V is being charged a copay for DV counseling under her ACA plan when they weren't charging her previously. How can she get them to stop charging?

WomensLaw doesn’t have information about the ACA on our website, so I did a bit of research to see if I could find the answer to your question. A person’s status as a domestic violence survivor matters in the sense that it allows them a special enrollment period - basically, this only affects when a person is allowed to sign up for a new plan and not what type of services they are entitled to. According to the HealthCare.gov website, marketplace plans must cover domestic violence screening and counseling for ALL women without charging a copay. However, for mental health services generally, a copay can in fact be charged. 

Although I cannot say for certain what has happened in your specific situation, I spoke to someone who has worked in the insurance industry to get a better understanding of how the process works. It’s important to remember that things can be very different from state to state and from plan to plan even within the same company, so this is very general information. I learned that sometimes an error can arise from the way that a doctor’s office enters the insurance claim into the system. The doctor’s office uses a specific code to tell the insurance company the reason for the treatment they provided to the patient, and the insurance company uses the code the doctor entered to determine how to pay a claim.

So let’s say, for example, that a person was initially receiving counseling for domestic violence and was thereafter diagnosed with anxiety or depression or something else related to the violence. For later visits, perhaps their doctor’s office used the code for the anxiety or depression but neglected to put the code for the domestic violence in the system as well. The insurance company would bill using the code that the doctor submitted for a non-domestic violence related mental health treatment, and the patient might then be charged a copay. Simply put, the code in the system might be wrong.

Have you reached out to your insurance company yet?  They would be best able to help investigate what has happened in your specific situation, and it is my general understanding that if there is in fact some sort of error, it may be possible for the doctor to submit a corrected claim.

Your health insurance company would also be able to tell you if something is different in your 2024 plan than it was in your 2023 plan, and if that could account for the change. For example, the HealthCare.gov page I linked to earlier that talks about services for women notes that “These services are free only when delivered by a doctor or other provider in your plan’s network.” So another possibility might be that your current doctor is no longer in your plan’s network. 

If something like that has happened but you’d like to stay with your current doctor, you may want to look into whether you qualify for crime victim compensation from your state. In many states, crime victim compensation can reimburse eligible victims of certain crimes for out-of-pocket counseling expenses that aren’t covered by insurance. In order to be eligible, there are often requirements that the victim must have reported the crime to law enforcement and applied for compensation within a certain time period. We have the link to the STATE criminal injuries compensation board and other victim assistance programs [HYPERLINK] in your state on our STATE Crimes page.

If you are looking for further assistance, some legal services organizations may provide free or low-cost health care advocates for eligible people. On our website we have a list of legal organizations who assist survivors of domestic violence. Many of those organizations are legal services organizations that may offer other services, including a health advocate, or may be able to provide referrals to an organization that does. If you can afford a lawyer, then a lawyer referral service may help you find a lawyer who has experience in this area of law. You can find contact information for all of these organizations on our Finding a Lawyer [HYPERLINK] page.