I WAS TOLD MY HEALTH PLAN ONLY COVERS GENERIC BIRTH CONTROL AT NO COST TO ME, BUT I DON’T USE A GENERIC

It should be easy to get birth control and other important women’s health needs, like breastfeeding supplies and well-women visits, at no cost to you. But sometimes it’s not so easy. If you’re still paying out-of-pocket for your birth control and other health care, use our information below to start getting help.

Step 1: Find out if the health care law has kicked in for your health insurance plan.

Step 2: Still not sure? Here’s how to ask your health insurance company.

Step 3: Use the instructions and template letter below to appeal to your health insurance company if they are incorrectly charging you out-of-pocket costs when they shouldn’t.

• Find out where to send your letter: Call your plan, or if you have an appeal form, the address will be on this.
• Fill out the letter (templates are below): Replace all of the words in capital letters with your information. For example, replace “YOUR NAME” with your full name, and “POLICY NUMBER” with your plan policy number. For the paragraph under this heading “[ADD THIS PARAGRAPH  IF YOUR METHOD HAS NO GENERIC EQUIVALENT]”:
  • Keep it if your birth control does not have a generic version. Ask your medical provider or pharmacist to find out if your brand has a generic version.
  • Delete it if your birth control has a generic version
• Send copies of these documents with your letter:
  • Records of any money you’ve paid for your birth control, such as receipts from the pharmacy.
  • The FDA’s “Birth Control Guide.”
  • A copy of this “Frequently Asked Questions” document.
• After you send your letter to your health plan:
  • Make a copy of your letter and keep it in your files.
  • Share your letter and appeal form (if your plan is through your job).
    • You can send a copy to your plan’s “Plan Administrator.” Look at the information you received when you got your plan (this could be called your “Evidence of Coverage” or “Certificate of Coverage” or if you get your insurance through your work, “Summary Plan Description”) to find where to send this.
    • You can give a copy to your Human Resources department or contact.
  • Keep copies of receipts or other records that show what you pay for your birth control.
• Please let us know if your health plan responds—we are tracking decisions so we can advocate with both health insurance and government officials.

If you have any questions, contact our us 1-866-745-5487 or [email protected] for free help.

Document(s): 

• Sample Letter (Generics) – .docx
• Sample Letter (Generics) – .pdf