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New Insurance Regulations Improve Preventive Care Options for Women

By Fran Berger
Beth Israel Deaconess Medical Center correspondent

Health care for women became more accessible in August when the U.S. government issued regulations calling for insurance plans to eliminate copays for women's preventive health care and birth control.

Seen by many as centering only on contraception, the new regulations go much further and are a major step forward in overall preventive care for women, says Dr. Monica Mendiola, a practicing obstetrician/gynecologist at Beth Israel Deaconess HealthCare-Chelsea.

"These new rules are definitely more than just about contraceptive management," says Dr. Mendiola. "As obstetricians and gynecologists, we are proud to be leaders in this area."

The concept behind preventive care is "to identify a poor health outcome and stop it from occurring, such that the intervention is more cost effective than the treatment."

Effective August 2012, the services that will be covered without copays include an annual well-woman exam, screening for HIV and sexually transmitted infections, HPV screening for the virus linked to cervical cancer, screening for gestational diabetes and domestic violence, breast feeding counseling and equipment, as well as all FDA-approved contraceptives, including sterilization.

"Each item on this list is important," says Dr. Mendiola. "Because many women do not have a primary care physician, the well-woman exam done by their OB/GYN doctor is often the only physical they receive. We regularly screen cholesterol levels and thyroid function, do a pelvic and breast exam, and also ask about behavioral issues, such as the use of seatbelts."

The elimination of copays "will now remove barriers for additional screening and will also serve as a way to educate women about the need to be tested," she adds.

Some of the new regulations will not constitute a significant change since they are already part of most routine exams, according to Dr. Mendiola.

"Testing for gestational diabetes is already being performed. Most pregnant women will eventually have some insulin resistance, or the inability to metabolize glucose. This can lead to an unhealthy pregnancy, and screening for gestational diabetes can again prevent poor outcomes." But, she adds, "Supporting this screening will educate women about key measures to better ensure the health of both baby and mom."

When it comes to screening for sexually transmitted infections, most women assume they are being checked during their well-woman exams, says Dr. Mendiola.

"Although they may get a Pap smear and a manual exam, that doesn't mean they are being tested for gonorrhea and chlamydia or other sexually transmitted infections," she says. "This gives us an opportunity to discuss the issue with our patients and if both the doctor and patient agree there are risks, we can perform the tests without out-of-pocket expenses."

The same is true of testing for HIV, the virus that causes AIDS. In the past, only those who were considered at high risk were tested.

"Now we realize that many more may be at risk - for example, healthcare workers or anyone who has had unprotected sex or is in a relationship with someone who has had unprotected sex," Dr. Mendiola says.

The reality is, "today we have medication that can prevent people from progressing to AIDS. If we can identify a problem early, we can take preventive measures and specifically keep women with HIV from transmitting the virus to their unborn child," she adds. "Whereas it used to be taboo to discuss, these measures will help us move the conversation forward so patients will opt to be tested."

Another important aspect is controlling the cost for breast-feeding equipment and counseling. Breast pumps can cost up to $40 to $50 a month to rent or between $600 and $800 to buy.

"Breast milk is often considered the healthiest nutrition for an infant, but not all women can produce milk right away," explains Dr. Mendiola. "This coverage will have a major impact on women bonding with the baby, their ability to continue breast feeding and returning to work, and giving infants a healthy start."

Also covered with the new regulations is domestic abuse counseling.

"Talking about abuse has always been part of obstetrics," says Dr. Mendiola. "There is a higher incidence of abuse when women are pregnant because the introduction of the concept of a baby may be perceived as a threat in some relationships."

Often a woman will confide in her doctor if asked, she adds.

"If we learn [of] or suspect abuse, we will give women information they need to be safe, such as hotline numbers as well as counseling on what to do when in imminent danger."

Each of these aspects of the new regulations, including contraception management, points to the larger issue of preventive care, says Dr. Mendiola.

"For some women, getting pregnant can be just as deadly as not taking their high blood pressure medication," she says.

In addition to family planning, birth control medications are used to treat anemia, painful periods, and have been shown to reduce the incidence of ovarian and uterine cancer, she adds.

The benefit of eliminating copays for birth control is also welcomed.

"We have women who are making decisions on what medication to take based on costs," Dr. Mendiola explains. "If it's a choice between medication for their heart or their birth control, they will opt for the heart medicine."

There was and continues to be some opposition to these new regulations, which prompted additional wording to allow exemptions for religious institutions that oppose birth control.

There was also concern as the rules were developed on how the costs will be covered. Dr. Mendiola cites the Pap smear as one of the best examples of preventive care in the recent century, which allows cells to be caught at a pre-cancerous stage. The cost of removing those cells is significantly less than treating full cervical cancer, saving money in the long run.

"This is the era of preventive medicine," says Dr. Mendiola. "By eliminating these financial barriers we are taking an important step forward."

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

Posted September 2011

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Beth Israel Deaconess HealthCare-Chelsea
1000 Broadway
Chelsea, MA 02150
617-975-6000
617-975-6010

Contact Information

Department of Obstetrics and Gynecology
Beth Israel Deaconess Medical Center
East Campus
330 Brookline Avenue
Boston, MA 02215
617-667-0475

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