On Getting and Using Contraceptive Insurance at Notre Dame

When I started off at Notre Dame, I already knew that getting contraceptive health care would be complex. The university was in the middle of a court battle, University of Notre Dame v. Sebelius.1 The government had already reached a compromise with the school—the school didn’t actually have to cover contraceptive insurance for its employees. Instead, it had to say that it wouldn’t, and then the employees would get their care funded through the government. Even this was too great a burden, it seemed. Of course, when one saw pictures in the news it was never the men in charge of this enormous enterprise and 11.8-billion dollar endowment. It would be nuns from a much smaller related case—to my cynical eye, a proxy deflection. Powerful men or humble women?2

I’ll note that the university’s president Fr. Jenkins earned $1,006,249 in 2015.3 It’s an institution run by organized religion. But it is also a prosperous educational and sports institution with a lot of money in play.

11.8 billion dollar endowment. Million dollar salary. Educational institution. I remain skeptical it merits the considerations a church might.

Taking Precautions

During the benefits portion of my orientation, I realized it was going to be on me to ask the question. “I know birth control is complicated here and… I don’t see anything about that in the health insurance papers. How do I go about ensuring I have coverage?”

The HR person doing our orientation told me that I would have to call our insurance company. She couldn’t walk me through that. Ok. Fair enough.

So I called them, “Yes hi, I just started working at Notre Dame. I need coverage for birth control.”

“Ok, lemme get your info … yeah, we’ll mail you two separate cards.”

“Two?”

“The one is for talking to your doctor and the other is for $0-copay prescriptions.”

“So I’ll have my health insurance card, the contraceptive visit card, my prescription card, and my contraceptive prescription card?”

It was about to get very busy in my purse.

Pink Like the Inside of Your…

An insurance card with the provider, Meritain Health, at the top and two segments with the plan information in the left one and the right a short statement saying that only the employee was covered. The card is bright pink around the edges and in the middle, with an all-caps Contraceptive Medical Services Only

“They… gave you a pink card?”

“Yep.”

“They gave you a … pink card.”

“Yep.”

“Wow.”

“Yep.”

Ins and Outs of my IUD

Let’s pause for a high-level overview of how I use contraception. Nobody owes you their business, but it’s important to my story. I’ve used a few forms over the years, but am currently an IUD user, Mirena. I got my first IUD just after the ACA went into effect. I’d had some issues for which my doctor thought the IUD would be a better solution than what I had been doing.

It was a great choice for me, dramatically reducing the side effects of my delibitating periods. When I’d arrived at Notre Dame, it was a little under 2 years out from needing to replace it. It’s one reason I hadn’t felt a rush in the contraceptive coverage (although I got it right away) and a reason I felt generally ok working at Notre Dame. The extra hoops around birth control shouldn’t affect me much. Plus, when I’d gotten this first IUD, I’d been lower-income (for DC) and using a Catholic neighborhood clinic. The resident had made the recommendation and referred me to a non-Catholic local group without any complications.

Putting the Card in Play

As ACA protections became a big part of the 2016 campaign season, I decided that I would schedule an IUD replacement before the inauguration. So, in August 2016, I asked my doctor how I could go about replacing my IUD in this town. My practice was under one of the many Catholic health care systems and I knew I’d have to go elsewhere.

My doctor’s assistant said that she couldn’t do a referral, but she gave me a list of three gynecologists to try. I scheduled a consultation, got a regular pelvic exam, had the gynecologist agree this seemed smooth, and was told they’d get back to me. After we hit mid-October without a scheduling call (I’d heard my Pap was fine, yay for that), I called them to see what was up. It turned out that while they could do it for me, all that my bright pink card and accompanying prescription card would pay for was an archaic use case in which they already had IUDs in-stock at the office. Offices had apparently stopped doing this after the early run on Mirena was over.

“So, you have to order the IUD and my insurance won’t pay for that?”

“Exactly.”

“But it would pay if you just had the IUD at the office already?”

“Essentially.”

“Ok, can I front you the money to order it” wince “and then you can bill the insurance and I get reimbursed? Can I get reimbursed by the insurance if I pay up front?”

“I’m afraid not.”

“Do you know anyone who does it the other way?”

“Sorry, no.”

Pink Cards at Planned Parenthood

After calling my insurance company and getting the phrasing of exactly how I’d need it billed, I started calling around town. First, the other two names on the list my doctor’s assistant had given me. Then elsewhere. “I’m sorry, no.” “Nobody does it that way any more.”

It was starting to look like I would have to pay for it out of pocket. It was feasible, if not easy, but it also seemed absurd. Here I was, having just re-entered the middle class. I was faculty, for crying out loud. I had the best insurance I’d had since I was a teenager on my father’s plan. I was a librarian, a profession which requires you to be good at finding information. And yet it seemed like I couldn’t get the care I needed without paying for at least the IUD, around $900.

At this point, I remembered Planned Parenthood. It flashed to me from the last time I was desperate to find reproductive care. In those days, I was new to DC and had finally gotten insurance, and needed to get an overdue pelvic exam and birth control prescription—somewhere and soon? So, while I tried to find a primary care physician, I’d stopped in the Planned Parenthood near my metro station and made an appointment. Worth a try.

