The employer (in the fantasy world where employers actually care about this) ostensibly files with the insurance company that they won't pay for birth control if it is used as birth control. Whore Lady who wants use birth control as birth control has to file with the insurance company that she is using it for acne problems, and provide evidence from her doctor that she's not just being a Whore Lady. Both sides of this interpretation have some disingenuity involved. The employer is going to know who/what they're objecting to, and the employee is going to know they're being whore-blocked by the employer, and the employer WILL know who it is, since HIPAA is a joke.