RRP successfully challenged an insurance company's refusal to cover an emergency room visit to obtain emergency contraception (EC) over a holiday weekend. This marks an important achievement in RRP's larger fight to increase access to EC.
RRP represented a college student who was denied insurance coverage for an emergency room (ER) trip for EC after a condom broke during the 2005 Thanksgiving holiday. The student had to go the ER because all provider offices were closed for the holiday. After two days of trying to get a prescription, she went to the ER because she knew that EC is most effective if taken as soon as possible after intercourse. Her insurer, however, denied the $800 ER bill. When she appealed this denial, the insurer claimed the situation was not an "emergency" and she was not covered for this "preventative" care visit.
RRP appealed in an extensive letter outlining the legal errors under the plain language of the insurance policy and New York State laws defining "emergencies" and setting forth the appeals process under the New York State Managed Care Patients' Bill of Rights. In essence, RRP argued that under the circumstances, the need for emergency contraception is indeed an emergency. When clinics and doctors' offices are closed, it is unreasonable to expect women to wait and increase the risk of an unwanted pregnancy. The insurance company responded to RRP's letter, agreeing that the ER visit was covered under the terms of the health insurance plan, and that the initial denial of coverage would be reversed.
This victory clarifies that EC should qualify as emergency treatment in certain contexts. It also highlights the need to make EC available over the counter. Unprotected sex frequently occurs over weekends or holidays, when most clinics and doctors' offices are closed. Until EC is available over the counter, women should ask their doctor or gynecologist for an advance prescription for emergency contraception, so they have access to it before the need arises.