Ashley and Kyle were newly married in early 2022 and were excited to welcome their first child. However, Ashley suffered from bleeding from the start of her pregnancy and in July, at seven weeks, she suffered a miscarriage.
The couple's grief got here weeks after the U.S. Supreme Court struck down federal abortion rights in Wisconsin, their home state, after reinstating an 1849 law that allowed abortions only when the pregnant woman was near death.
Abortion insurance is a mixed bag within the United States. Patients often don't know if and when a procedure or abortion pill might be covered, and the proliferation of abortion bans has added to the confusion. Ashley says she's caught up within the tangle of uncertainties.
Ashley's life was not at risk throughout the miscarriage, however the state's abortion ban meant that even during a miscarriage, doctors in Wisconsin couldn’t perform a D&E (dilation and evacuation) until the embryo died. She went backwards and forwards from hospital to hospital, bleeding and on sick leave, until doctors could confirm the pregnancy had ended. Only then did doctors remove the pregnancy tissue.
“My first pregnancy was the first time I realized that something like this could affect me,” said Ashley, who asked to be identified only by her middle name and her husband by his first name. She works in a government agency with conservative colleagues and fears retaliation if she talks about her abortion care.
A 12 months later – the 1849 abortion ban was still in force in Wisconsin – Ashley was pregnant again.
“Everything was perfect. I started feeling kicks and movements,” she said. “It was the day I turned 20 weeks, a Monday. I went to work and then picked Kyle up from work. When I got up from the driver's seat, there was fluid on the seat.”
The amniotic sac had ruptured, a condition called previable PPROM. The couple headed straight to obstetric triage at UnityPoint Health-Meriter Hospital, the most important maternity hospital in Wisconsin. The fetus was deemed too underdeveloped to survive, and the ruptured membranes posed a serious risk of infection.
Gynecologists from across the state of Wisconsin had decided that “in cases of pre-existing PPROM, every patient should be offered an abortion because there is a significant risk of ascending infection and possible sepsis and death,” said Eliza Bennett, the gynecologist who treated Ashley.
Ashley needed an abortion to avoid wasting her life.
The couple called his parents; Ashley's mother got here to the hospital to comfort her. Because of Wisconsin's 1849 abortion ban, Bennett, an associate clinical professor on the University of Wisconsin School of Medicine, needed two other doctors to verify that Ashley was facing death.
But despite a wealth of medical documentation, Ashley's medical insurance, the Federal Employees Health Benefits Program, didn’t cover the fee of the abortion. Months later, Ashley logged into her medical billing portal and was surprised to search out that while the insurance had paid for her three-day hospital stay, it had not paid for the abortion.
“Every time I called the insurance company about my bill, I cried on the phone because it was so frustrating having to explain the situation and why I think it should be covered,” she said. “I feel like it's my fault and I should be ashamed of it,” Ashley said.
Eventually, Ashley spoke to a lady within the hospital's billing department, who passed on the insurance company's statement to her.
“She told me,” Ashley said, “quote: 'FEP Blue does not cover abortion costs. Period. It doesn't matter what it is. We do not cover abortion costs.'”
The University of Wisconsin Health, which manages billing for the UnityPoint Health-Meriter hospital, confirmed this exchange.
The Federal Employees Health Benefits Program has contracts with FEP Blueor the BlueCross BlueShield Federal Employee Program to supply medical insurance plans for federal employees. In response to an interview request, FEP Blue emailed an announcement saying it was “committed to complying with federal law that prohibits federal employee health insurance plans from covering procedures, services, drugs and supplies related to abortion, except when the life of the mother would be in danger if the fetus were carried to term, or when the pregnancy is the result of rape or incest.”
These restrictions, generally known as the Hyde Amendment, have been passed by Congress yearly since 1976 and forestall abortion services from receiving federal funding.
In Ashley's case, doctors said her life was at risk and her bill must have been paid immediately, said Alina Salganicoff, director of ladies's health policy at KFF, a nonprofit health information organization that features KFF Health News.
What tripped up Ashley's bill was the word “abortion” and a billing code that’s kryptonite to insurance, Salganicoff says.
“Right now we're in a situation where there's really a heightened sensitivity about what is a life-threatening emergency and when it's a life-threatening emergency,” Salganicoff said. The same chilling effect that keeps doctors and hospitals from offering legal abortion care could also affect insurance coverage, she said.
In Wisconsin, Bennett said, underprovision of abortion services is widespread.
“Many of the patients I see who have a pregnancy complication or, more commonly, a severe fetal abnormality, are uninsured,” Bennett said.
Recently, the $1,700 bill disappeared from Ashley's online billing portal. The hospital confirmed that the insurer paid the claim eight months later after several appeals. When contacted again on August 7, FEP Blue responded that it will not “comment on the specifics of individual members' medical care.”
Ashley said battling together with her insurance company and experiencing the impact of abortion restrictions on her health care — just like other women across the country — gave her courage.
“I'm here with all these people now,” she said. “I feel much more connected to them, which wasn't the case before.”
Ashley is pregnant again, and he or she and her husband are hoping that this time her insurance will cover the medical care her doctor deems crucial.
image credit : www.mercurynews.com