Useless Insurance [female BC talk warning!]

I talked to my gyn when I was 22 about getting either Implanon (which she strongly advised against, because almost all the patients they've had asked for it removed within a month due to side effects), or the Mirena IUD. I figured I was taking a long shot - being 22 and having no kids. Surprisingly, after talking with her for awhile, she was totally cool with the idea and told me to schedule an appointment.

Fast forward to the next yearly, February 2010 ... I chickened out/got comfortable continuing with pills the year in between. She asked if I was still interested, and I said yes. I'd just turned 23. She said if I keep Mirena in for the 5 years, she will do the Essure (sterilization) procedure on me when I'm 28 if I still do not want kids, because right now she still feels I'm too young. I get that, I was still shocked she was willing to do Mirena.

Finally, today I got up the courage to make an appointment for December 10th (I'll be 24 in 2 months ), after reading a good bit of positive experiences on a childfree forum. There was the occasional bad experience, but I still felt better seeing positive ones too, including those going for a 2nd round on Mirena. Went in and made an appointment today since I was in the area of the office. There was a note on the file in the computer - I guess they consulted with my insurance company in February, and the procedure was denied coverage.

The price? $825 for the Mirena + $175 insertion fee. What do I bother paying insurance for? This isn't the first time I got denied for crap. They get probably over $300/month from me, to pay $20 on office visits? When I was taking Yaz, the insurance started covering less and less of the cost, to where I went from paying ~$30/month to $55/month for them. They switched me to Gianvi out of the blue, a generic version, which is only $15. I think insurance covers $5 on it right now. I had to fight them earlier in the year when my husband was diagnosed with TMJ at the doctor. They refused to pay for his visits saying it was pre-existing, though there was never any proof or Dr visits before hand stating that. He had no idea until he went.

The husband isn't so amused at the cost, considering if I stay on Gianvi for 5 years, it'll be $900. He said if I were still on Yaz, he could see the point in trying it, because Yaz would be $3300 for 5 years. There's no guarantee Mirena will be a success story for me reaction-wise, and could ultimately mean throwing out $1k (I assume there are no partial refunds for side effects ) But I'm sick of taking pills daily, having to remember them, having to be sure to order them in time and pick them up from the pharmacy. They've been messing with my periods lately, cutting them down to 2 days, 1 day, or not at all, which trips me out. I know Mirena usually leads to none, but on my pills I'm still supposed to get them. My gyn says its normal after 3+ years of use. Meh. I don't want to do Depo, NuvaRing, etc. I really would prefer to just be darn fixed and be done with it all.

I feel like since he voiced his opinion on it may not being worth it, that he won't be as supportive if I still do it. I know he'll say it's up to me, but I want him to be there for support when its done, and know that he thinks its a good thing.

Stupid useless insurance - I've been seeing threads about people getting it done for the cost of the co-pay. Now I know why most people at work say our insurance coverage sucks.

Yeah, that never made sense to me either. If they cover the cost of birth control, any form of it, from pills to sterilization, they must realise they'll still be out $1000s less than covering the cost of a pregnancy and childbirth. Sheesh! Not to mention your insurance probably covers Viagra... Insurance is getting worse and worse for us the patients. Very frustrating.

I hope you can work something out, whatever you decide to do...

you may want to try going to planned parenthood or the health department. Not 100% sure, but they may be able to do it a little cheaper. Just a thought!

Wonder if it was denied because of your age and it not being medically necessary?? You might want to petition to see if you can get a reversal.

Yeah I'd definitely check something like Planned Parenthood out...

I got to a similiar clinic and only pay $10 a month for my Marvellon. And Yaz is only $15 a pack there too.

Local planned parenthood also said up to $1,000 for an IUD.

The age/medically necessary thing may have been a factor, didn't think too much about that.

Hubby says that insurance co's would rather you have kids, so you pay for them to have coverage as well.

Buy some books about this, get some charts (can be online), buy a basal thermometer, and enjoy the low cost. If you are committed it works. We have been using the above for birth control successfully when I decided years ago I would no longer take BC as there had to be a better, healthier, and cheaper way.

Any chance that you're a carrier for anything bad genetically that has a high likelihood of being passed on? (To put doctors saying "have kids" in their place)

Wow! That's REALLY expensive! I was told by my doctor that most plans here don't cover it either but that it will cost between $300-$400, not double that!

