Is IUD Removal Covered by Insurance?
Understand IUD removal insurance coverage. Learn key factors, how to confirm your benefits, and manage potential financial responsibilities.
Intrauterine Device (IUD) removal is a routine medical procedure. Understanding your health insurance policy’s specifics is important to determine potential costs and ensure appropriate coverage.
Key Factors Influencing Coverage
The Affordable Care Act (ACA) mandates FDA-approved birth control, including IUDs, are covered without cost-sharing. This includes the device, insertion, counseling, removal, and follow-up care. Coverage depends on the medical reason.
IUD removal is classified as “medically necessary” or “elective.” Medically necessary removal (due to complications, expiration, or pregnancy desire) often has comprehensive coverage, aligning with ACA preventative care. Elective removal for personal preference without medical indication may lead to out-of-pocket costs.
Insurance plan type influences coverage. HMOs, PPOs, and HDHPs have distinct structures for deductibles, co-pays, and coinsurance. In-network care results in lower out-of-pocket costs. Familiarize yourself with your plan’s network and cost-sharing rules.
Steps to Confirm Coverage and Minimize Costs
Contact your insurance provider directly to determine IUD removal coverage. The member services phone number is on your insurance card. Inquire about specific CPT codes: 58301 for routine removal, 58562 if embedded and requiring hysteroscopic removal.
Ask about coverage for associated costs: office visit fees, anesthesia, and facility charges. Some procedures require pre-authorization. Pre-authorization confirms coverage and medical appropriateness, but not payment.
Verify your healthcare provider and facility are in-network to minimize expenses. Document your call: date, time, representative’s name, and reference numbers. This record helps with billing discrepancies.
Understanding Your Financial Responsibility
Even with insurance, you may have financial responsibility for IUD removal. Understand common terms: deductible (amount paid before insurance pays more), co-pay (fixed amount for a service), and coinsurance (percentage of cost after meeting deductible).
The out-of-pocket maximum is the highest amount you pay for covered healthcare services annually. Once reached, your plan covers 100% of additional in-network medical expenses. For example, 2025 marketplace plans have individual maximums up to $9,200 and family maximums up to $18,400.
After the procedure, you will receive an Explanation of Benefits (EOB). This document details services, billed amount, insurance coverage, and what you owe. An EOB is not a bill; review it carefully and compare it with your provider’s bill for accuracy. If a claim is denied or costs are unexpected, you can appeal through an internal review with your insurer (usually within 180 days). If unsuccessful, an external review by an independent third party is an option.