Strategies to expand contraception coverage: another tool in the box.

Despite the extensive body of evidence about the health benefits and cost-savings of contraception coverage, women's health care advocates are bracing themselves for the possibility that contraceptive care will lose the political debate as a no cost-sharing preventive service under the Affordable Care Act (ACA). As a second alternative to no cost-sharing, the Health Resources and Services Administration (HRSA) may determine that contraceptive care under the ACA is an essential women's health preventive service that all health plans must cover, but with cost-sharing. Should HRSA decide to exclude comprehensive contraceptive coverage as an essential women's health preventive service altogether, strategists would likely attempt to (a) convince more states to classify contraceptive services as essential benefits that all health plans must cover (with cost-sharing) or (b) convince more employers to include contraceptive services as covered benefits in the health plans that they sponsor or participate in (with cost-sharing). Yet, as a last resort to the strategies listed above, one additional strategy can be added to the mix — that of advocating for the development of a numerical International Statistical Classifications of Diseases (ICD) code for “unwanted fertility” — meaning one's desire to temporarily or permanently remove his or her state of fertility to prevent potential conception; as a diagnosis, unwanted fertility can be treated with contraception. The ICD system, which includes alphanumeric designations that serve to standardize various diseases, such as “diabetes,” or other problems, such as “nonspecific low blood pressure reading,” is required for billing and reimbursement. Health maintenance or preventive clinical visits use supplemental designations, referred to as “V codes” to identify encounters for reasons other than illness, injury or problems [1]. All visits involving routine contraceptive care, be it counseling, prescribing or a device-insertion procedure, are coded for billing purposes with a preventive V code. Employers who, through their insurance benefit design, exclude most “preventive” visits are excluding not only the contraceptive method itself, but also office visits that include the use of the V code. Should attempts at