That is ridiculous. Your insurance should cover birth control if they cover birth! It's much cheaper to cover BC than it is to cover a pregnancy and birth. That is just stupid. I would appeal.

But what about your husband. Is he willing to have a vasectomy? Or won't his doc do it for the same reason that your doc would do a tubal ligation?

Most insurance companies only cover a small amount of a brand-name drug, BC or not. That seems to be the issue with Yaz vs. generic here.

As far as covering an IUD, I think it might also have something to do with your age and health as opposed to the IUD itself. To them, it might be considered cosmetic, not necessary, which would reduce their contribution. This is the same for any type of procedure labeled as cosmetic. For example, someone who has rhinoplasty (nose job) because they can't breathe vs. someone who really just wants a new nose.

You might want to contact the company directly and see what they say. You never know, you could sway them to your case. Good luck!!

Originally Posted by Dusty's Mom

That is ridiculous. Your insurance should cover birth control if they cover birth! It's much cheaper to cover BC than it is to cover a pregnancy and birth. That is just stupid. I would appeal.

But what about your husband. Is he willing to have a vasectomy? Or won't his doc do it for the same reason that your doc would do a tubal ligation?

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We had a long discussion about that last night. He doesn't want to do it at 25. He told me a few years ago that he'd do it around 30, thinks 30 is a good, round age, but right now he's not comfortable with the idea. I always take things in a negative way it seems, so of course I figured that meant he was unsure about where he stands kid-wise. He said he is 99.9% sure right now he's never going to change his mind, but still doesn't want to get one just yet - he feels at 30ish, he can make a decision, he'll be older and "wiser" and others won't look at him like he's nuts . He also told me "who knows, next year I might decide I want to do it, life is uncertain." I told him the Mirena will come out about a week before he turns 30

He said he supports my decision to get an IUD instead of staying with pills, but wants to be sure I'm not going to say "OMG the pain is too bad, I want it out." after 1 month (I've read many experiences, usually the first 2 months are the worst, but usually bearable). I did tell him that there's no way to control how my body reacts with it and I don't want him mad at me if we spend the money and it doesn't work out for me - heck there's no guarantee anything will work for anyone. Some people are completely fine, others have pain for a long time, some have other side effects, and I'm willing to deal with most of them. My friend had Paragard (copper one), she dealt with it for a year before having it removed because cramps brought her to her knees on it, and her husband had a vasectomy (how Rob and I got on the topic of it - after she brought that up. The difference is that my friend has a kid, and her husband is 30, though I don't know when exactly he did it).

I don't know if the doctors would do it at 25 or not - I did read somewhere once that 21 is the minimum age for guys (seemed off, though...), but my FIL had to go through "counseling" before he was permitted to get one, since he was 25 (but he had 2 kids by then).

I hate that insurance is so quick to cover those who want kids, but not those who are doing everything they can to not have them

Originally Posted by strange_wings

Any chance that you're a carrier for anything bad genetically that has a high likelihood of being passed on? (To put doctors saying "have kids" in their place)

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Nope, nothing to pass on. I almost want to go to my appointment and say "Can we just get on with the Essure instead. I'm still as certain as I was 2 years ago..." I'm already nearly 2 years closer to the time she said she'd do it if I hadn't psyched myself out about the Mirena for so long. Luckily my doctor never said she thinks I don't know what I want, I think she feels it's ethically "wrong" to do Essure at my age without having something genetic or a health risk.

I'm tempted to ask HR why we have an insurance company that fights just about anything people file claims on This wouldn't be the first time I have to fight them on things. The fact it's not "necessary" makes sense, but at the same time, what makes pills more necessary than an IUD ... they'd probably save money in the long run covering just part of an IUD instead of pills every month for the same amount of time.

Edit: Earlier I mentioned PP says up to $1k also ... I think its because the Mirena costs $843 itself according to their site

I just think it's so messed up for doctors to ask you to go through councilling or refuse to do sterilization at an early age..What the heck, as though they won't let you choose what you want done to your own body? It must be easier to get plastic surgery than get a sterilization procedure done
I'm just mad because I want to get a tubal ligation done too and I'm 22 and I think the only person who should decide is ME and I shouldn't have to explain my choice for it either...

My DIL had triplets in Aug. and they won't do her either!

