My IUD is covered by insurance, so why was I billed?

Filed Under: Costs, Health plans, Patients

Is my IUD covered by insurance?

(Updated 2022) Summary: Technically, getting an IUD is covered by insurance with no co-pay under the Affordable Care Act, but many women are getting billed.

In 2014, we launched PriceCheck, our legacy project crowdsourcing health costs. We worked in collaboration with KQED public media in San Francisco and KPCC public media in Los Angeles, with funding from the John S. and James L. Knight Foundation. We heard from three patients that caught my attention; one woman paid $0, one paid $199.24, and one paid $730. What’s up with that?

We didn’t ask them whether it was a Mirena or a Paragard IUD — we’ve learned that Mirena typically costs around $100 or $200 more — so the results are a bit bare-bones. (There are other IUD’s but they have tiny market share.) Even not knowing that, it’s interesting to see these three women telling us what they paid for their IUD’s in California, via our PriceCheck sharing tool.

IUD No. 1: “I had a large deductible of over $1,500, so the entire procedure was billed in full, I payed it with my HSA (Health Savings Account through Bank of America) and applied to my deductible.” She got an IUD at Bayspring Medical Group; her insurance is with Aetna Health of California. She was billed $730 and paid $730: Note: We’re curious why her insurance policy didn’t pay for an IUD. Do you think you are being charged when you shouldn’t be?  This article by the National Women’s Law Center  is a good guide to what to do; we referenced it in a blog post I wrote on the topic of A.C.A. regulations a year ago.

IUD No. 2: “The bill lists the following three types of services: drug non-oral administration ($1002), Surgery OB-GYN ($338), and Lab Urology ($14). The diagnostic code for the drug non-oral administration is V259 and I verified with an Anthem rep that this was the charge for the Mirena. Although my plan has a few thousand dollar deductible that I had not yet satisfied, this procedure was mostly covered because it was considered preventative. The 6 week follow up appointment was billed at $197 which I had to pay in full.” She got an IUD at Palo Alto Medical Foundation in Palo Alto. She was billed $1,354; Anthem Blue Cross paid $1,148.56, and she was charged $2.24 — but will pay the $197 for follow-up.

IUD No. 3: “Process is 100% covered under women’s heath provisions under Affordable Healthcare Act.” She got an IUD at East Bay Family Practice in Oakland. The charge was $1,611 and her insurer (which she did not name) paid the price in full. [Update: The insurer, United HealthCare, paid $988.43, we learned after asking her by email.]

So, My IUD is covered, but what will I have to pay?

Here’s our blog post, with lists of cash or self-pay prices in several metropolitan areas. If you’re insured, it should be covered, but certain conditions may apply (see the National Women’s Law Center fact sheet above).

Here’s a fact sheet about IUD’s from Planned Parenthood.

Here’s another collection of women’s experiences in New York City from a blog post not long ago: one woman got hers with no co-pay, in a month; another spent 5-1/2 months and ultimately got hers with no co-pay.