Ashley and Kyle were newly married in early 2022 and were excited to welcome their first child. However, Ashley suffered from bleeding from the beginning of her pregnancy and in July, at seven weeks, she suffered a miscarriage.
The couple’s grief came weeks after the U.S. Supreme Court struck down federal abortion rights in Wisconsin, their home state, after reinstating an 1849 law that allowed abortions only when the pregnant woman was near death.
Abortion insurance is a mixed bag in the United States. Patients often don’t know if and when a procedure or abortion pill will be covered, and the proliferation of abortion bans has added to the confusion. Ashley says she’s caught up in the tangle of uncertainties.
Ashley’s life was not in danger during the miscarriage, but the state’s abortion ban meant that even during a miscarriage, doctors in Wisconsin could not perform a D&E (dilation and evacuation) until the embryo died. She went back and forth from hospital to hospital, bleeding and on sick leave, until doctors could confirm the pregnancy had ended. Only then did doctors remove the pregnancy tissue.
“My first pregnancy was the first time I realized that something like this could affect me,” said Ashley, who asked to be identified only by her middle name and her husband by his first name. She works in a government agency with conservative colleagues and fears retaliation if she talks about her abortion care.
A year later – the 1849 abortion ban was still in force in Wisconsin – Ashley was pregnant again.
“Everything was perfect. I started feeling kicks and movements,” she said. “It was the day I turned 20 weeks, a Monday. I went to work and then picked Kyle up from work. When I got up from the driver’s seat, there was fluid on the seat.”
The amniotic sac had ruptured, a condition called previable PPROM. The couple headed straight to obstetric triage at UnityPoint Health-Meriter Hospital, the largest maternity hospital in Wisconsin. The fetus was deemed too underdeveloped to survive, and the ruptured membranes posed a serious risk of infection.
Gynecologists from across the state of Wisconsin had decided that “in cases of pre-existing PPROM, every patient should be offered an abortion because there is a significant risk of ascending infection and possible sepsis and death,” said Eliza Bennett, the gynecologist who treated Ashley.
Ashley needed an abortion to save her life.
The couple called his parents; Ashley’s mother came to the hospital to comfort her. Because of Wisconsin’s 1849 abortion ban, Bennett, an associate clinical professor at the University of Wisconsin School of Medicine, needed two other doctors to confirm that Ashley was facing death.
But despite a wealth of medical documentation, Ashley’s health insurance, the Federal Employees Health Benefits Program, did not cover the cost of the abortion. Months later, Ashley logged into her medical billing portal and was surprised to find that while the insurance had paid for her three-day hospital stay, it had not paid for the abortion.
“Every time I called the insurance company about my bill, I cried on the phone because it was so frustrating having to explain the situation and why I think it should be covered,” she said. “I feel like it’s my fault and I should be ashamed of it,” Ashley said.
Eventually, Ashley spoke to a woman in the hospital’s billing department, who passed on the insurance company’s statement to her.
“She told me,” Ashley said, “quote: ‘FEP Blue does not cover abortion costs. Period. It doesn’t matter what it is. We do not cover abortion costs.'”
The University of Wisconsin Health, which manages billing for the UnityPoint Health-Meriter hospital, confirmed this exchange.
The Federal Employees Health Benefits Program contracts with FEP Blue or the BlueCross BlueShield Federal Employee Program to provide health insurance to federal employees. In response to an interview request, FEP Blue emailed a statement saying it is “committed to complying with federal law that prohibits Federal Employees Health Benefits Plans from covering procedures, services, drugs and supplies related to abortion, except when the life of the mother would be endangered if the fetus were carried to term, or when the pregnancy is the result of rape or incest.”
These restrictions, known as the Hyde Amendment, have been passed by Congress every year since 1976 and prevent abortion services from receiving federal funding.
In Ashley’s case, doctors said her life was in danger and her bill should have been paid immediately, said Alina Salganicoff, director of women’s health policy at KFF, a nonprofit health information organization that includes KFF Health News.
What tripped up Ashley’s bill was the word “abortion” and a billing code that is kryptonite for insurance, Salganicoff says.
“Right now we’re in a situation where there’s really a heightened sensitivity about what is a life-threatening emergency and when it’s a life-threatening emergency,” Salganicoff said. The same chilling effect that keeps doctors and hospitals from offering legal abortion care could also affect insurance coverage, she said.
In Wisconsin, Bennett said, underprovision of abortion services is widespread.
“Many of the patients I see who have a pregnancy complication or, more commonly, a severe fetal abnormality are uninsured,” Bennett said.
Recently, the $1,700 bill disappeared from Ashley’s online billing portal. The hospital confirmed that the insurer paid the claim eight months later after several appeals. When contacted again on August 7, FEP Blue responded that it would not “comment on the specifics of individual members’ medical care.”
Ashley said battling with her insurance company and experiencing the impact of abortion restrictions on her health care — similar to other women across the country — gave her courage.
“I’m here with all these people now,” she said. “I feel much more connected to them, which wasn’t the case before.”
Ashley is pregnant again, and she and her husband are hoping that this time her insurance will cover the medical care her doctor deems necessary.
KFF Health News is a national newsroom that produces in-depth coverage of health issues and is one of the core operating programs of KFF – an independent source of health policy research, polling and journalism. Learn more about KFF.
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