Tips From the Hotline: Help! My IUD Was Covered But Not the Check-Up
You’ve decided, after consulting with your healthcare provider, to get an IUD. And why not? They are safe and effective. Plus, you don’t ever have to worry about forgetting to take another pill, apply a patch, or insert a ring. Because you have health insurance that is covered by the ACA, you didn’t pay a cent when you got your IUD put in, and your provider recommended that you come back for a follow-up visit just to see how your IUD is doing.
A few weeks after your follow up visit you receive an explanation of benefits (EOB) from your health insurance plan telling you that only part of your follow-up visit was covered by insurance and you owe money to your healthcare provider.
If the IUD is covered, shouldn’t that include the follow-up visit?
The federal government has made it clear that services related to any one of the 18 FDA approved birth control methods for women should be covered without out-of-pocket costs to the patient, stating that “coverage must also include the clinical services… needed for provision of the contraceptive method.” The bottom line is that if your plan is required to cover your birth control without out-of-pocket costs then it is also required to cover services related to your birth control. For methods you pick up from the pharmacy, like pills, the patch, or the ring, there might be one visit to your health care provider to get started. But for methods like the IUD or sterilization, you might need to have more than one visit or have some testing done.
What if I have a problem with my IUD, is that covered?
While IUDs are great for many women, some experience side effects requiring a visit to their healthcare provider. Sometimes an IUD or implant will need to be removed because of a complication. The federal government has said that when you seek medical services for problems related to your IUD or implant, it should be covered without out-of-pocket costs. In this 2013 guidance the government makes clear that “services related to follow-up and management of side effects, counseling for continued adherence, and device removal are included under the HRSA Guidelines.” The bottom line is, if you have a problem with your birth control that requires a visit with your healthcare provider or the removal of your IUD or implant, those services should be covered without out-of-pocket costs.
What should I do if I am charged for a visit related to my birth control?
First, you will want to check if this part of the healthcare law has kicked in for your plan. Then, make sure your healthcare provider is in your health plan’s network, because if they are not your insurer can charge you out-of-pocket costs. This might require a call to your insurance plan. If you went to an in-network provider and still received a bill, the next step is to appeal the claim with your insurance plan. The EOB you received should have information on filing an appeal. If not, you might need to call your plan.
If you have more questions we might be able to help. To see our online resources and sample appeal letters visit www.coverher.org, or contact us at [email protected], or 1-877-745-5487 and we’ll do our best to answer your questions.