Physics Prof's Solution to Ms Fluke's Dilemma

[A Turtle Named Mack]

Originally Posted by erwins

And it's my understanding that she was talking about someone taking BC pills for a medical condition, not for BC purposes.

No, just for contraception. All of the health plans which had not been covering contraception were covering hormone treatments for other purposes (and I have heard that it is not unusual for doctors to get contraception covered by putting down 'irregular periods' as a diagnosis, and since there is almost always some amount of irregularity to a woman's periods, it is accepted as appropriate).

To confirm that she meant for contraception, her words:

Fluke testified, “Without insurance coverage, contraception, as you know, can cost a woman over $3,000 during law school."

http://cnsnews.com/news/article/pelo...-control-pills

[Chloe]

http://georgetownvoice.com/2012/02/2...contraception/

In this case, Fluke’s friend, despite confirmation of her illness from her doctor, was never able to get her medication. “Her claim was denied repeatedly on the assumption that she really wanted the birth control to prevent pregnancy,” Fluke said. “She’s gay, so clearly polycystic ovarian syndrome was a much more urgent concern than accidental pregnancy.”

[Jahungo]

Sandra Fluke's testimony can be found here.
The relevant quote from her testimony:

Without insurance coverage, contraception, as you know, can cost a woman over $3,000 during law school.

So she wasn't talking about her personal expenses for birth control, but simply how much it "can cost."

$3,000 over 3 years of law school (so $1,000/yr) would be quite expensive for birth control. This US News article assesses the costs of various birth control methods, and the most expensive method there would be about $600/yr. So one would have to use both an expensive hormonal method and an expensive barrier method to reach $1,000/yr.

While the OP comment is a load of sexist bullcrap, $1,000 a year for birth control is a somewhat misleadingly high number. That doesn't change the fact that the cost of contraception is a burden on many women and some might forego contraception based on cost, potentially leading to greater costs in the long run (to them, but potentially also to the taxpayer).

[Chloe]

Originally Posted by Jahungo

$3,000 over 3 years of law school (so $1,000/yr) would be quite expensive for birth control. This US News article assesses the costs of various birth control methods, and the most expensive method there would be about $600/yr. So one would have to use both an expensive hormonal method and an expensive barrier method to reach $1,000/yr.

No, one wouldn't. One could be on Yaz at $80+ per month, and have an annual pap smear and doctor visit. Have you ever tried to get hormonal birth control without a pap? Aren't you in med school or something?

[erwins]

Originally Posted by A Turtle Named Mack

No, just for contraception. All of the health plans which had not been covering contraception were covering hormone treatments for other purposes (and I have heard that it is not unusual for doctors to get contraception covered by putting down 'irregular periods' as a diagnosis, and since there is almost always some amount of irregularity to a woman's periods, it is accepted as appropriate).

She was referring to contraception in general in that sentence, yes. There are about 2 paragraphs of her testimony addressing contraception in general. She says that contraception can cost over $3,000 over 3 years, not that it does for all women.

Most of the remaining 3 (of 4) pages of her testimony is about how the ban affects women who need the medication for medical purposes. Apparently the insurance and medical staff think a lot like you do as far as questioning medical diagnoses:

In sixty-five percent of cases, our female students were interrogated by insurance representatives and university medical staff about why they needed these prescriptions and whether they were lying about their symptoms. For my friend, and 20% of women in her situation, she never got the insurance company to cover her prescription, despite verification of her illness from her doctor. Her claim was denied repeatedly on the assumption that she really wanted the birth control to prevent pregnancy. She’s gay, so clearly polycystic ovarian syndrome was a much more urgent concern than accidental pregnancy. After months of paying over $100 out of pocket, she just couldn’t afford her medication anymore and had to stop taking it. I learned about all of this when I walked out of a test and got a message from her that in the middle of her final exam period she’d been in the emergency room all night in excruciating pain. She wrote, “It was so painful, I woke up thinking I’d been shot.” Without her taking the birth control, a massive cyst the size of a tennis ball had grown on her ovary. She had to have surgery to remove her entire ovary. On the morning I was originally scheduled to give this testimony, she sat in a doctor’s office. Since last year’s surgery, she’s been experiencing night sweats, weight gain, and other symptoms of early menopause as a result of the removal of her ovary. She’s 32 years old. As she put it: “If my body indeed does enter early menopause, no fertility specialist in the world will be able to help me have my own children. I will have no chance at giving my mother her desperately desired grandbabies, simply because the insurance policy that I paid for totally unsubsidized by my school wouldn’t cover my prescription for birth control when I needed it.” Now, in addition to potentially facing the health complications that come with having menopause at an early age-- increased risk of cancer, heart disease, and osteoporosis, she may never be able to conceive a child.

