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Payers to Fully Cover Forensic Exams for Sexual Assault Victims in New Bill

Analysis  |  By Jay Asser  
   September 23, 2022

The legislation would protect victims who would otherwise be forced to pay surprise costs out-of-pocket.

A bipartisan bill has been introduced in the House of Representatives which would require private health insurers to fully cover forensic exams for sexual assault victims, protecting them from unexpected bills.

The No Surprises for Survivors Act, backed by Representatives Linda T. Sánchez (D-Calif.), Gwen Moore (D-Wis.), and Carol Miller (R-W.Va.), would ensure victims with private insurance don't have to pay out-of-pocket for rape kits following an attack, beginning in 2025.

Forensic exams are already covered for sexual assault victims under the Violence Against Women Act (VAWA), which was enacted in 1994. However, the law stipulates that the exam must be conducted by an accredited sexual assault nurse examiner (SANE) for it to be free of charge.

A study published in Kaiser Family Foundation found that 66% of privately-insured women who likely presented for a rape kit after a sexual assault from 2016 to 2018 were charged out-of-pocket costs for some services, with an average out-of-pocket spend of $347.

Building on VAWA, the No Surprises for Survivors Act would require insurers to provide coverage, without cost-sharing, for exams no matter where they are administered, unless it is on the state to reimburse. If a bill is received by the victim and it is the state's responsibility to cover the costs, insurers must inform their members on how to go through the reimbursement process.

Further, the legislation would place forensic exams under the emergency services protections of the No Surprises Act, which protects patients from surprise bills for emergency services at out-of-network facilities or for out-of-network providers at in-network facilities.

"The last thing a survivor of sexual violence should have to worry about is an unexpected medical bill," Moore said in a statement. "This legislation is needed because too many survivors, grappling with trauma, also become burdened with the cost of a forensic medical exam – even though they shouldn't be. With our bipartisan bill, we build on VAWA's no-cost coverage to ensure victims are protected from cost sharing for exams."

Jay Asser is an associate editor for HealthLeaders.

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