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QUESTION: Hello,

I went through the weirdest thing when I first started my job and it has continued to bother me. I was pregnant when I started a new job but didn't know it yet. Ultimately, I decided to get an abortion. I went to Planned Parenthood and then submitted the receipt for reimbursement to my new insurance company. That's when I learned that even though abortion was a covered service on paper and by contract, it was much less black and white in practice. PP was not in network so that was denied. my only question, at that point, was where should I have gone instead? I asked the insurance company this and they told me try the provider search.

The provider search lists nothing under abortion; I was then told I had to print out every OB-GYN in my area and call each place to ask if they provide abortions- something I thought was ridiculous. Then the insurance company told me that they didn't set the network so I needed to take it up with HR at my job. I contacted them and they had no idea where one could obtain an abortion either and suggested going to doctors and getting a referral- something that isn't a guaranteed and also means unnecessary costs in co-pays and labs.

At that point, I was shocked and angry and suspected it was more political than anything. I started contacting everyone at my job I could think of to find an in-network abortion provider. It took 2 weeks of daily calls and emails before someone suggested trying a small clinic that has no online presence, no directory entry. I eventually made contact with them and they are the only in-network abortion provider. They were nearly impossible to find. Had I still been pregnant, I would have given up much earlier. It turned into a political pursuit for me. I called the insurance company to give them the name of the clinic and contact info and asked them to include it in their lists; I also shared with HR. Periodically, I call the insurance comp to inquire about getting an in-network abortion and they still say they have no idea. I've called requesting physical therapy providers and dermatologists and also asked for Viagra providers for my partner and the difference is night and day. They can give all info for these.

Something is wrong here- is this some type of gender discrimination? After all, all the services are covered and part of the contract.

Thank you!
Kathy

ANSWER: The insurance company is not correct in everything they told you. HR and the company do not have control over the network. When HR and the company purchase group insurance coverage from an insurance company we are paying for their coverage and their network. Yes you must use the network proviers to be in network, but the insurance company has the network. If there is any discrimination it would lie with the insurance company. I would think it is simply a lack of providers for this type of service.

Shirley

---------- FOLLOW-UP ----------

QUESTION: Hi Shirley, Thank you for your response.

I don't think it's from a lack of providers in the area- I mean, there's never A LOT of abortion providers anywhere but there are 3-4 well-known clinics in the area. They just aren't in the network.

If the insurance company decides abortion is a covered health service, then isn't it their duty to ensure that their network includes and accessible provider? If there's just one provider, it doesn't make sense that no one at the ins company and no one in HR would know of it. It's easier to be aware of one clinic than 10.

I did everything I could to try to spread the info so that other patients wouldnt have to go thru the same thing. I've pasted all the steps I had to go thru in order to find the much needed info (I've taken out names since I didnt make my question private- and also, so sorry that it's long!)

I'm just curious if any of that was acceptable? I dont think it is- it's beyond what any patient paying for insurance should have to go through in order to access covered services. I guess I'm just interested in what someone on the outside thinks and if you have advice as to what I should/could have done differently?

Day 1 (9-19)
1.   called WP Ins com and asked about claim. Was told it was denied bc the provider was not “in network”.
2.   Called back and asked what abortion provider was in network. Was told to go online and search provider directory.
3.   Searched directory under “abortion”. Nothing is found in state of NC.
4.   Called the WP nurse line. They called me back and I asked where I can get an abortion that is in network. The nurse did not know. Told me to call customer service again in the morning.
5.   I emailed Planned Parenthood to inquire about other abortion providers in the area.
6.   I did a google search and found 4 abortion providers- 3 in Chapel Hill, 1 in Raleigh.