[Jahungo]

Originally Posted by Chloe

No, one wouldn't. One could be on Yaz at $80+ per month, and have an annual pap smear and doctor visit. Have you ever tried to get hormonal birth control without a pap? Aren't you in med school or something?

But the Pap smear and doctor visit would be covered by health insurance. Her testimony was in relation to her university health insurance not covering contraception, but it surely still covers routine care such as this.

(There's also no need for an annual Pap smear - the current recommendation is once every 3 years for a typical woman over 21).

[Ryda Wong, EBfCo.]

Originally Posted by Jahungo

(There's also no need for an annual Pap smear - the current recommendation is once every 3 years for a typical woman over 21).

That recommendation is really to be questioned.

[Chloe]

Originally Posted by Jahungo

But the Pap smear and doctor visit would be covered by health insurance.

You still get a co-pay, on most plans, and a deductible depending on the plan. Add that to the $80+ a month for Yaz (and that's at Costco), and you can be at $1K right quick.

(There's also no need for an annual Pap smear - the current recommendation is once every 3 years for a typical woman over 21).

I suggest you google what actual women have to say about trying to get b/c without an annual exam.

[Lainie]

Originally Posted by Jahungo

But the Pap smear and doctor visit would be covered by health insurance.

In every case? How do you know that? Are health insurers legally required to cover pap smears?

I'm not sure if my current insurance covers pap smears, but they didn't pay for my routine mammogram.

[A Turtle Named Mack]

Originally Posted by erwins

She was referring to contraception in general in that sentence, yes. There are about 2 paragraphs of her testimony addressing contraception in general. She says that contraception can cost over $3,000 over 3 years, not that it does for all women.

Most of the remaining 3 (of 4) pages of her testimony is about how the ban affects women who need the medication for medical purposes. Apparently the insurance and medical staff think a lot like you do as far as questioning medical diagnoses:

anecdote =/= evidence, and much more so when it is a FOAF anecdote. I doubly question this claim since most hormonal birth control treatments would apparently be cheaper than the deductible anyway, from the amounts I have seen cited here. If the treatment would not cost the insurance company any money, there would be no reason to review it.

And a general question - the regulation requires birth control to be covered without any copay or deductible. Why? Why should this one group of medicines be mandated to have no-copay when all the rest, presumably for treatment for a medical problem, are not?

[Ryda Wong, EBfCo.]

Originally Posted by A Turtle Named Mack

And a general question - the regulation requires birth control to be covered without any copay or deductible. Why? Why should this one group of medicines be mandated to have no-copay when all the rest, presumably for treatment for a medical problem, are not?

Because it prevents one of the more expensive health issues that can happen at any time from puberty to menopause to over 50% of the population.

The no co=pay stuff is for preventative medicine.

[erwins]

Originally Posted by A Turtle Named Mack

anecdote =/= evidence, and much more so when it is a FOAF anecdote. I doubly question this claim since most hormonal birth control treatments would apparently be cheaper than the deductible anyway, from the amounts I have seen cited here. If the treatment would not cost the insurance company any money, there would be no reason to review it.

What deductible? Do you know the details of their insurance plan? If so, please share so we can be on the same page. If you're saying that it would be cheaper than the co-pay, I think that's probably inaccurate, and it ignores--again--the fact that not all women can take or have access to the very cheap BC version that people keep talking about. That strikes me as saying something like, why should anyone complain that their $100/month pain medications aren't covered under their insurance plan--you can get generic aspirin at Walgreens, $5 for 250. There's your analgesic, stop complaining.

Also, I don't know what it means that you "doubly question" something, but Fluke at least was providing actual statistics and examples, as opposed to your "doctors will put down 'irregular periods' just to get it covered" (paraphrasing here) statement that I'm guessing you pulled out of your, um, let's say sleeve (you've provided no evidence for it, anyway). I can't believe that you would seriously question (esp. based on your statement) that women with legitimate medical conditions requiring treatment with hormonal BC would be denied or hassled as a result of the policy at the school.

Or is it that you doubt that being denied access to the medication could cause a woman to lose an ovary?

[Jahungo]

Originally Posted by Lainie

In every case? How do you know that? Are health insurers legally required to cover pap smears?

Insurance companies are required to cover pap smears without any copay in "new" health insurance plans since September 2010.

However, I did not realize that plans from prior to this date are "grandfathered" in and exempt from this requirement.

