Report criticizes Tennessee's insurance companies, claims women's health requirements violated

Report criticizes Tennessee's insurance companies, claims women's health requirements violated

May 2nd, 2015 by Kate Belz in Local Regional News

A laptop shows the HealthCare.com web site during an Affordable Care Act enrollment event in this Feb. 12, 2015, photo.

Photo by Associated Press /Times Free Press.

 

Insurance companies that sold plans on Tennessee's marketplace during 2014 violated the Affordable Care Act's requirements for women's health coverage, according to a report released Wednesday by a women's legal advocacy group.

The report, issued by the National Women's Law Center, analyzed new insurance plans in 15 states, including Tennessee, and found some excluded dependents from maternity coverage, prohibited coverage of breast pumps and limited the genetic testing needed for women at high risk for breast or ovarian cancer.

"The Affordable Care Act has made dramatic improvements in women's health coverage, but insurers' failure to comply with its requirements has serious consequences that affect women every day," the center's Vice President for Health and Reproductive Rights Gretchen Borchet said in a prepared statement.

Tennessee-specific problems cited by the report included one 2014 Community Health Alliance plan that wouldn't provide maternity coverage for dependents, which could include spouses or offspring under age 26, saying that maternity expenses for dependents are excluded from coverage "unless there are life-threatening complications."

Officials with Community Health did not return requests for comment. But Kevin Walters, the spokesman for the Tennessee Department of Commerce and Insurance, said state regulators "had previously identified the maternity coverage exclusion for dependents in [Community Health Alliance]'s policies, and such language did not appear in their approved 2015 plans."

In addition, the report stated that 2014 BlueCross BlueShield of Tennessee plans limited breastfeeding education to one visit per pregnancy. Company spokesman Roy Vaughn said those limitations have been removed in plans going forward.

"We have provided millions of Tennessee women with affordable access to quality care with a wide range of products and services," said Vaughn. "As a Qualified Health Plan, BlueCross must meet state and federal requirements related to benefits and coverage."

All insurers are also required to cover genetic counseling and testing for genetic mutations for women at high risk for family-related breast or ovarian cancer. But a plan under Humana Insurance in Tennessee allows genetic testing only as part of a fertility evaluation, the report found.

Humana representatives could not be reached for comment Friday.

The report also criticized Tennessee plans for excluding transition-related care for transgender people, including hormone therapy or transition-related surgery, sometimes referred to by insurers as "transgender surgery" or "transsexual surgery."

Karen Ignagni, CEO of the trade association America's Health Insurance Plans, told The Associated Press that the report presented a distorted picture.

"Health plans provide access to care for millions of women each day and receive high marks in customer satisfaction surveys. To use highly selective anecdotes to draw sweeping conclusions about consumers' coverage does nothing to improve the quality, accessibility or affordability of health care for individuals and families," she said.

Meanwhile, Walters said state officials are "currently reviewing the report as well as insurers' plans" and are reaching out to the insurer community for clarification of certain language and provisions.

The U.S. Department of Health and Human Services, which gives final approval to plans sold on the exchange, had not identified any of the issues outlined in the report, he said.

The Associated Press contributed to this story.

Contact staff writer Kate Belz at kbelz@timesfreepress.com or 423-757-6673.


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