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My insurance said I need to "try and fail" other methods first and/or they don't seem to have a waiver/exceptions process.

It should be easy to get birth control and other important women’s health needs at no cost to you. But sometimes it’s not so easy. If you’re still paying out-of-pocket for your lactation consultation 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.

Instructions for Sending An Appeal Letter: If your insurance said you need to "try and fail" other methods first and/or they don't seem to have a waiver/exceptions process.

  • Find out where to send your letter: Call your plan, or if you have an appeal form, the address will be on it.
  • 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.
  • 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.
    • A copy of this FAQ from the Department of Labor
    • 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 preventative services.
  • 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 us at 1-866-745-5487 or [email protected] for free help.

Document(s): 

CoverHer - The health care you need. The coverage you deserve. CoverHer.org Cover Her - Need our help? Contact our free hotline.

 

 

 

Cover Her - Call us at 1-866-745-5487. Cover Her - Email us at CoverHer@nwlc.org