{"id":32662,"date":"2025-07-02T13:22:09","date_gmt":"2025-07-02T13:22:09","guid":{"rendered":"https:\/\/www.europesays.com\/us\/32662\/"},"modified":"2025-07-02T13:22:09","modified_gmt":"2025-07-02T13:22:09","slug":"insurance-is-often-a-barrier-to-menopause-symptom-treatment-california-lawmakers-want-to-change-that","status":"publish","type":"post","link":"https:\/\/www.europesays.com\/us\/32662\/","title":{"rendered":"Insurance is often a barrier to menopause symptom treatment. California lawmakers want to change that"},"content":{"rendered":"

This story is part of a series produced for the USC Annenberg Center\u00a0<\/a>for Health Journalism<\/a>\u2019s 2025 California Health Equity Fellowship.<\/p>\n

Some people experiencing menopause symptoms miss out on treatment because their insurance won’t cover it. That could harm patients and frustrates providers \u2014 and California lawmakers are taking notice.\u00a0<\/p>\n

\u201cAbsolutely insurance impacts people’s ability to access care,\u201d said Dr. Karen Adams, director of the Stanford University Program in Menopause and Healthy Aging.<\/p>\n

She said doctors can appeal denials, and often do.<\/p>\n

\u201cIt is really a requirement that the provider go that extra mile to advocate for their patient with the insurance companies,\u201d Adams said, adding that the process wastes valuable time for providers, their staff and patients whose health and well-being depend on treatment.\u00a0<\/p>\n

Even when doctors appeal, there\u2019s no guarantee they will win, she said.\u00a0<\/p>\n

Adams was one of the authors of a study<\/a>, which was published last year in the journal Menopause. It concluded that over 60% of people experiencing moderate to severe menopause symptoms were not receiving any treatment.\u00a0<\/p>\n

\u201cWe found that it’s pretty abysmal all the way across the board,\u201d she said. \u201cBut it’s even worse if people are on public insurance or uninsured.\u201d<\/p>\n

Treatment can be prohibitively expensive for many, even when recommended by a doctor. That\u2019s especially true for people of color, without legal status or who live in rural areas.\u00a0<\/p>\n

Adams said co-pays for menopause treatment can cost over a thousand dollars a year. That forces many people to opt out \u2014 and with it, lose out on preventative care entirely.<\/p>\n

\u201cIt’s life-threatening. It is literally life-threatening,\u201d she said.\u00a0<\/p>\n

Assembly Bill 432,<\/a> which is moving through the California legislature, would require insurance plans to cover certain kinds of menopause symptom treatments, including hormone replacement therapy and osteoporosis treatment and prevention.\u00a0<\/p>\n

\u201cWe just decided to say, \u2018You know what? We’re going to say it needs to be covered because we believe it’s medically necessary,\u2019\u201d said Bay Area Democratic Assembly member Rebecca Bauer-Kahan, who wrote the bill.\u00a0<\/p>\n

Two states<\/a> have already passed laws that require plans to cover some menopause symptom treatments. In Illinois<\/a>, plans have been required since 2023 to cover symptom treatment when a patient experiences early menopausal symptoms after having a hysterectomy. Louisiana<\/a> passed a law in 2023 mandating plans cover treatment for menopause and perimenopause.<\/p>\n

Last year, California\u2019s Democratic Governor Gavin Newsom vetoed a similar bill, also authored by Bauer-Kahan, calling it \u201ctoo far-reaching\u201d <\/a>in what it required health plans to cover.\u00a0<\/p>\n

Newsom\u2019s office declined to comment on the new bill for this story.\u00a0<\/p>\n

The California Association of Health Plans, which represents insurers, has spoken out against the new bill and others like it<\/a>.\u00a0<\/p>\n

Mary Ellen Grant, a spokesperson for the organization, turned down an interview, but said in a statement that the organization doesn\u2019t support the bill because it rolls back prior authorization, adding that it\u2019s a critical tool \u201cused by health plans that ensures care aligns with the latest medical guidelines while protecting patients from unnecessary procedures, excessive costs, and harmful treatments.\u201d<\/p>\n

Prior authorization<\/a> is a process by which insurance companies require providers to submit for approval on individual treatments or procedures. Companies say it keeps costs down, but providers say it\u2019s a barrier to care.\u00a0<\/p>\n

Garen Corbett is the director of the California Health Benefits Review Program at UC Berkeley, which analyzes legislation that relates to health plan benefits. He said each insurance company has its own way of handling how it covers treatment approval \u2014 which complicates regulating them.<\/p>\n

\u201cA lot is happening to sort of move towards better guidelines and consistency,\u201d he said.\u00a0<\/p>\n

But several bills moving through the legislature \u2014 including the menopause bill \u2014 would do just that.\u00a0<\/p>\n

These measures include a proposal to ban insurance companies from using prior authorization for HIV and AIDS treatment<\/a>, insulin<\/a> and even air purifiers<\/a> for people near wildfire smoke.\u00a0<\/p>\n

Corbett said that policy trend has grown as health care costs continue to rise<\/a>.\u00a0\u00a0<\/p>\n

\u201cIt’s part and parcel of this long-term struggle of, how do you provide broad access and maintain affordability?\u201d he said, adding that legislators are limited in the tools they have to do that.\u00a0<\/p>\n

He said they are taking a piecemeal approach, mostly because there\u2019s no single solution for every situation.<\/p>\n

\u201cIt is really hard to get consensus and buy-in, particularly if there’s a big issue that’s really complicated affecting a lot of players,\u201d he said.\u00a0<\/p>\n

Le Ondra Clark Harvey, chief executive officer of the advocacy group California Behavioral Health Association, believes insurance plans have gone too far in their use of prior authorization. She said these bills would provide needed regulation.\u00a0<\/p>\n

\u201cThe gaping hole is pretty obvious here,\u201d she said. \u201cThat’s why so many folks are all over this.\u201d<\/p>\n

She pointed out that Californians can appeal denials through the Department of Managed Health Care<\/a>, but said that\u2019s not enough.\u00a0<\/p>\n

\u201cMost consumers, despite the legal postings that are in doctors’ offices, etc., really don’t make it to the level where they are challenging\u201d denials, she said.\u00a0<\/p>\n

If the menopause bill or any other bill trying to address prior authorization becomes law, Clark Harvey said\u00a0 it could provide a blueprint for scaling back unnecessary denials. <\/p>\n


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