Post # 1
Member
900 posts
Busy bee
Before I had my Mirena inserted I called my insurance company to make sure my Mirena is covered. They said it was 100% covered at no cost to me, which is what I though because that Affordable Health Care Bill that Obama passed says that health insurance companies must pay 100% of birth control costs, but I wanted to make sure because I have heard that some places have found loop holes to keep from covering it. I was getting my Mirena put in at a place that works in contract with my health insurance, no problem. A month after getting the Mirena inserted I received a bill for the Mirena where I OWE THE ENTIRE BILL MYSELF.
So I call my insurance, and they said that the person who put in my Mirena does not work in contract with them so they are not covering it. Um, what? I called the place I had it done at, and they said that the person who put it in DOES work in contract with my insurance, and then they transfered me over to their billing office. I speak to the billing office, and they tell me that “100% covered does not mean 100% paid.” They said that my insurance moved the bill as a deductable, and I must meet the deductable before I get covered. Um, what do I need their coverage for if I have to pay the entire bill myself?? So the entire bill for this procedure is now my deductable because they don’t want to cover it. My bill, or “deductable” for this is $1,368 btw.
This is a big name insurance company by the way. This isn’t some weird company that no one has heard of before. I don’t know if it’s ok to name names here, but if anyone wants to know who I’m with, feel free to PM me. I called the people at CoverHer and will hear back from them sometime next week, maybe I can get something worked out, but in the mean time I am so pissed right now.
Post # 2
Member
6262 posts
Bee Keeper
- Wedding: August 2013 - The Liberty House
What type of insurance plan do you have? What is your deductible supposed to be?
Post # 3
Member
4424 posts
Honey bee
PBeeWriter: Hmmm…this doesn’t sound right. If your insurance was enacted after the ACA was put into effect, then yes birth control should be covered 100%
regardless of if the deductible has been met. Now, I’m not going to claim to know totally about the IUD as there has been some isues with certain methods of BC and the ACA…but, in my experience (and in my insurance) birth control is completely paid for even if I haven’t met my $1200 deductible for the year.
Post # 4
Member
47427 posts
Honey Beekeeper
PBeeWriter: Many plans have an annual deductible before they start paying. Does your plan have a deductible? If so, have you already paid it for this year?
My understanding is that plans are not required to cover ALL types of birth control, but must offer at least one type with full coverage
ObamaCare Birth Control
Post # 5
Member
1305 posts
Bumble bee
From the way you are describing, you don’t understand what a high deductible health care plan is, and possibly didn’t read over/understand the plan before you took it on. I recommend asking your HR department or calling customer service with the insurane provider to send you something again and going over it until you understand.
I also wonder if you have an HSA or FSA that you didn’t utilize as well.
I could be wrong, but I don’t believe insurance covers ALL types of BC. But then again, I could be wrong. I have been on the pill for the past ten years so I haven’t researched this to death.
-
This reply was modified 5 years, 5 months ago by
doglover89.
Post # 6
Member
1565 posts
Bumble bee
Ugh! I’m so sorry you’re having to jump through hoops just so you DON’T get knocked up and your insurance company has to pay for medical care for both pregnant you and your offspring. It’s so stupid. I tried to switch from birth control that was making me fat, moody, and is probably going to cause osteoperosis down the line to the pill. Whatever pill my doc prescribed apparently isn’t covered by my insurance company because it’s sometimes prescribed for something other than birth control, so they classify it as a “Tier 2” medication, one that isn’t preventative. I was shocked when I went to pick it up and they were going to charge me $43 for 30 pills. I’m back to my free but annoying birth control for now thanks to the stupid insurance company. I know I’m not making you feel any better but I wanted to vent too because crap like this shouldn’t be such a hassle for us women!
Post # 7
Member
18628 posts
Honey Beekeeper
Ugh that’s annoying. I have heard of some plans not covering all BC types and still being in compliance with ACA. I think as long as they have options available, they don’t have to offer all types of pill for examply to be in compliance.
That super sucks that they counted it toward your deductible! I had mine put in the year before ACA took effect so I have to pay the majority of it myself and thought that I was still saving money instead of $40 a month for BC. But still sucks that they didn’t explain your benefits and cost to you beforehand.
Post # 8
Member
2051 posts
Buzzing bee
This doesn’t really surprise me, most insurance plans have a deductible you have to spend before insurance coverage starts.
KatiePi: maybe the Mirena itself is covered, but the procedure / doctors time might not be?
Post # 9
Member
9388 posts
Buzzing Beekeeper
PBeeWriter: Ouch. 🙁
I wish I had something more useful to say, but I don’t. I really hope something works out–it’s so immoral for them to have TOLD you it was covered when it isn’t. It’s one thing for you to ASSUME it is and be wrong, but a whole nother thing if they actually said go ahead and get it inserted and we’ll pay.
My only advice is never call insurance companies–always email. Get it in writing!
Post # 10
Member
4424 posts
Honey bee
CityBearBride: Maybe. If that’s the case, that totally sucks. I have a bit of pregnancy brain and didn’t even think of that aspect of it.
OP, I would call your insurance directly (again) and ask them specifically why you are being charged this money and have them talk you through it.
Post # 11
Member
900 posts
Busy bee
julies1949: I had some oral surgery earlier this year and my deductable was met through that. This was before my Mirena, though I don’t know if it counts because it was dental and not medical.
Post # 12
Member
690 posts
Busy bee
I don’t think this is legal. Doesn’t sound in compliance with Obama care.
Post # 13
Member
900 posts
Busy bee
KatiePi: I called them today, and they said it was because the woman who put in it wasn’t in contract with them (she is). I called and emailed CoverHer, I’ll also give myself the weekend to cool off and call the insurance company on Monday to see what can be done.
-
This reply was modified 5 years, 5 months ago by
PBeeWriter.
Post # 14
Member
3470 posts
Sugar bee
- Wedding: July 2012 - The Gables Inn, Santa Rosa, CA
KatiePi: Birth control is only 100% paid for pre-deductible if you’re on a method that has a generic available. I fought with this for my nuva ring before we were TTC.
PBeeWriter: That really sucks, but unfortunately they absolutely can get away with that. For example, my deductable is NORAMALLY $250, but for certain medications that aren’t generic yet, I have to pay a lot more because of the way my blue cross plan is structured. Also, deductables aren’t as simple as a single dollar amount, you can have different deductables for different coverage, for example, when I give birth if it’s natural/vaginal my deductable will be $4,000 but if I have a C-section, that counts as surgery, so my deductable is $6,000. It’s all a tangled mess!
Post # 15
Member
3695 posts
Sugar bee
Seems like it would be easier. Like, they would want to avoid paying the $250k in medical bills we’ve had so far this year due to pregnancy, pre-term childbirth, and a NICU stay. After I paid our out of pocket max for all that though, my Mirena was free.