations are now being forced to provide insurance coverage for contraceptives, this seems like th other side of the coin.

I would absolutely appeal the decision citing:

Birth control pills, IUDs, diaphragms, sterilizations and abortions etc. are covered under the plan. The purpose and function of these is to prevent the pregnancy coming to term. NFP achieves a similar goal (minus the abortifacients and direct induced abortion aspect, of course.)

There are health risks associated with each of the chemical/barrier/surgical (non-natural) methods. NFP does not have such risks.

The cost of the non-natural methods, over the course of a policy period, generally surpass that of the NFP course.

Since they will pay for the non-natural methods which are riskier and more expensive but are denying your claim for a safer, non-chemical, non-invasive method that you are using because of your religious beliefs, you can only assume that they are discriminating against you because of these beliefs.

Include information on the effectiveness of NFP as well as Church endorsement.

Carbon copy your local newspaper and/or your local television station.

Watch how fast your claim is paid.
 
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condan:
Since Catholic organizations are now being forced to provide insurance coverage for contraceptives, this seems like th other side of the coin.

I would absolutely appeal the decision citing:

Birth control pills, IUDs, diaphragms, sterilizations and abortions etc. are covered under the plan. The purpose and function of these is to prevent the pregnancy coming to term. NFP achieves a similar goal (minus the abortifacients and direct induced abortion aspect, of course.)

There are health risks associated with each of the chemical/barrier/surgical (non-natural) methods. NFP does not have such risks.

The cost of the non-natural methods, over the course of a policy period, generally surpass that of the NFP course.

Since they will pay for the non-natural methods which are riskier and more expensive but are denying your claim for a safer, non-chemical, non-invasive method that you are using because of your religious beliefs, you can only assume that they are discriminating against you because of these beliefs.

Include information on the effectiveness of NFP as well as Church endorsement.

Carbon copy your local newspaper and/or your local television station.

Watch how fast your claim is paid.
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You’re assuming the local media doesn’t have a strong liberal bias. There’s not much that the insurance companies haven’t heard. The bottom line that in all of them is the definition of who is an eligible provider. Couples to Couples and religious/non-medical groups aren’t considered licensed medical professionals so that’s where they close the claim. If they make an exception to the licensure rule on this claim, then they’re setting a precident that’s going to open up everything from native shamans to witch doctors and prostitutes as surrogate sex therapists.
 
I agree with you completely that this is an unfair issue. Once upon a time insurance only covered contraceptives if they were “medically necessary” but since that could range from severe disorders to cramps, any doctor could add such a diagnosis to ensure coverage. Now this is completely different and the logic of covering for medical reasons has gone by the wayside. Plus there is the factor of insurance getting kickbacks and incentives from drug manufacturers themselves - they know they won’t get the same here…This is my opinion based on what I have seen after working for 10 years in the pharmacy. However, I think your cause is one that must be fought, not just for the coverage for you and anyone else, but because I believe it may get the word out on NFP to people that might otherwise never hear of it.

Michelle
 
Find a good Catholic, pro-life attorney (who might take this case *pro bono * because it’s an important issue). He or she will be able to advise you what to do. Who knows, it might be the beginning of a big, stinky class-action suit that sets a good precedent for everyone.

Betsy
 
like a few post before me… write to the insurance company because to not get pregnant saves them big bucks, the paultry 300 (to the insurance company it’s paultry) is a drop in the bucket compared to the cost of prenatal, delivery, and well baby care… and i would recommend that you CC the letter to the state insurance commissioner, insurance companies don’t like to see their names laid on the desk of your state insurance commissioner… good luck… 👍
 
First my disclaimer: I have been in Human Resources for nearly 20 years.

While they have not been particulary clear in what they say, the real reason that NFP is not covered likely has less to do with it being natural and more to do with it being non-perscription. The plan probably also doesn’t cover spermacides, condoms etc. which are also non-perscription family planning material.

Check with your NaPro provider. Some classes are done with nurses and doctors while others use trainers. You may be able to have this covered as a doctor’s visit if a doctor or nurse is doing the training. The insurance company probably won’t volunteer this information. You have to ask specifically.

While CCL and other kinds of NFP classes may be cheaper, they do not always use the same method. I believe that NaPro is Billings and CCL is Sympto Thermal. Each has it’s pros and cons and they may not work equally for everyone.

See if your company has a flexible spending plan. You may be able to use that and it would represent a significant savings. The IRS controls what is covered, not individual companies, and they recently greatly expanded their categories.

All that being said, lobby hard with the insurance company and with your employer’s benefits department. Find out when the contract with United will be up for renewal and who at Administaff handles the contract negotiation. Many times, changes that are nearly impossible to make due to a contract are easily modified at renewal time.

Good luck.
 
space ghost:
like a few post before me… write to the insurance company because to not get pregnant saves them big bucks, the paultry 300 (to the insurance company it’s paultry) is a drop in the bucket compared to the cost of prenatal, delivery, and well baby care… and i would recommend that you CC the letter to the state insurance commissioner, insurance companies don’t like to see their names laid on the desk of your state insurance commissioner… good luck… 👍
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Uh…I work for an insurance company (auto) and I can tell you that while it’s not great to have insurance commissioner involvement, for the most part it doesn’t phase us. However, that said, it is the correct place to appeal or inquire and they should be able to direct you to a process.

Whatever you do, if you speak directly to someone in the insurance company in question, don’t throw out the Insurance Commissioner as a threat…at best, that tactic discredits you. If you have an honest inquiry, simply make it and you will recieve an answer.

In regards to this issue, I can kinda understand why they are not calling it “medically necessary” as NFP does not involve any type of chemicals, drugs, or special medical treatment. Technically it’s outside their jurisdiction as the course would be more educational. However, one could argue medical necessity based on any number of health issues and the religious issue already recognized by the medical field. (What religion is it…they don’t believe in blood transfusions…etc.?)

I say try to go about the decision through basic inquiry, keep it very conversational and respectful and don’t let a tone of disdain or disrespect creep into your voices. If you fail when you appeal through the Insurance Commission, contact an attorney and consult about the issue…something like this could require a public arena which would not only get the word out about what NFP is or is not, but gain further participants! 😉
 
Neither the employer or the insurance company is doing anything wrong here. The insurance company puts a bunch of packages together. The employer then buys one. If an employer wants to add a feature to a package, they can have it added at an increased cost.

Some employers offer dental, some don’t. Some cover eyeglasses, some don’t. Some cover contraceptives, some don’t. There are no rights involved.
 
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Ken:
Neither the employer or the insurance company is doing anything wrong here. The insurance company puts a bunch of packages together. The employer then buys one. If an employer wants to add a feature to a package, they can have it added at an increased cost.

Some employers offer dental, some don’t. Some cover eyeglasses, some don’t. Some cover contraceptives, some don’t. There are no rights involved.
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Interesting point of view. And I totally respect your opinon. But I have to ask…why is it ok to cover the pill (contraceptive) and not cover a morraly acceptable alternative (like NFP)?

Everyone else ~~ Thanks so much for the advice. I have decided to write an appeal/complaint and see what kind of reception I receive.
🙂 Lilder
 
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