IUD insurance coverage

[isabel]

Has anyone had an issue with this? I got Mirena at the end of June. Didn't think to make sure it was covered; just assumed. We have a VERY good BCBS PPO with 90/10 co-insurance and they cover specialty things like PT and specialty visits. It never would have occurred to me that it wouldn't be covered.

I got a bill from my doctor for $2,600 for the IUD. I called them and they had mistakenly submitted the claim to an HMO plan, not the PPO plan. So I had a sigh of relief and figured it would be fine. Well, I just got a bill today (30 days past due) that shows it was submitted to a PPO plan, and it's for the same amount as the last bill.

Has anyone else dealt with this? And did you try to appeal or something? My OOP max is covered for the year from having DS, so this should be free if it's covered. I'm just kind of bewildered that it might not be.

[Jalapeñomel]

I think IUDs are notorious for being terrible with insurance coverage.

[anlo]

My doctor had to get some kind of prior authorization for mine to be covered. I got it to manage my endometriosis symptoms. It would not have been covered for birth control only. Do you have a need for it other than bc? Not that it's not reason enough, just asking. Good luck, I hope you can get something worked out.

[isabel]

Sept 5, 2015 16:15:47 GMT -5 anlo said:

My doctor had to get some kind of prior authorization for mine to be covered. I got it to manage my endometriosis symptoms. It would not have been covered for birth control only. Do you have a need for it other than bc? Not that it's not reason enough, just asking. Good luck, I hope you can get something worked out.

I don't. I'm just kind of shocked. I mean, they covered a breast pump. I found something online for my plan thought that says there's coverage. I'll call on Tuesday to confirm, I guess. It's just so frustrating. And, while it's my fault for not checking, if this is a typical issue, I'm annoyed that my doctor didn't say anything.

[bugandbibs]

I have Kaiser and they are 100% covered, every form of birth control is except condoms.

[anlo]

Sept 5, 2015 16:23:30 GMT -5 isabel said:

Sept 5, 2015 16:15:47 GMT -5 anlo said:

My doctor had to get some kind of prior authorization for mine to be covered. I got it to manage my endometriosis symptoms. It would not have been covered for birth control only. Do you have a need for it other than bc? Not that it's not reason enough, just asking. Good luck, I hope you can get something worked out.

I don't. I'm just kind of shocked. I mean, they covered a breast pump. I found something online for my plan thought that says there's coverage. I'll call on Tuesday to confirm, I guess. It's just so frustrating. And, while it's my fault for not checking, if this is a typical issue, I'm annoyed that my doctor didn't say anything.

That is annoying. I hope you get good news Tuesday!

[steph96]

I also have BCBS. I got my Skyla (smaller version of Mirena) at the end of last year. It was 100% covered. I would definitely try calling the insurance company.

[calmcosmo]

I have Tricare Standard (PPO version of military insurance).

I got a lot of pushback trying to get a Mirena last year. For Tricare it was all about how it was billed. My OB didn't stock them, they had patients get them from Caremark or a similar pharmacy and then inserted in the office. Tricare was a big fat no-go on that. They would only pay if the doctor billed them directly. No third party pharmacies allowed.

So nuances seem to matter. My first Mirena was a breeze because my doctor had them in stock and billed directly. I didn't realize that at the time (since when things work you rarely analyze why).

[calmcosmo]

Just adding... $2600 seems insane even if it's totally not covered. I asked how much the Mirena would cost me when talking to the third party pharmacy and they said about $850. And even with an insertion fee added I can't imagine it getting to $2600.

[marylennox]

I have bcbs and my doctor had their office call and check into it for me before getting it. They told me it's covered at 100%. I would call your insurance and ask them about it.

[marina007]

Sept 5, 2015 18:28:41 GMT -5 calmcosmo said:

Just adding... $2600 seems insane even if it's totally not covered. I asked how much the Mirena would cost me when talking to the third party pharmacy and they said about $850. And even with an insertion fee added I can't imagine it getting to $2600.

Agreed. Only the insertion was covered by my insurance (which is ridiculous imo), so I had my mom bring one over from Norway (where they're subsidized and thus cost 150$). My office also said total cost would be approx 900$ if I was to get it.

[isabel]

Yeah, there's no way I'll pay $2,600. That's insane. I'll definitely negotiate with the doctor's office if I have to. I'll be curious to see what they say on Tuesday though.

When I called about getting a breast pump, the guy told me they didn't cover it at all. I then called a few days later and it turned out it was covered under our standard 90/10 coinsurance, so I paid like $40. I hope this is something like that.