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I’m Having Problems With Insurance Coverage of the Implant or a Related Doctor’s Appointment

It should be easy to get birth control and other important women’s health needs, like breastfeeding supplies and well-women visits, at no cost to you. But sometimes it’s not so easy. If you’re still paying out-of-pocket for your birth control and other health care, use our information below to start getting help.

Step 1: Find out if the health care law has kicked in for your health insurance plan.

Step 2: Stil not sure? Here’s how to ask your health insurance company.

Step 3: Use the instructions and template letter below to appeal to your health insurance company if they are incorrectly charging you out-of-pocket costs when they shouldn’t.

Instructions for Sending An Appeal Letter: If you were charged for an implant

  • Find out where to send your letter: Call your plan, or if you have an appeal form, the address will be on it.
  • Fill out the letter (templates are below): Replace all of the words in capital letters with your information. For example, replace “YOUR NAME” with your full name, and “POLICY NUMBER” with your plan policy number. Under “Last paragraph options”:
    • Choose (1) if you have had your implant put in
    • Choose (2) if you have not yet had your implant put in
  • Send copies of these documents with your letter: 
    • If you’ve had your implant put in:
      • Records of any money you’ve paid for your implant, such as receipts or an “Explanation of Benefits” from your plan.
      • Records of money you paid for your visit for insertion or follow-up visits, such as a receipt, (if your plan did not cover these and you had to pay a “co-pay”).
    • A copy of the FDA’s “Birth Control Guide.”
    • A copy of this “Frequently Asked Questions” document.
  • After you send your letter to your health plan:
    • Make a copy of your letter and keep it in your files.
    • Share your letter and appeal form (if your plan is through your job).
      • You can send a copy to your plan’s “Plan Administrator.” Look at the information you received when you got your plan (this could be called your “Evidence of Coverage” or “Certificate of Coverage” or if you get your insurance through your work, “Summary Plan Description”) to find where to send this.
      • You can give a copy to your Human Resources department or contact.
    • Keep copies of receipts or other records that show what you pay for your birth control.
  • Please let us know if your health plan responds—we are tracking decisions so we can advocate with both health insurance and government officials.

If you have any questions, contact us at 1-866-745-5487 or [email protected] for free help.