Commentary Contraception

Who Decides? Delays and Barriers to Accessing Birth Control at Georgetown University

Sandra Fluke

Although Georgetown’s student health insurance doesn’t cover contraception, it does cover birth control pills when they’re prescribed for medical reasons other than preventing pregnancy. But barriers to access illustrate the consequences for women’s health when university administrators dictate which reasons for a birth control prescription are the “right” reasons.

Cross-posted with permission from the Repossess Reproductive Justice blog in partnership with #HERvotes.

See all our coverage of the 2012 Contraceptive Mandate here.

As you may have recently read in the New York Times, although Georgetown’s student health insurance doesn’t cover contraception, it does ostensibly cover birth control pills when they’re prescribed for medical reasons other than preventing pregnancy (e.g. severe acne, mood disorders, and so forth). This is called the “over-ride” process because it over-rides the usual ban on contraceptive coverage. Unfortunately, this over-ride process is terribly flawed and fails many women at Georgetown. The problems with this process illustrate the consequences for women’s health when university administrators dictate which reasons for a birth control prescription are the “right” reasons.

Because of an obsession with preventing students from fraudulently using the over-ride to get contraception coverage for the “wrong” reason (preventing pregnancy), students who attempt to use the over-ride process are sometimes subjected to questioning and accusations that they are lying about their qualifying medical needs. This is followed with long delays and bureaucratic barriers that don’t exist for any other prescription covered by Georgetown’s insurance. The Times profiled how Georgetown’s policy resulted in a medical tragedy for one woman. In response a Georgetown spokeswoman said that:

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problems like this were rare and that doctors at the health service knew how to help students get coverage for contraceptives needed for medical reasons.

If only that were true! Georgetown Law Students for Reproductive Justice actually surveyed students at the law school about this. For some students, the over-ride process works adequately, but 65 percent of students attempting to utilize the over-ride process reported being subjected to extensive questioning, inordinate clerical issues, extensive delays, or other complications because of disbelief from doctors and insurance administrators. Twenty percent either never received their medication or were never reimbursed by the insurance company. Here are the experiences of just a few students:

“I was without birth control for many months because of problems with the over-ride. I spoke with people at [the student health] clinic, the Georgetown main insurance office, the insurance company, the drug insurance company, and a pharmacy. I was put on hold multiple times and had to call some of these people multiple times. After investing at least ten hours in the process, I gave up. . . .”

“Simply because I am sexually active, the doctor assumed I was lying even though I have medical needs. I struggled with getting an over-ride because the doctor was hesitant even though I reported severe pain and mood changes that affect my functioning as a student. . . .”

“[M]y OB/GYN suspects that I have endometriosis and I took a specific pill to help control it. Endometriosis cannot be definitively diagnosed without surgery, and obtaining a waiver was stressful and time consuming. It unnecessarily distracted me from my classes. . . .”

“I have found the health care coverage ban on birth control embarrassing and potentially harmful. When scheduling a yearly gynecological exam, I was subject to a line of hostile questioning twice: once by the person scheduling the exam and once by the doctor performing the exam. The questions included queries about my sexual history, which seems appropriate for the doctor to ask about, but not the scheduler. A yearly gynecological exam is a recommended procedure and may not even be tied to a birth control prescription. Georgetown’s refusal to cover birth control creates a potential burden on a woman getting this exam at all. . . .”

Tragically, Georgetown’s policy has also created rampant misinformation regarding student insurance coverage of women’s reproductive healthcare generally, leading to some students foregoing essential medical care:

“[I] was intimidated by the [‘override’] process and thus I did forego OBGYN care for over a year. More importantly, the reputation that Georgetown has as being . . . unsupportive of women’s reproductive health prevented me from seeking out STD testing after I was sexually assaulted. (I assumed [Georgetown] would not cover my HIV/STD testing because when I was tested last year at my provider’s office . . . as part of a regular/routine exam, I paid $500 due to lack of coverage. It was not until several months after I was assaulted that I found out . . . that [Georgetown] would cover such tests. In general, there is a problematic lack of info about women’s health coverage on campus. I did not even know I could get an OBGYN exam at the law center until a friend told me my 2L year. While I support Georgetown’s Jesuit identity and am a person of faith myself, I find our school’s policy to be . . . harmful to students. . . .”

I’d say “harmful to students” is putting it lightly. That’s why we’re so thankful that the new Affordable Care Act regulations will protect vulnerable students and end these types of dangerous insurance policies!

For more information about hurdling institutional barriers to birth control, see: How to Host a Birth Control Clinic in 3 Easy Steps by Emily T. Wolf, Vice President of Fordham Law Students for Reproductive Choice.

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