It turned out that, yes, the Planned Parenthood in Elkhart kept IUDs in stock and the nurse practitioner could do the removal/insertion. I got an appointment for the first week of December and breathed a sigh of relief.

Stuck for $5$2000?

When I got to Planned Parenthood, they ended up copying all my cards. My pink card raised some eyebrows. Nothing about my appointment is notable, except that the nurse practitioner did a quick finger-stick beforehand to test my anemia levels. I left a thank-you note because I was grateful that they provided a space where I could get the care I couldn’t anywhere else. I left a thank-you note because I knew things were about to get harder for all of us.

By the time I got the insurance notification, everything about the nation and my finances was strained. My husband’s contract had not been renewed and he was job hunting. He’d been on the market two months without any interviews. So when I opened the Meritain Statement of Benefits and saw that the amount I would owe was over $2000, I nearly fainted. I scrolled down the list of services – ok, cost of IUD, cost of office, cost of removal, cost of insertion… nothing negotiated, even, which had been my experience even with the worst insurance coverages.

Oh, but the $5 anemia stick was covered. Insurer pays $5. Patient responsibility $2000+.

It feels a little dishonest, holding back on the ending, to write this now. But I remember falling onto the ironing board, getting my back against our rough plastered living room wall, and collapsing to the floor, where I sobbed over what felt like a complete betrayal at a time we could no longer afford to take a hit.

The next day, I had pulled myself together enough to call the insurance company. Was it a mistake? Was there something I could negotiate? After a few transfers, I spoke to a helpful, soothing woman. This was a side effect of the four-card system. I had only gotten the first statement of a bureaucratic process. My procedure would be billed three times, against everything but my regular prescription card.

Billing cycle the first: what would my “real” insurance negotiate and pay for? Well, they made sure my anemia was under control!

Billing cycle the second: what would my bright pink CONTRACEPTIVE MEDICAL SERVICES ONLY card cover? That would be the removal and insertion.

Billing cycle the third: and then the IUD itself would be billed to my contraceptive prescription card.

I saved every statement until it’d all zeroed out. I hardly allowed myself to believe it would. 2017 had turned into a pretty bad year. But this one thing, at least, resolved.

Post-Mandate

I talked to other women who’d been there before the mandate. “My husband had a vasectomy after our third kid. But I still need the pill because it helps with my endometriosis. He had to take HR a doctor’s note about his fertility in order for them to cover me talking about the pill and other options with my doctor.”

“My doctor had to fax a note to HR outlining the health reasons why I need it. Of course they couldn’t mention that the other reason I need it was TO NOT GET PREGNANT.”

By November 2017, when Notre Dame announced they’d gotten a special deal so they wouldn’t have to cover employee birth control, I was working for Penn State. But it seems I can’t escape entanglement with Notre Dame’s contraceptive rules. On that day, I was at a conference with some former coworkers and party to the flurry of emails. I was furious and heartbroken for everyone I’d left behind. I was relieved that, by the end of the conference, the insurer, Meritain, decided it was in their best interests to offer it anyway. But that’s just for employees, not students.

Things continue to develop for the students and employees (including grad students), and some students are suing the university. And the announcement of Justice Kennedy’s retirement has led to justified concerns over what kind of decisions might be overturned. Griswold v. Connecticut (1965) struck down laws restricting marital contraception a mere 53 years ago. Eisenstadt v. Baird (1972) expanded the right to get contraception just 46 years ago.

Think of someone you know who’s 47 in 2018. Some states had these laws on the books when they were born. It’s not really that long.

Pregnancy is a medical condition. Contraceptive care is health care. My employer is not my spiritual counselor. I wish these things were straightforward. And yet, here we are.

Notes


  1. In April 2018, I learned that the new Assistant General Counsel/Data Protection Officer for OCLC was one of the attorneys who’d fought the ACA mandate, for Notre Dame and against all the employees who used contraception. I know, it surprised me as much as you. Civil Rights Litigation Clearinghouse entry for Brandy H. Ranjan and LinkedIn Profile. [By mid-2019 she had moved on from OCLC.] ↩︎

  2. Before I became a Mennonite, I was torn for several years between the Mennonites and Catholics. Both have strong peace traditions. The Catholic church includes extraordinary voices for justice. I’m humbled by Sister Megan Rice and all the women religious who have participated in Plowshares Actions. I’m inspired by the Catholic Workers and other lay movements. I have found sisterhood with Catholic lay women theologians, as we toil over dubious artistic efforts—“NO BAN, NO WALL” and “THE POPE IS PISSED."

    I’m aware of threads of dissent within the church on some teachings. I think I could’ve been a passionate cradle Catholic torn between faithfulness and fury. But when it came to membership and accepting the collective baggage of either church, birth control was one of a set of sticking points. It’s one thing to dissent with certain positions of a faith in which you were raised, while pouring yourself into all the teachings which heal this broken world. It’s another to convert in with a handful of asterisks. ↩︎

  3. Fr. Jenkins transfers it back to the order which runs Notre Dame, the C.S.C., perhaps after taxes? It’s a complicated transaction. But it’s a complicated financial game with over a million dollars. Not small, humble potatoes. ↩︎