Q. I have health insurance through my husband’s union. I need to have my IUD removed and replaced and it is not covered by insurance. The self-pay price is over $1,000. Is there anything I can do about this?
A. You can appeal the coverage denial to your health plan. Under the health law, patients generally don’t have to pay anything out of pocket for medical care that’s considered preventive, and contraceptives are included in that definition.
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The only broad exemption from the preventive coverage requirement is for plans that are considered grandfathered under the law because they haven’t significantly changed benefits or consumer costs since the law passed in 2010. In addition, some religious organizations are exempt from the requirement to provide birth control services without cost sharing.
Unless your plan is exempt from the rules for one of the above reasons, chances are you shouldn’t owe anything out-of-pocket for having your IUD replaced.
Under the law, health plans must cover the full range of FDA-approved methods of birth control, including intrauterine devices, “if … prescribed for a woman by her health care provider, subject to reasonable medical management.” In addition, guidance from the Department of Health and Human Services specifically says that the removal of an IUD should be covered without cost sharing.
As noted above, insurers can use “reasonable medical management” in applying the law. So, for example, an insurer might try to impose limits on the number of IUDs someone can receive over the course of a year, says Adam Sonfield, a senior public policy associate at the Guttmacher Institute who authored a report examining implementation of the contraceptive coverage requirements under the law.
But assuming you simply need a new IUD because it’s time for a replacement, “if she’s not in a grandfathered plan, it sure sounds to me like that’s a violation,” says Sonfield.