Reports: 12 Oregon health insurance companies failed to fully comply with the Reproductive Health Equity Act
SALEM, Ore. (KTVZ) – All 12 health insurance companies in the individual, small group, and large group markets in Oregon failed to fully comply with the Reproductive Health Equity Act at varying levels, according to reports released Wednesday by the Oregon Department of Consumer and Business Services ‘Division of Financial Regulation.
The agency found that most noncompliance involved improperly charging copays, coinsurance, and deductibles or failing to cover mandated benefits.
The division examined Aetna Life Insurance Company, BridgeSpan Health Company, Cigna Health and Life Insurance Company, HealthNet Health Plan of Oregon, Kaiser Foundation Health Plan of the Northwest, Moda Health Plan, PacificSource Health Plans, Providence Health Plan, Regence BlueCross BlueShield of Oregon , Samaritan Health Plans, UnitedHealthcare Insurance Company, and UnitedHealthcare of Oregon.
The examinations found that each of the 12 insurers failed to pay all eligible claims according to RHEA requirements. They applied copays, coinsurance, and deductibles, which are prohibited under RHEA for reproductive health and preventive care services. In some cases, insurers improperly denied claims for RHEA covered services.
In addition, the report found that three insurers – Aetna, BridgeSpan, and Regence – failed to cover certain types of contraceptives or applied improper limitations in the amount or timing of when a member could refill a prescription.
Finally, examiners found that Cigna, HealthNet, Kaiser, and Samaritan each failed to properly resolve all consumer complaints and maintain adequate records demonstrating that they timely and adequately resolved member complaints, appeals, and complaints.
“RHEA is a critically important tool in the state’s effort to remove barriers to reproductive health care,” said Oregon Insurance Commissioner Andrew Stolfi, who is also the DCBS director. “As with every law, our insurers have an obligation to fully and timely implement each aspect of RHEA across all of their systems. It is disappointing to see