Day 2 (9-20)
7.   Read the benefit book. Page 35 ensures that abortions are covered.
8.   Emailed D*work HR and asked where I can go in network to obtain an abortion.
9.   Called WP and asked again where I can obtain an abortion. Customer service rep did not know. I made reference to my claim and explained the situation. He told me it was denied bc the provider was not in network. I explained that I understand that and simply want to know what abortion provider is in network. Again, he told me the provider I saw was out of network. Again, I explained that I want to know where to go in network. Eventually, I just said “I want to know where to go for future abortions” and he agreed to search. He then asked me what he should search under… as if I should know?? I said “abortion”. He responded “Well, I don’t think it will be under that!” (*customer service rep from the day before did not tell me that abortion services would be listed under a different category. Regardless, WHY would they?) He then searched GYN and told me he came up with 100+. I had already done this search prior and the information given under “more info” does not include what services that provider offers. (does this mean the insured is supposed to call every 100+ provider until they find what they are looking for??) He implied that he couldn’t go through that many providers to find an abortion provider. I told him that I certainly was not going to do that either. Once again, I explained that is why I called my ins comp customer service. He suggested I call the WP customer service line- which is the number I called. He apparently did not know that the customer service line routes calls to his number (why would he not know that??). he told me that D*work creates its own network and that I should take this issue up with D*work. he then put me on hold, asked health services what I should do, the response was to submit an appeal and to have Planned Parenthood send my entire medical record so that they can review it. They have 30 days to review and respond. (1. I do not want to send my entire record to them. They have the receipt that details all the procedures included. 2. This has nothing to do with what services they provided. The fact that they do not know where to refer someone in network is not going to be found in my medical records. 3. This is ridiculous). He told me that no one has ever asked this question in his 7 years working customer service.
10.   I contacted D*work HR and asked what I should do when a covered service seems to have no in-network provider. I was asked what service so I explained the situation. She gave me JW Head of HR Insurance Plans email.
11.   I emailed JW*Head and asked her to call me to discuss.
12.   JW*Head called and I, again, explained the situation. She told me that D*work does provide abortions so I asked “where”. She said “ob-gyn” and I asked “are you sure?” She said “yes”. I then told her that WP customer service does not know that and abortion is not listed under ob-gyn’s services online. She also said that abortion services probably would not be listed under “abortion” in the provider directory because it is controversial. (Why not? What else should someone search for if they need an abortion? No one knows this, either) JW*Head agreed that this is unacceptable and said she would look into it and get back to me the next day.
13.   I searched D*work med for “abortion” and “termination” and still found nothing.
14.   I looked under OB-GYN’s listed services. Abortion is not included.
15.   I searched the entire D*Work website for “abortion” and “termination” and found nothing.
16.   I tried a google search including “D*work” and “abortion” and found nothing.
17.   I requested an appt for an abortion through D*work's online health portal.
18.   I contacted D*work Referrals and also asked.
19.   Received an email response from HR that said “You can call WP directly at (800) 385-3636 and they should be able to assist you.” I responded to let him know that WP ins is not helpful in this situation and they will in turn suggest you take it up with D*Work HR.
20.   I asked a friend to independently seek an abortion referral that is in network for D*work to see if I am just missing something; found the same inaccessibility as me.
21.   Read the benefit book rights and responsibilities. “reasonable access” to health care is a Right according to the “contract”. What defines “reasonable access”?
22.   I received a response from D*work Referrals that said “Thank you for your information in D*work Medicine.  You may call The RC at ***-668-****.  They may be able to provide you with the information you are requesting.” I searched for the “RC” on the D*work website and there are no results.
23.   After work, I called the RC and asked. The woman said they do provide abortions and started asking for my information. I explained to her what was going on and she told me that they do not have a website and it is partly because abortion is controversial. She then told me that they ARE listed on the Student Affairs website with Planned Parenthood as an abortion provider. This is the only place that one can find this information online. (This would only be helpful for students. And why is Planned Parenthood there if not in network?) She did tell me that Planned Parenthood is good about directing people with D*work insurance to the RC. (an out of network provider is supposed to tell those insured where they can go in network?? Completely unacceptable. It is not their responsibility to do this.)
Day 3 (9-21)
24.   Received a follow-up email from HR telling me that JW*Head would be in touch shortly. I waited for her follow-up phone call but she did not call me as she had said she would.
Day 4 (9-24)
25.   Am still awaiting JW*Head's phone call.
26.   Am thinking about who to contact to bring this information to the public in case that needs to happen.
27.   Emailed D*work HR to ask them to define “reasonable access” to healthcare. (never got a response)
28.   Documented this (so far) 4 day, 28 step search to obtain information about a covered service on D*work's insurance plan.
29.   Searched d*work's website for “student affairs”; searched the student affairs page for “abortion”- received 4 results, none of which mention the RC, as I was told. (a return that suggests Planned Parenthood for abortion information among other wellness resources; the 1987 proposal for a women’s center at D*work; link to classes under term “ethical”; and link to careers in k-12 teaching); also searched “pregnancy” which returns results but none of which are for abortion; searched “RC”- nothing and “R”- nothing.
30.   Follow up phone call with JW*Head; follow-up email with JW*Head.
Day 6 (9-26)
31.   Follow up email with JW*Head; JW*Head makes an implied threat twice
32.   Contacted NC ACLU; WRAL; D*work Progressive Alliance; Planned Parenthood; feminist advocates in area
33.   Called member services again and gave a different name (Sue Jilley) and a fake date of birth and phone number- they refused to give me any information unless they got this information- “have to document the call”. I specifically said I did not want them to have my personal information and was told then they will not give me any information. So I made it up. I asked where I can go in network for an abortion. This time I was told that surgeons do abortions and I would need to call around and find one that will do it, then call member services to ask if that surgeon is in network. I stated that I wanted a specific name of a provider that I could go to, in network, for an abortion. Member services does not have that information. So, I asked for a specific name of a provider for a skin lesion and then a twisted ankle- member services can direct a member to an in network provider for all services EXCEPT abortion.
34.   Received another useless email from J.W.; contacted ACLU
35.   Contacted DTH; will contact Ipas, NC IOM; Indy
36.   Printed a list of surgeons and started calling them to ask if they did abortions. I got to 7 “no”s and gave up. (this was the suggestion of WP customer service #33)
37.   Contacted I.W and plans to speak to reporter
38.   Have been asked to come speak to a class at nearby university about this
(10-4)
39.   Started a poll on FB asking how people access their healthcare when insured:
if you have health insurance and need to see a provider for a certain service, what are the different things you would do to ensure that you visited an in network health provider (so that the service was covered and you did not have to pay out of pocket?)
a.   Check the provider directory          [16 votes]
b.   Call member services          [8 votes]
c.   Search Google          [2 votes]
d.   Search booklet for covered services,       [1 vote]
drugs, preferred doctors, clinics and hospitals
e.   Ask a primary care doctor          [1 vote]
f.   Call each local provider and ask         [1 vote]
g.   Make an appt with a PCP for a referral      [0 votes]

