Regence BlueShield must repay $148,000 to 1,000 women over IUDs

One woman's persistence paid off big time: She and nearly a thousand others will share $148,000 in back payments after being illegally denied coverage by Regence BlueShield for prescription birth-control services over an eight-year period.

The woman, from Seattle, was the only one of 984 women denied coverage who contacted the state insurance commissioner's office, which took action on the basis of a statewide rule that took effect in 2002.

That rule says that any insurance plan that provides general, comprehensive coverage of prescription drugs and devices must also cover Food and Drug Administration-approved contraceptives and contraceptive devices, including dispensing, administration and removal, to the same extent it covers other outpatient services.

The contraceptives in question were IUDs — intrauterine devices — and the women were requesting coverage for removal of the devices.

For more than eight years, Regence denied payment under a variety of codes, including "Condition not covered by this contract" and "Medical necessity for this service or supply has not been established," according to Stephanie Marquis, spokeswoman for the insurance commissioner, on her blog, http://wainsurance.blogspot.com.

Regence had maintained that removal of an IUD was not medically necessary, Marquis said, but after her office sent the insurer a copy of the regulation, "they sent a letter saying it was a covered benefit."

Regence spokeswoman Rachelle Cunningham said on Monday that the complaint alerted the company that it had been incorrectly processing claims for this procedure.

"While the company has always covered birth control as part of its standard benefits, it had mistakenly coded the removal of these particular devices, which resulted in denied claims," she said. "Regence immediately reprocessed affected claims and changed its policies to ensure compliance" with guidelines of the insurance commissioner's office.

Cunningham said the error affected fewer than one-tenth of 1 percent of those insured by Regence in Washington.

Three of the women denied coverage appealed to the insurer, which upheld the denials. They apparently did not ask Regence for an independent third-party review, a process established by the state's Patients' Bill of Rights.

Marquis said the case highlights a need for consumers to pursue answers if they don't understand or agree with coverage denials or decisions. Ask the insurer for more information, Marquis advised, appeal the decision, seek third-party review (www.insurance.wa.gov/consumers/health/billofrightsQA.shtml) or contact the Office of the Insurance Commissioner at 800-562-6900 or askmike@oic.wa.gov.

Carol M. Ostrom: 206-464-2249 or costrom@seattletimes.com