By Amy Griffin
For many women on Church-provided insurance, the story is heartachingly familiar: a woman is told by her doctor that, due to a serious medical condition, she needs birth control. Yet regardless of the pain, the suffering or the stakes, the Church’s insurance declines to cover the necessary treatment.
“After years of suffering, I learned I had uterine polyps,” wrote an anonymous woman on an Instagram petition. “When I awoke from the surgery to remove them, the doctor said I had polyps ‘covering every surface of (my) uterus.” To prevent further polyps and uterine cancer, the 48-year-old woman would need an IUD — something her insurance would fail to cover.
“My choices were (to) spend $1,300 at my doctor’s office, get cancer or go to Planned Parenthood,” she wrote. “Gotta love health insurance that doesn’t provide healthcare.”
The woman’s story is one of the dozens recorded by the Instagram account @dmba_stories, which calls itself a “petition” of “hundreds of personal impact stories” submitted by women who have experienced “the pain caused by these exclusions.”
So what, exactly, is the problem?
For the thousands of women on The Church of Jesus Christ of Latter-day Saints’ health insurance, there is a gaping hole in what is otherwise considered adequate coverage: a broad failure to cover birth control. Though the policy exclusion is far from new, it’s only been in the past few months that an organized social media effort has emerged and begun to call for change.
Deseret Mutual Benefit Administrators (DMBA) is an agency established by the Church that provides health insurance for more than 16,000 Church employees, including BYU employees as well as all students on the university health care plan.
DMBA’s medical plans cover other fertility services including artificial insemination and in vitro fertilization, but exclude from any coverage “family planning, including contraception, birth control devices, and/or sterilization procedures unless the covered individual meets DMBA’s current medical criteria.”
Just what those medical criteria consist of, however, is unclear.
The conditions that would qualify an individual for birth control coverage are not found in DMBA’s explanations of benefits or other documentation. Multiple calls to DMBA and Magellan Health, the company it contracts with to manage prescriptions, found no representative who could provide any criteria that DMBA nurses use in determining who to accept pre-authorizations for and who to deny.
In fact, Magellan said that most birth control is covered and proved it by filing a test claim for an oral contraceptive on behalf of an individual on the call. That claim, despite contradicting DMBA’s policy, was approved — because DMBA never saw it.
This means DMBA, which processes prescriptions before sending them on to Magellan, is stopping most prescriptions for birth control from ever reaching Magellan’s approval system. A DMBA representative said that their agency nurses “review” medical necessity claims on pre-authorizations from doctors to determine if the conditions “meet guidelines,” but would not provide any information to the patient on what those guidelines consist of.
If the @dmba_stories account is any indication, many claims for birth control to treat serious medical conditions at the sincere urging of the doctor are nevertheless denied under the “guidelines” at DMBA without ever being forwarded on to Magellan for approval.
Individuals whose experiences were posted on @dmba_stories claim that DMBA’s nurses and administrators — who have never examined the patient themselves — have denied treatment to patients suffering from endometriosis, repeated ectopic pregnancies and dangerous miscarriages, severe postpartum depression, risk of cancer and even the insistence of a doctor that a future pregnancy would result in death.
The Affordable Care Act, popularly known as Obamacare, requires health insurance providers to pay for contraceptives. DMBA’s exclusionary policy is legal in part due to a landmark 2014 Supreme Court case, Burwell v. Hobby Lobby, in which the court ruled that under the Religious Freedom Restoration Act, employers are not required to cover birth control if it contradicts the company’s religious values.
In this case, Hobby Lobby and other employers felt that several Obamacare-required contraceptives were “effectively facilitating abortion.” The court allowed Hobby Lobby and other similarly-positioned employers to “grandfather in” their old medical plans, which excluded contraceptives, while the majority of employers still had to abide by the federal contraceptive mandate. The ruling was generally seen as a win for religious freedom.
DMBA is one of these “grandfathered” programs. Yet The Church of Jesus Christ of Latter-day Saints has no formal objection to birth control. In fact, the Church’s official stance is that the baby decision “is a private matter for the husband and wife.”
After realizing that essential care is unavailable to them through regular means, many Church-employed women turn to Planned Parenthood.
For Sydney Mogotsi, a former employee in the Church’s humanitarian department, the decision to not provide birth control actually seems to go against Church policy.
“If we want to be pro-life, we have to support universal access to birth control,” Mogotsi said. “That’s really how you’re going to prevent unwanted pregnancies.” Mogotsi has considerable experience working in women’s reproductive healthcare worldwide.
“Overwhelmingly, when women have universal access to birth control, everything improves,” she said. “They are better educated, they have a longer lifespan.”
Rachel Fountain is a recent BYU graduate who is on DMBA’s health insurance due to her parents’ position as Church mission presidents.
She and Mogotsi agree that the problem likely comes from a leadership imbalance.
“Within Church employment, we don’t see a lot of women in leadership roles,” Mogotsi said. She expressed concern that the lack of diversity among the people making decisions means that women’s issues aren’t treated as seriously as they ought to be. When she’s tried to bring the issue up, however, she’s been met with criticism.
“I’ve been told that you know, I’ve been painting the wrong picture of the Church,” Mogotsi said. “(That) if I keep publicizing this, they’re not going to be able to recruit and retain women. And so I’ve kind of been made to feel like the villain.”
Mogotsi said she only felt comfortable speaking up now as she transitioned out of her Church position and into another workplace.
Fountain has felt similarly disregarded and misunderstood as a student under DMBA’s policy.
“I kind of feel like I’m being told like, ‘We don’t care about your education, we don’t care about your job. You are a baby-making machine,'” Foutain said.
Fountain, a returned missionary who calls her family “the most Latter-day Saint family you can get,” becomes frustrated when she feels that speaking up gets her dismissed as “anti-Church.” She wishes that those who would dismiss her instead would see that “this daughter of God is hurting.”
Though a newlywed who needed contraceptives for family planning purposes, she especially sympathized with those who need them for medical conditions. She compared these individuals to the biblical “woman having an issue of blood 12 years,” who many scholars believe suffered from a condition affecting her menstrual cycle, Fountain said she expects the Church to step up and try to heal as Christ would.
“That’s such a great example to me of Christ reaching out to women and defying societal norms of the time,” Fountain said. “And saying, ‘I’m going to help you. And I don’t care what society says, you’re a daughter of God, and I love you, and let me heal you.’”
For Sydney Springer, a current BYU student, the exclusion affects how she feels about herself. Springer has what she describes sarcastically as “some really delightful health conditions,” which require birth control as a treatment in order to “not be bedridden and miserable for (her) entire life.” Yet with DMBA refusing to provide care, Springer felt discouraged.
“It’s hard to feel like you matter,” Springer said. “That your voice and your decisions matter when there are people making decisions for you about your own body.”
With a growing account following and dozens of yet-unshared stories on the backburner, @dmba_stories is attempting to bring the experiences of countless affected women to the public.
Springer hopes, but isn’t especially optimistic that anyone is listening.
“Is that actually reaching the policymakers? And if it is, do they even care?” Springer said. “Probably not, is my guess. Or else I think we’d see change at this point.”
For Fountain, acknowledgment and a commitment to change are central.
“I hope someone will listen,” Fountain said. “This isn’t Christ-like, this needs to change. And it’s okay to admit mistakes. This is the gospel of repentance.”