Health plans are required to cover, without copayments, the preventive services recommended by the United States Preventive Services Task Force (USPSTF), including cervical cancer screenings. This provision took effect in September 2010. Additionally, the list of free required preventive services will be updated in 2011 to ensure that services women in particular need are included. "Grandfathered" plans--those that existed before the Affordable Care Act was passed--are exempt from this requirement, but plans will lose their grandfathered status if they significantly cut benefits, increase out-of-pocket spending, or change insurance carriers. link

So for those grandfathered plans I think it depends on state regulations. According to that same link, 28 states (including Washington DC, home of Georgetown University, where Fluke attends and was testifying about, require health insurance plans to cover Pap smears.

So while there are probably still some people on these grandfathered plans in the other 23 states who have insurance that does not cover Pap smears, that is not really relevant to anyone at Georgetown, which is what Fluke was testifying about.

[Ramblin' Dave]

Originally Posted by A Turtle Named Mack

(and I have heard that it is not unusual for doctors to get contraception covered by putting down 'irregular periods' as a diagnosis, and since there is almost always some amount of irregularity to a woman's periods, it is accepted as appropriate).

I'd like to know where you heard that, first of all. FWIW, my wife has PCOS and she often just refers to it as "irregular periods" because that's much easier to understand. That does not mean the same thing as "I'm three days late one month, two days early the next," etc., and just because that is true of most women doesn't mean there can't be much more serious issues at hand. Even if your claim were true about doctors using that as a catch-all excuse, so what? Maybe the doctors in question don't think it ought to be up to people like this "professor" whether or not a woman can get affordable medication for a perfectly legitimate problem.

[Liza]

Originally Posted by Jahungo

Sandra Fluke's testimony can be found here.
While the OP comment is a load of sexist bullcrap, $1,000 a year for birth control is a somewhat misleadingly high number. That doesn't change the fact that the cost of contraception is a burden on many women and some might forgo contraception based on cost, potentially leading to greater costs in the long run (to them, but potentially also to the taxpayer).

I had insurance, and I paid $65 every three weeks for my birth control before I got my iud. That comes to around $1125 every year. Without coverage it would have been $90 a refill, for a whopping $1560 each and every year. The patch does not have a generic form available.

I have been on one form of birth control or another since middle school, most of them on a three week cycle to prevent periods. One non-bc hormonal treatment that was tried was $427 a month. My family had to fight to get that covered, even though one of the warnings on the box was specifically that you could get pregnant while on the medication.

Since particular types and brands of birth control turn me into a sociopath for part of the month, I didn't have the option of going for the cheapest generic. And since I did not want a hysterectomy when I was 20, I did not have the option of forgoing the medication.

Originally Posted by Ryda Wong, EBfCo.

That recommendation is really to be questioned.

The recommendation is that you go to every three years after you have a certain number of (I think 3) clear pap smears. I'm also pretty sure that they still want you to have annual exams. And the vaccine.

Hijack: I was having a conversation with a friend the other night, and I realized that I was channeling you. Fortunately the other person is a snopes person, so they knew what I was talking about when I finished my rant with "and that's what Ryda would say, too!"

[Ryda Wong, EBfCo.]

Originally Posted by Liza

Hijack: I was having a conversation with a friend the other night, and I realized that I was channeling you. Fortunately the other person is a snopes person, so they knew what I was talking about when I finished my rant with "and that's what Ryda would say, too!"

LOLZ! Too funny! I'm a star.

[ULTRAGOTHA]

My doctor prescribed birth control pills for non-birth control reasons (I don't need birth control).

I got a list of all the different medicines with the right hormones from my prescription drug insurance. The prices ranged from $10 per 30 days to $90 per 30 days and that's the copay cost, not what I would pay out of pocket.

We started with the $10 per month pills. The next prescription was $25. I hope I don't end up needing the $90 pills. That would be very hard to afford and I'm employed full time at a decent paying job.

ATNM, there are tons of insurance plans that don't cover hormonal birth control no matter why you're using it. Which burned my britches when most of them covered ED drugs as soon as they hit the market. That's changing under "Obamacare" but if it wasn't for federal regulations it would still be the case.

[Esprise Me]

I originally went on birth control for debilitating cramps that caused me to miss school, although I later came to appreciate their contraceptive function as well. I can't take the pills anymore; they make me throw up. (In addition to being unpleasant and bad for my teeth, this also tends to negate their efficacy. I got knocked up soon after I developed this reaction, before I switched to a transdermal method.) As has been mentioned, there's no generic patch or ring, so I have to spend a little more money, but thankfully not as much as I would if my insurance didn't cover BC at all.

It's really not as simple as a lot of non-uterus-havers seem to think.