Ashley and Kyle were newlyweds in early 2022, excited to be expecting their first child. Ashley had been bleeding since the beginning of her pregnancy, and in July, at seven weeks, she began miscarrying.
The couple’s grief occurred a few weeks after the United States Supreme Court removed the federal right to abortion. In Wisconsin, their home state, an 1849 statute had been reinstated, prohibiting abortion except in cases when a pregnant woman faced death.
The insurance coverage for abortion care in the United States is patchwork. Patients frequently don’t know when or whether a procedure or abortion pills are covered, and the spread of abortion laws has aggravated the situation. Ashley admitted to becoming caught up in the web of uncertainties
A protracted process
Ashley’s life was not in danger during the miscarriage, but Wisconsin’s abortion law prevented doctors from performing a D&E — dilation and evacuation — until the embryo died. She drove back and forth to the hospital, bleeding and taking sick leave from work, until physicians confirmed the pregnancy was over. Only then did the physicians remove the pregnant tissue.
“The first pregnancy was the first time I realized that something like that could affect me,” said Ashley, who preferred to be known by her middle name and her husband’s first name alone. She works in a government organization with conservative coworkers and is afraid of being punished for discussing her abortion treatment.
Ashley became pregnant again a year later, while Wisconsin’s 1849 abortion prohibition remained in effect.
“Everything was perfect.” “I started to feel kicking and movement,” she explained. “I turned 20 weeks on a Monday. I drove to work, then picked up Kyle from work, and when I got up from the driver’s seat, there was fluid on the seat.”
Ashley needed to have an abortion to save her life
Documented dangers
The couple called their parents, and Ashley’s mother came at the hospital to soothe them. Bennett, an associate clinical professor at the University of Wisconsin School of Medicine, needed two more physicians to certify Ashley’s imminent death under Wisconsin’s 1849 abortion law.
Despite having an armory of medical paperwork, Ashley’s health insurer, the Federal Employees Health Benefits Program, did not cover the abortion operation. Ashley entered into her medical billing portal months later and was astonished to see that the insurer had covered her three-night hospital stay but 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 told me. “It’s making me feel like it was my fault, and I should be ashamed of it.”
Ashley eventually spoke with a woman in the hospital billing department, who conveyed what the insurance company had indicated.
“She told me,” Ashley recounted, “quote: ‘FEP Blue does not cover abortions at all. Period. No matter what it is. “We do not cover abortions
The Hyde Amendment
The University of Wisconsin Health, which handles billing for UnityPoint Health-Meriter Hospital, acknowledged the exchange.
The Federal Employees Health Benefits Program works with FEP Blue, or the BlueCross BlueShield Federal Employee Program, to provide health insurance to federal employees.
Following a request for an interview, FEP Blue sent a statement indicating that 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.”
These limits, known as the Hyde Amendment, have been voted by Congress every year since 1976 and ban government monies from paying abortion services. However, the Hyde Amendment makes exceptions for rape, incest, and maternal life, according to the health insurer in answer to questions from KFF Health News and NP
Insurance kryptonite
In Ashley’s instance, doctors claimed her life was in danger, and her bill should have been paid right away, according to Alina Salganicoff, director of Women’s Health Policy at KFF, a health information charity that includes KFF Health News.
Salganicoff explained that Ashley’s bill was tripped up by the word “abortion” and a billing number that is insurance kryptonite.
“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 told the media.
The same chilling effect that has deterred doctors and hospitals from offering legal abortion care, she believes, may also be hurting insurance coverage.
According to Bennett, there is a widespread shortage of abortion coverage in Wisconsin.
“Many patients I take care of who have a pregnancy complication or, more commonly, a severe fetal anomaly don’t have any coverage,” Bennett told reporters
Settled and looking forward
Ashley’s $1,700 bill recently disappeared from her online bill site. The hospital acknowledged that eight months later, after numerous appeals, the insurer reimbursed the claim. When approached again on August 7, FEP Blue stated that it would “not comment on the specifics of the health care received by individual members.”
Ashley added that dealing with her insurance company and seeing the impact of abortion restrictions on her health care, like other women throughout the country, has emboldened her.
“I’m in this now with all these people,” she told me. “I feel a lot more connected to them, in a way that I didn’t as much before.”
Ashley is pregnant again, and she and her husband are hoping that this time their insurance will cover any medical care her doctor says she requires.
KFF Health News is a national newsroom that delivers in-depth journalism on health topics. It is one of KFF’s primary operating programs.
