\u201cShe told me that IUDs are almost universally covered under insurance but she would send out the prior authorization anyway,\u201d Anderson said.<\/p>\n
She said she heard nothing more and assumed that meant it was covered.<\/p>\n
After waiting months for an appointment, Anderson had the insertion procedure last March. She paid $25, her copay for an office visit, and everything went well.<\/p>\n
\u201cI was probably in the room itself for less than 10 minutes, including taking clothes on and off,\u201d she said.<\/p>\n
Then the bill came.<\/p>\n
The Medical Procedure<\/strong><\/p>\n According to Planned Parenthood, IUDs and implantable birth control represented nearly 25%<\/a> of its contraceptive services provided from October 2021 to September 2022, per the latest data available.<\/p>\n There are two types of IUDs<\/a>: copper, which Planned Parenthood says can protect against pregnancy for up to 12 years, and hormonal, which can last from three to eight years depending on the brand. Hormonal IUDs can prevent ovulation, and both types affect the movement of sperm, designed to stop them from reaching an egg.<\/p>\n A physician or other practitioner uses a tube to insert the IUD, passing it through the cervix and releasing it into the uterus.<\/p>\n Doctors often recommend over-the-counter drugs for insertion pain, a concern that prompts some patients to avoid IUDs. Last year, federal health officials recommended doctors discuss pain management with patients beforehand, including options such as lidocaine shots and topical anesthetics.<\/p>\n The Final Bill<\/strong><\/p>\n $14,658: $117 for a pregnancy test, $9,862 for a Skyla IUD, $4,057 for \u201cclinic service,\u201d plus $622 for the doctor\u2019s services.<\/p>\n The Billing Problem: A \u2018Grandfathered\u2019 Plan<\/strong><\/p>\n Anderson got a rare glimpse of what can happen when insurance doesn\u2019t cover contraception.<\/p>\n The Affordable Care Act requires health plans to offer preventive care, including a variety of contraceptives<\/a>, without cost to the patient.<\/p>\n But Anderson\u2019s plan doesn\u2019t have to comply with the ACA. That\u2019s because it\u2019s considered a \u201cgrandfathered\u201d plan<\/a>, meaning it existed before March 23, 2010, when President Barack Obama signed the ACA into law, and has not changed substantially since then.<\/p>\n It\u2019s unclear how many Americans have such coverage. In its 2020 Employer Health Benefits survey<\/a>, KFF estimated that about 14% of covered workers were still on \u201cgrandfathered\u201d plans.<\/p>\n Anderson said she didn\u2019t know that the plan was grandfathered \u2014 and that it did not cover IUDs \u2014 until she contacted her insurer after it denied payment. Her doctor with Geisinger, a nonprofit health system<\/a> in Pennsylvania, was in-network.<\/p>\n \u201cMy understanding was Geisinger would reach out to insurance and if there was an issue, they would tell me,\u201d she said.<\/p>\n Mike McCullen, a Geisinger spokesperson, said in an email to KFF Health News that with most insurance plans, \u201cprior authorization is not required for placing birth control devices, however, some insurers may require prior authorization for the procedure.\u201d<\/p>\n He did not specify whether it is the health system\u2019s policy to seek such authorizations for IUDs, nor did he comment on the amount charged.<\/p>\n The Pennsylvania State Troopers Association, which offers some retirees the plan that covered Anderson, did not respond to requests for comment. Highmark Blue Cross Blue Shield, the insurer, referred questions to the state.<\/p>\n Dan Egan, communications director for the state\u2019s Office of Administration, confirmed in an email that the insurance plan is a grandfathered plan \u201cfor former Pennsylvania State Troopers Association members who retired prior to January 13, 2018.\u201d<\/p>\n A benefit handbook<\/a> for the plan identifies it as grandfathered and lists a variety of excluded services. Among them are \u201ccontraceptive devices, implants, injections and all related services.\u201d<\/p>\n The $14,658 bill, an amount that typically would be negotiated down by an insurer, was solely Anderson\u2019s responsibility.<\/p>\n \u201cFourteen thousand dollars is astronomical. I\u2019ve never heard of anything that high\u201d for an IUD, said Danika Severino Wynn, vice president for care and access at the Planned Parenthood Federation of America.<\/p>\n Costs for IUDs vary, depending on the type, where the patient lives, insurance status, the availability of financial assistance, and additional medical factors, Severino Wynn said.<\/p>\n She said most insurers cover the devices, but coverage can vary, too. For instance, some cover only certain types or brands of contraceptives. Generally, an IUD insertion costs $500 to $1,500, she added.<\/p>\n Many providers, including Planned Parenthood, have sliding-scale rates based on income or can set up payment plans for cash-paying or underinsured patients, she said.<\/p>\n According to FAIR Health<\/a>, a cost estimation tool that uses claims data, an uninsured patient in the Scranton area could expect to be charged $1,183 for an IUD insertion done at an ambulatory surgery center or $4,319 in a hospital outpatient clinic.<\/p>\n The Resolution<\/strong><\/p>\n Anderson texted and called her insurer and Geisinger multiple times, spending hours on the phone. \u201cI am appalled that no one at Geisinger checked my insurance,\u201d she wrote in one message with staff at her doctor\u2019s office.<\/p>\n She said she felt rebuffed when she asked billing representatives about financial assistance, even after noting the bill was more than 20% of her annual income.<\/p>\n \u201cI wasn\u2019t in therapy at the time, but at the end of this I ended up going to therapy because I was stressed out,\u201d she said. The billing office, she said, \u201ctold me that if I didn\u2019t pay in 90 days, it would go to collections, and that was scary to me.\u201d<\/p>\n Eventually, she was put in touch with Geisinger\u2019s financial assistance office, which offered her a self-pay discount knocking $4,211 off the bill. But she still owed more than she could afford, Anderson said.<\/p>\n The final offer? She said a representative told her by phone that if she made one lump payment, Geisinger would give her half off the remaining charges.<\/p>\n She agreed, paying $5,236 in total.<\/p>\n The Takeaway<\/strong><\/p>\n It\u2019s always best to read your benefit booklet or call your insurer before you undergo a nonemergency medical procedure, to check whether there are any exclusions to coverage. In addition, call and speak with a representative. Ask what you might owe out-of-pocket for the procedure.<\/p>\n While it can be hard to know whether your plan is grandfathered under the ACA, it\u2019s worth checking. Ask your insurance plan, your employer, or the retiree benefits office that offers your coverage. Ask where the plan deviates from ACA rules.<\/p>\n With birth control, \u201csometimes you have to get really specific and say, \u2018I\u2019m looking for this type of IUD,\u2019\u201d Severino Wynn said. \u201cIt\u2019s incredibly hard to be an advocate for yourself.\u201d<\/p>\n Most insurance plans offer online calculators or other ways to learn ahead of time what patients will owe.<\/p>\n Be persistent in seeking discounts. Provider charges are almost always higher than what insurers would pay, because they are expected to negotiate lower rates.<\/p>\n Bill of the Month is a crowdsourced investigation by <\/em>KFF Health News<\/em><\/a> and <\/em>The Washington Post\u2019s Well+Being<\/em><\/a> that dissects and explains medical bills.\u00a0Since 2018, this series has helped many patients and readers get their medical bills reduced, and it has been cited in statehouses, at the U.S. Capitol, and at the White House. Do you have a confusing or outrageous medical bill you want to share? <\/em>Tell us about it<\/em><\/a>!<\/em><\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\n![](\"https:\/\/fctuckerbatesville.com\/wp-content\/uploads\/2025\/01\/ANDERSON-5-scaled.jpg\")
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