Nearly every day for three months, Carl Bechdel had to make calls or send emails to try to get family insurance coverage for his husband and himself under President Barack Obama's landmark health law.
The Harrisburg, Pa., couple had sent an insurer their application and a month's premium in early December but heard nothing. Weeks later, they were told their application was not processed because Pennsylvania doesn't recognize same-sex marriage. So Bechdel pushed back, repeatedly explaining their predicament in phone calls and emails. Finally, they got a call and apology from the president of the insurance company last month, plus a family plan that started in March.
"It was never a matter of price. It was a matter of respect," said Bechdel, a 60-year-old retired attorney who married Dan Miller in 2012 in Washington, D.C.
For gay couples, access to family insurance plans under the law is not guaranteed this year, and their options run the gamut, mirroring in part the patchwork of state laws governing same-sex marriage that have changed rapidly in recent years.S
In Iowa, where gay marriage is legal, insurers selling plans in the marketplace created under the law offer policies to gay couples and families. But the major company in Tennessee's marketplace does not offer coverage at all to same-sex couples. Policies vary by insurer in Florida. And in Ohio, a couple sued for access to family insurance plans.
The federal government has belatedly sought to solve the inconsistencies, telling insurers this month that if they offer spousal coverage to heterosexual couples, they must provide that benefit to legally married, same-sex couples. But that doesn't become a requirement until next year, and doesn't address coverage for couples in civil unions and domestic partnerships.
In the meantime, the administration has encouraged companies to comply with the new policy voluntarily. Federal regulations do not require insurers to offer any family policies. And when companies do, they have some flexibility in how they define family members.
In Aberdeen, N.C., Thomas Hafke, 30, went online in December and bought a family plan for his husband and himself from Blue Cross and Blue Shield of North Carolina.
But the Chapel Hill-based company then canceled family coverage it sold to Hafke and about 20 other same-sex couples through the marketplace because of contract phrasing that defined "spouse" as "opposite sex."
"It felt like legalized discrimination," said Hafke, a server, who married 32-year-old Chad Higby in Washington, D.C., last fall.
Blue Cross and Blue Shield reversed course in January, saying it would offer the coverage to same-sex married couples and domestic partners.
"It was very important for these people to be able to purchase family coverage," said Michelle Douglas, a Blue Cross and Blue Shield spokeswoman. "In recognition of that, the company made the decision to make that coverage available."
Knowing that a partner can get coverage is one of the more effective messages in getting those in the LGBT community to enroll in a plan under the law, said Katie Keith, a researcher at Trimpa Group, a consulting firm that works with gay rights advocates.
"Even though it's not a requirement for 2014, it makes it more of a possibility for people," Keith said.
While it will be months before insurers are obligated to offer such coverage, gay rights groups have praised the administration's move, saying it brings some clarity to the issue and will ease access for gay couples when the requirement takes effect next year.
"Many same-sex married couples and their families are hurting right now because they've been refused access to more affordable family health insurance plans," Rea Carey, executive director of the National Gay and Lesbian Task Force, said in a statement.
Bechdel and his husband sought coverage from one of Pennsylvania's biggest insurers, Pittsburgh-based Highmark Inc. The insurer is now reworking its policies there and in West Virginia to let same-sex couples and domestic partners purchase family coverage, a spokesman said. In the meantime, the company has worked with about 15 couples in the two states to get them family policies.
"Originally, the products were developed following the guidelines of recognized marriage of state laws," said Aaron Billger, a Highmark spokesman.
In Delaware, where Highmark also offers plans and same-sex marriage is legal, the insurer already provides such coverage for gay couples.
The company expects to offer family coverage in the early spring in Pennsylvania and West Virginia.
Other gay couples have found uneven access to family plans.
Al Cowger Jr. and Tony Wesley Jr. of suburban Cleveland sued the state of Ohio and U.S. government after hours-long phone calls and months of trying to get family coverage through the federal insurance marketplace.
The couple, who have been together for 28 years, married in 2012 in upstate New York and have a 7-year-old adopted daughter. They say that because of Ohio's gay marriage ban, they have been denied a family plan under Obama's law in violation of their constitutional rights.
In their lawsuit, Cowger said he talked to help-desk personnel with healthcare.gov who told him that he and Wesley had been approved for family coverage in the marketplace. But a problem surfaced when the representative tried to purchase the policy and couldn't.
Cowger said he was then told he couldn't get family coverage because Ohio does not recognize his marriage. But the insurance company, Medical Mutual of Ohio, says it offers family coverage to same-sex couples both on and off the exchange.
"After 28 years," Cowger said recently, "we're just so sick of having to jump through hoops and get around all these restrictions, all the stuff that comes with these prohibitions, to be treated like a family."
Associated Press writers Kelli Kennedy in Miami; Amanda Lee Myers in Cincinnati; Catherine Lucey in Des Moines, Iowa; Brady McCombs in Salt Lake City; and Erik Schelzig in Nashville, Tenn.; contributed to this report.