Reproductive healthcare denials among a privately insured population

Abstract

This study aimed to quantify and examine reproductive healthcare denials experienced by individuals receiving employer-sponsored health insurance. We conducted a national cross-sectional survey using probability and non-probability-based panels from December 2019-January 2020. Eligible respondents were adults employed by any Standard and Poor’s 500 company, who received employer-sponsored health insurance. Respondents (n = 1,001) reported whether anyone on their healthcare plan had been denied a reproductive healthcare service in the past five years and details about their denials. We conducted bivariate analyses and multiple logistic regression to estimate factors associated with denials. Eleven percent of respondents (14% of women; 10% of men) reported a denial. Compared to lower-income respondents, those with income ≥ $50,000/year were less likely to experience a denial (aOR = 0.53; 95% CI 0.29–0.97). Compared to respondents who were never married, being married (aOR = 2.33; 95% CI: 1.03–5.30) or cohabiting (aOR = 2.43; 95% CI: 1.03–5.72) significantly increased odds of experiencing a denial. In 38% of cases the patient learned of the denial at a scheduled visit, while 23% learned in an emergency setting, and 13% after the encounter. Individuals covered by employer-sponsored health insurance continue to be denied coverage of preventive services. Employers and insurers can facilitate access to reproductive healthcare by ensuring that their plans include comprehensive coverage and in-network providers offer comprehensive services.

Randomized experimental testing of new survey approaches to improve abortion reporting in the United States

“…A similar approach has been used in other studies. 37,57 We then compared the 2021 GSRHE weighted lifetime estimate to lifetime reports in the 2015-2019 NSFG face-to-face interview.…”

“…Their TrueNorth calibration approach uses small area estimation methods to adjust the weights for the non‐probability sample to bring the weighted distributions in line with the population distribution of characteristics correlated with the survey variables. A similar approach has been used in other studies 37,57 …”

Beyond Hobby Lobby: Employer's responsibilities and opportunities to improve network access to reproductive healthcare for employees

“…However, as previous research has demonstrated, patients seeking care at religiously affiliated health centers are often unaware of religious restrictions or are uncomfortable complaining to their employers about sensitive topics [ 12 , 14 , 20 ]. We know that denials due to religious restrictions occur, based on reports from providers as well as survey findings showing employees experience care denials at religious facilities [ 13 , 15 , 17 ]. Employees may be hesitant to address reproductive health issues with their employer, especially if the desired service is private or carries greater stigma, such as contraception or abortion care [21] .…”

“…Or perhaps the employee was eventually able to receive the care due to workarounds used by providers [ 15 , 22 ]. It may also be that employees believe there is little the employer could or would do to address the situation, even if the employer was informed [13] .…”

“…Interviewees described each of these roles as follows: benefits managers oversee insurance and other employee benefits, consultants advise companies on employee benefits, and brokers can serve as third parties who help companies assemble and purchase insurance products to offer employees. Findings from these interviews also informed the development of a nationally representative, cross-sectional survey of employees at Standard and Poor's (S&P) 500 companies who receive health insurance through their employer [ 13 , 18 ]. We conducted interviews between January and May 2019 by trained researchers and recorded for transcription, allowing for qualitative data analysis of thematic content [19] .…”