40.   spoke with a reporter at the Indy who is following up on her own to see what she can find out.
41.   Making a list of as many insurance companies as I can to call and see how they approach the very same question. (**need to find help with this**) So far, 3 friends have offered to call their companies.



***I eventually got a bit burnt out on this but it is still a problem and would like to see change. How do I do that? Pregnant women don't have the time or emotional resources to deal with this kind of stuff- especially when abortion access has become even more restricted now than it was when I started dealing with this.

Thanks,
Kathy

Answer
My insurance company is one of the biggest companies in the U.S. They could not give me the name of a covered abortion clinic. I think that those clinics stay under the radar so those against abortion don't go there and harrass thier clients.

We have one clinic in our largest city and one planned parenthood clinic. If you look on line it will sned you out of state. Planned parenthood did have the information of the other clinics.

I don't know where you would go with your fight as it is ultimately up to the insurance companies to make this information available. If they do not do so I have no idea what you can do about it.

Shirley

Employment Law

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Shirley McAllister, CPP, PHR

Expertise

I can answer questions about payroll laws and payroll tax laws and Human Resource laws and agencies. I can answer federal payroll and human resource law questions and most states; I do not have a knowledge of the local taxes for cities and counties within the state. If and when I can I will try and send you the website where you can reference the answer and where you can obtain more information as well as a contact number if needed for that particular agency. Some agencies I have worked with are IRS, Department of Labor (federal and state), Revenue Canada (and provincial governments), Inland Revenue, OSHA (0ccupational Safety and Health Administration); Social Security Administration and National Child Support as well as other agencies in Payroll and Human Resources. Some Laws I am particularly familiar with are FLSA (Fair Labor Standards Act), ADA (Americans With Disabilities Act), FMLA (Family Medical Leave Act) COBRA (Consolidated Omnibus Reconciliation Act ) , QDRO's, QMCSO's, and other support orders and garnishments, USERRA (Uniformed Services Employment and Remployment Rights Act,PPA Act (Pension Protection Act of 2006, As well as most other employment type acts. I am also well versed in the Title V Civil Rights Act and the HIPAA (Health Insurance Portability and Accountability Act).

Experience

30 years in Payroll and Human Resources

Organizations
SHRM (Society of Human Resources) APA (American Payroll Association) DOLEA (Department of Labor Employers Association) CPA (Canadian Payroll Association) NAPW (National Association of Professional Women) The Mentoring Network

Education/Credentials
PHR Certification in Human Resources CPP Certification in Payroll in U.S. Payroll Administrator and Payroll Supervisor certification in Canada

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