How will the Supreme Court’s Hobby Lobby Decision Affect Medical Billing and Coding?

The Supreme Court’s recent Hobby Lobby decision may have generated as much misunderstandings as it did headlines. The high court made its ruling on the last day of its session, deciding in favor of the craft chain in Burwell v. Hobby Lobby. At issue was whether or not Hobby Lobby, a for-profit corporation, could opt-out of providing certain contraceptives to its employees based on its moral and religious objections to some forms of birth control. Under the Affordable Care Act, most corporate employers are required to provide healthcare coverage to their female employees that includes contraceptives.

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What the Decision Does Not Do

Contrary to some hysteria in the media, the Supreme Court’s decision does not undermine the Affordable Care Act. It does not even begin to do this, however there will likely be some limited additional litigation generated by this decision. It also does not mean that all employers are exempt from providing healthcare coverage that includes contraception to their employees. In fact, by far the vast majority of employers who were required to provide this type of coverage to their employees before the court’s decision remain obligated to continue to do so. Finally, it should be reaffirmed that women’s overall healthcare coverage will not be affected by this decision with the exception of those employed in the three companies who were co-litigants in this case, in which case they will have to pay out-of-pocket for contraceptives.

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What the Decision Does Do

From the beginning when the Affordable Care Act was passed in 2010, certain religious and non-profit organizations could apply for an exemption from the obligation to provide healthcare coverage to their employees that included contraceptives. This decision in Burwell v. Hobby Lobby means that closely held private corporations do not have to provide their employees with healthcare that includes contraception.

The basis for this decision was on the Religious Freedom Restoration Act (RFRA) passed with near unanimity in 1993 and signed into law by President Clinton. RFRA states that federal laws that are objectionable on religious grounds for closely held corporations (not those traded on a stock exchange) must be implemented in the least restrictive way, and because an exemption was not offered for these types of organizations but was offered to religious and non-profit groups, the law was not enforced in the least restrictive way; i.e. the ACA could have offered an exemption to these types of corporations but did not.

How the Decision Impacts Medical Billing and Coding

As a result of this ruling Hobby Lobby and a few other companies that were co-litigants in this case do not have to provide contraceptive healthcare coverage to their employees, joining the rest of the religious institutions and non-profits who already share this exemption. That means billing and coding professionals will not see a drop in the number of claims for insurance coverage of contraceptives – unless of course you process the insurance claims for Hobby Lobby.

Any form of contraceptive that is approved by the FDA is considered to be preventive care under the Affordable Care Act. The ACA requires the vast majority of insurance plans sold on the group or individual markets to provide coverage for preventative care at no cost to the individual holder of the insurance policy. Therefore billing and coding professionals should not expect to see any changes spurred by this recent Supreme Court decision.