DSC Health & Wellness Committee member Jennifer Prince goes above and beyond to wring the answer out of our healthcare providers…

After writing this H&W blog entry back in September, 2012, I knew that our NYSHIP plan was renewed as of January 1, 2013, and finally we could expect our free birth control… Right?

I expectantly walked into my local pharmacy this month to refill my birth control prescription, hoping that now, after all this time, I’d finally see a $0.00 price tag when the order was filled. Nope. I paid with my credit card and came home to investigate which contraceptives were now free. After all, I promised I would update this blog with the information once the new plan rolled over, since the prescription pricing list for 2013 was not available when I originally did research on the subject a few months ago.

Answers on the NYSHIP website? Uh, no

First, I checked the new NYSHIP Summary of Benefits that I’d received in the mail. Our premiums have gone up, so we should expect more services, shouldn’t we? Neither the Summary nor the Flexible Formulary made mention of the Affordable Care Act (ACA) and the change in benefits mandated by that law.

So, I returned to the suggestion of one of the United Healthcare workers who took my frustrated phone call a few months back: I logged on to empireplanrxprogram.com and again painstakingly entered the 10 different contraception choices one at a time into the “Price a medication” feature on that website.

I bet you can guess where this is going… Not a single prescription was free, neither the 30-day, commercial pharmacy supply, nor the 90-day, mail-order pharmacy supply.

Here is where we need to stop and reflect on the absurdity of this situation. Women have been told for months and months that free birth control and other well-woman services were on their way. When that didn’t happen for us back in August, I investigated and was led to believe we would have to wait until January.  Now, as it turns out, all of the information that I was told in September was just flat-out wrong.  And NYSHIP has been less than transparent in this process—neither explaining what benefits we should have under the ACA nor why we wouldn’t be getting them.

So what’s really going on? Where is the information?

Further down the rabbit hole

Trying to get to the source, I first called NYSHIP Benefits Services who connected me to MedCo because my specific question was about prescriptions. After getting through all the automated prompts, I finally spoke with a MedCo representative. She continually cut me off, not letting me completely explain what information I was after. She insisted that I shouldn’t be concerned about prices and should just accept whatever my doctor prescribes even though she seemed to maintain that some contraceptives should be free.

But when I explained again that, even if my doctor would prescribe or recommend another form of birth control the pricing feature on the website indicated that there were no free options, she then admitted that she had no clue as to why none of the contraceptives were completely covered by the insurance.  So she transferred me to a representative at United Health Care…

To be clear, MedCo and United Healthcare are completely separate entities contracted by the State of New York to provide different services in the NYSHIP plan. While my question was specifically a prescription issue, which is MedCo’s domain, I was being transferred to speak with someone from the company that covers medical services: doctors’ office visits, lab tests, etc.

An answer, at last

At least the UHC representative with whom I spoke had some answers, even if the answers were frustrating. He told me that the MedCo staff should in fact have the information he was about to give me and that he shouldn’t be the one having to give me prescription information—but, since he knew the answers to my questions, he had accepted the call transfer.

Basically, the answers are these: NYSHIP–SEHP (New York State Health Insurance Plan–Student Employee Health Plan) is an insurance plan that has been grandfathered in to the new law. The State of New York has made a decision to not cover the ACA’s well-woman benefits. The representative insisted that either our employer, Empire Health Plan (the over-arching administrator of all the various health service providers for NYSHIP), or the NYS Civil Service should be providing the information I was searching for and could not tell me if or when our plan would be including those benefits. The law allows for this grandfathering-in process, so that certain employers can choose to not comply with these provisions of the ACA.

Why are we grandfathered in, according to this representative’s speculation? Because we are a student plan, and those, traditionally, are more limited in benefits.