Nearly 9,000 Vermonters will be reimbursed for wrongly billed contraceptive services dating back to 2017, Vermont’s Department of Financial Regulation announced Thursday.
Under the Affordable Care Act and Vermont state law, Vermonters are entitled, with rare exception, to contraceptive services without bearing any costs. Covered contraceptives include birth control pills, intrauterine devices, voluntary sterilization and more.
But in an audit conducted over nearly two years, Vermont’s Department of Financial Regulation found more than 14,000 instances affecting 9,000 Vermonters who faced improper out-of-pocket costs for their contraceptive services.
The department said its audit showed that the state’s top three health insurance carriers — Blue Cross Blue Shield of Vermont, MVP Health Care and Cigna Healthcare — “wrongfully shifted in excess of $1.5 million in contraceptive care costs to Vermont consumers.”
Eligible Vermonters will receive checks “within the coming weeks” with their reimbursed contraceptive costs, plus interest, as a result of the department’s audit, the department announced in a press release on Thursday.
The state began receiving complaints of wrongful contraceptive medical bills in 2021, prompting a review dating back to 2017. According to the department’s press release, none of Vermont’s three major insurance carriers were fully compliant with state and federal laws governing contraceptive service cost-sharing during that time, but the department “found no intent on behalf of any carrier to violate the mandate.”
The department’s director of market conduct, Karla Nuissl, said the improper bills “were generally the result of incorrect coding, differing interpretations of the mandate, and system limitations.”
The department also said that all three carriers were responsive to the department’s investigation, providing more than 250,000 medical claims for auditors to review, and were “agreeable to working toward solutions with the team.”
“Ensuring that Vermonters have affordable access to family planning services is a top priority for the Department and we plan to continue our efforts to provide education and outreach to policyholders,” Commissioner of Financial Regulation Kevin Gaffney said in Thursday’s press release.
Policyholders who wrongly paid out-of-pocket for covered services should automatically receive a check from their insurer by the end of the year, the department said. They should contact their insurers if they have questions about the status of their reimbursements.
In a statement, MVP spokesperson Ashley Breen-Verga said the insurer’s “unwavering commitment is to provide our valued customers with vital access to no-cost contraceptive services.” She added, “We apologize for any inconvenience caused and remain committed to addressing this matter promptly.”
In a written statement provided to and published by the Department of Financial Regulation, Blue Cross Blue Shield of Vermont said they “are working to ensure that every member who paid a co-payment for these services since 2017 is reimbursed. We collaborated with DFR to proactively identify the individuals who are owed a refund.”
Also in a statement provided to the department, Cigna said the carrier is “proud to cover contraceptive care with no cost share for our Vermont customers,” and that they “appreciate the collaborative approach by the Department of Financial Regulation to ensure that all who were charged a cost-share in error for contraceptive coverage are paid back.”
