Woman's Insurance Denies Claim for Lifesaving Abortion: 'I Was Sobbing on the Phone'

It took 8 months for a Wisconsin woman's insurance company to pay for a surgical abortion, which she needed after a life-threatening condition

• Ashely, from Wisconsin, was pregnant when she suffered a condition called previable PPROM that caused her to have a miscarriage

• She required a surgical abortion as her life was at risk, but later learned her insurance company would not cover the procedure due to state laws

• After eight months of appeals, Ashley was able to get her $1,700 bill covered

Newlyweds Ashely and Kyle went through months of appeals after their health insurance refused to pay for Ashley’s abortion following their heartbreaking and life-threatening miscarriage.

In 2023, Ashley was pregnant for the second time. Her first pregnancy a year prior resulted in a miscarriage that required a surgical abortion, and she was excited and hopeful to start a family this time.

“Everything was perfect. I was starting to feel kicking and movement,” she told NPR. “It was the day I turned 20 weeks, which was a Monday. I went to work, and then I picked Kyle up from work, and I got up off the driver’s seat and there was fluid on the seat.”

The couple drove straight to UnityPoint Health-Meriter Hospital where they learned that the amniotic sac had broken, a condition called previable PPROM (pre-term premature rupture of the membranes), which the National Institute of Health says can cause significant complications.

Ashley was told that the fetus was too underdeveloped to survive and the ruptured membranes now posed a serious threat of infection. Eliza Bennett, the OB-GYN who treated Ashley, told the outlet that “in cases of previable PPROM, every patient should be offered termination of pregnancy due to the significant risk of ascending infection and potential sepsis and death.”

Ashley needed a dilation & evacuation (D&E), a surgical abortion procedure during the second trimester that is also commonly used after a miscarriage to remove all the remaining pregnancy tissue.

Related: Feds Launch First Investigation into Allegations that a Woman Was Denied a Medically-Necessary Abortion

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With Wisconsin’s active ban on abortion, Ashley was only able to receive the procedure after two additional doctors were able to attest that she was facing death due to the pregnancy. She had the life-saving procedure and began to recover.

However, Ashley later learned that her health insurer, the Federal Employees Health Benefits Program, did not cover the abortion procedure. She received a bill for $1,700.

“Every time I called insurance about my bill, I was sobbing on the phone because it was so frustrating to have to explain the situation and why I think it should be covered,” she said. “It’s making me feel like it was my fault, and I should be ashamed of it.”

After speaking with someone from the hospital’s billing department, Ashley recalled,
“She told me, ‘FEP Blue does not cover any abortions whatsoever. Period. Doesn’t matter what it is. We don’t cover abortions.’”

The Federal Employees Health Benefits Program — which contracts with FEP Blue or the BlueCross BlueShield Federal Employee Program —  told NPR in statement that the company “is required to comply with federal legislation which prohibits Federal Employees Health Benefits Plans from covering procedures, services, drugs, and supplies related to abortions 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 an act of rape or incest.”

Related: Pregnant Florida Woman Denied Emergency Abortion, Sent Home from Hospital: ‘I Knew I Would Die Within … Days’ (Exclusive) 

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With this policy, Ashley’s procedure should have been paid for as doctors confirmed her life was in danger.

Alina Salganicoff, director of Women’s Health Policy at KFF, told the outlet that this error is increasingly common since the Supreme Court's decision to overturn Roe v. Wade in June 2022. She explained that Ashley’s bill used the word “abortion” and billing code that is “insurance kryptonite.”

“Right now, we’re in a situation where there is really heightened sensitivity about what is a life-threatening emergency, and when is it a life-threatening emergency,” Salganicoff told the outlet.

Now, after eight months and multiple appeals, the hospital confirmed that the insurer has paid the claim. Ashely explained that entire experience and seeing the effects of abortions bans firsthand has encouraged her to stand with other women going through similar journeys.

“I’m in this now with all these people,” she said. “I feel a lot more connected to them, in a way that I didn’t as much before.”

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