Sarah Varney, KFF Health News
Ashley and Kyle have been newlyweds in early 2022 and thrilled to expect their first little one. But bleeding had plagued Ashley from the start of her being pregnant, and in July, at seven weeks, she started miscarrying.
The couple’s heartbreak got here just a few weeks after the U.S. Supreme Court overturned the federal proper to abortion. In Wisconsin, their house state, an 1849 legislation had sprung again into impact, halting abortion care besides when a pregnant lady confronted loss of life.
Insurance protection for abortion care within the U.S. is a hodgepodge. Patients typically don’t know when or if a process or abortion tablets are coated, and the proliferation of abortion bans has exacerbated the confusion. Ashley stated she obtained caught in that tangle of uncertainties.
Ashley’s life wasn’t in peril through the miscarriage, however the state’s abortion ban meant docs in Wisconsin couldn’t carry out a D&E — dilation and evacuation — even throughout a miscarriage till the embryo died. She drove backwards and forwards to the hospital, bleeding and taking sick time from work, till docs may affirm that the being pregnant had ended. Only then did docs take away the being pregnant tissue.
“The first pregnancy was the first time I had realized that something like that could affect me,” stated Ashley, who requested to be recognized by her center identify and her husband by his first identify solely. She works in a authorities company alongside conservative co-workers and fears retribution for discussing her abortion care.
A yr later, the 1849 abortion ban nonetheless in place in Wisconsin, Ashley was pregnant once more.
“Everything was perfect. I was starting to feel kicking and movement,” she stated. “It was the day I turned 20 weeks, which was a Monday. I went to work, and then I picked Kyle up from work, and I got up off the driver’s seat and there was fluid on the seat.”
The amniotic sac had damaged, a situation referred to as previable PPROM. The couple drove straight to the obstetrics triage at UnityPoint Health-Meriter Hospital, billed as the biggest birthing hospital in Wisconsin. The fetus was deemed too underdeveloped to outlive, and the ruptured membranes posed a severe menace of an infection.
Obstetrician-gynecologists from throughout Wisconsin had determined that “in cases of previable PPROM, every patient should be offered termination of pregnancy due to the significant risk of ascending infection and potential sepsis and death,” stated Eliza Bennett, the OB-GYN who handled Ashley.
Ashley wanted an abortion to avoid wasting her life.
The couple referred to as their mother and father; Ashley’s mother arrived on the hospital to console them. Under the 1849 Wisconsin abortion ban, Bennett, an affiliate medical professor on the University of Wisconsin School of Medicine, wanted two different physicians to attest that Ashley was dealing with loss of life.
But even with an arsenal of medical documentation, Ashley’s well being insurer, the Federal Employees Health Benefits Program, didn’t cowl the abortion process. Months later, Ashley logged in to her medical billing portal and was shocked to see that the insurer had paid for her three-night hospital keep however not the abortion.
“Every time I called insurance about my bill, I was sobbing on the phone because it was so frustrating to have to explain the situation and why I think it should be covered,” she stated. “It’s making me feel like it was my fault, and I should be ashamed of it,” Ashley stated.
Eventually, Ashley talked to a girl within the hospital billing division who relayed what the insurance coverage firm had stated.
“She told me,” Ashley stated, “quote, ‘FEP Blue does not cover any abortions whatsoever. Period. Doesn’t matter what it is. We don’t cover abortions.’”
University of Wisconsin Health, which administers billing for UnityPoint Health-Meriter hospital, confirmed this change.
The Federal Employees Health Benefits Program contracts with FEP Blue, or the BlueCross BlueProtect Federal Employee Program, to offer well being plans to federal workers. In response to an interview request, FEP Blue emailed a press release saying it “is required to comply with federal legislation which prohibits Federal Employees Health Benefits Plans from covering procedures, services, drugs, and supplies related to abortions except when the life of the mother would be endangered if the fetus were carried to term or when the pregnancy is the result of an act of rape or incest.”
Those restrictions, generally known as the Hyde Amendment, have been handed every year since 1976 by Congress and prohibit federal funds from protecting abortion providers.
In Ashley’s case, physicians had stated her life was in peril, and her invoice ought to have instantly been paid, stated Alina Salganicoff, director of Women’s Health Policy at KFF, a well being data nonprofit that features KFF Health News.
What tripped up Ashley’s invoice was the phrase “abortion” and a billing code that’s insurance coverage kryptonite, stated Salganicoff.
“Right now, we’re in a situation where there is really heightened sensitivity about what is a life-threatening emergency, and when is it a life-threatening emergency,” Salganicoff stated. The similar chilling impact that has spooked docs and hospitals from offering authorized abortion care, she stated, may additionally be affecting insurance coverage protection.
In Wisconsin, Bennett stated, lack of protection for abortion care is widespread.
“Many patients I take care of who have a pregnancy complication or, more commonly, a severe fetal anomaly, they don’t have any coverage,” Bennett stated.
Recently, the invoice for $1,700 disappeared from Ashley’s on-line invoice portal. The hospital confirmed that eight months later, after a number of appeals, the insurer paid the declare. When contacted once more on Aug. 7, FEP Blue responded that it could “not comment on the specifics of the health care received by individual members.”
Ashley stated tangling together with her insurance coverage firm and experiencing the impression of abortion restrictions on her well being care, much like different girls across the nation, has emboldened her.
“I’m in this now with all these people,” she stated. “I feel a lot more connected to them, in a way that I didn’t as much before.”
Ashley is pregnant once more, and she or he and her husband hope that this time their insurance coverage will cowl no matter medical care her physician says she wants.
KFF Health News is a nationwide newsroom that produces in-depth journalism about well being points and is without doubt one of the core working packages at KFF—an unbiased supply of well being coverage analysis, polling, and journalism. Learn extra about KFF.
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