Originally Posted by ut0pia

I just think it's so messed up for doctors to ask you to go through councilling or refuse to do sterilization at an early age..What the heck, as though they won't let you choose what you want done to your own body? It must be easier to get plastic surgery than get a sterilization procedure done

I'm just mad because I want to get a tubal ligation done too and I'm 22 and I think the only person who should decide is ME and I shouldn't have to explain my choice for it either...

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I'm not sure what country this one girl was from, but she was 20 and got a tubal done. Brought some paperwork talking about laws that give you the right to your own body and what you do with it is up to you, and the doctor agreed.

I, too, think it should be up to ME to decide what to do to my body. Make me sign a legal form saying I willingly did it, that I insisted it's what I want for the entire time I've visited the doc, if they are afraid of me suing them later on or something

My friend made me feel a bit better about the whole thing today overall (my fears and whatnot, said its stupid they wont just do what I ultimately want), but I'm still royally irked I have to pay for the whole thing ... crappy insurance. Bet they're covering the three pregnant girls at work completely though

Did some research earlier and there were a lot of statements that insurance will only cover Mirena if its needed for a health reason, not if it's used as birth control. WTH?

I'm on my second Mirena and I love it(it was covered by insurance both times.) Of course I also have a child and I know want another if I can ever find the other necessary requirement for that(a man) so I don't want anything permanent. I would ask the insurance why it was denied.

Taryn

Now I am no expert but is Mirena just recommended for those who have had at Least one child? Ie works better in those who have physically had a baby?

As for why they wont let you get a tubal is beoynd me ...

You're correct sharky. Its recommended for those who have had a child already because it's easier to get through the cervix.

Originally Posted by Tara & Rob

I'm not sure what country this one girl was from, but she was 20 and got a tubal done. Brought some paperwork talking about laws that give you the right to your own body and what you do with it is up to you, and the doctor agreed.

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I think I saw that - the Canadian fighter pilot, correct? Up there women are able to argue that denying it because one is younger is ageism, a type of discrimination. I'm not sure if it would work in the US, but it's worth pointing out that it is discrimination. But we have doctors here that can refuse to even prescribe BC pills if they want to...

If your husband would seriously consider a vasectomy but is worried about wanting children someday he could always have some sperm frozen.

Before we had our LO; DH's insurance wouldn't cover any BC. We paid out of pocket. I got off of it when we wanted to try and let me tell you; there is no way I am going back on it! I didn't realize what a number it was doing on me. I feel better off of it....like SOOO much better. After I was pregnant DH's insurance decided to cover BC. His insurance is paid by his union. The down side to that for us is that because his union is based in a neighboring state; almost no doctors or hospitals in our area are "in-network" so we end up paying about 20% of the cost of our medical bills. Pretty standard from what I used to see for patients at work. I think it cost us about $4000 to have our baby; including her time in the NICU. Crazy.

I thought you had to have already had a child for the mirena too. My step-sister has it and that was also what she told me. I could never do it; just because the warnings make it sound like it is still possible to concieve; but implantation cannot occur; or it could cause a tubal. I plan on having my tubes tied once we are done having kids. Basically now I just follow some of the advice from the book "taking charge of your fertility." So far so good; and I don't feel like I did on BC.

They usually won't use Mirena on a woman who hasn't had a child. Having had it done twice, once about 8 weeks after giving birth(at 23) and once when my son was around 4(I had the first removed when I got divorcedafter I had it for around 3.5 years.) It is easier when you are postpartum and your cervix hasn't clamped shut yet. 'Opening' me up the second time was the worst part, even though I will say that the contractions(and yes insertion will cause contractions) when they insert it are a lot harsher postpartum. Either way it's not a comfortable insertion, but it's not really bad, just uncomfortable. Getting it removed is the easiest thing in the world, I didn't feel a thing.

It hasn't bothered me at all and I like it. I wouldn't get a Paraguard(copper T) if you paid me, my periods are bad enough(massive cramps and heavy bleeding) without having something that will make them worse. Let me just say the first period I had after having the Mirena removed reminded me why I had it in the first place, well other than the obvious of I didn't need another kid. I liked the first Mirena, it finally settled down to having my period every 6months for 1 day and only needing a panty liner. This time it comes when it comes and stays for about a week but it is very light(for me, I still need pads.)

I would fight it out with the insurance and find out WHY they won't cover it first. You need to know what the reason was for the denial before you can find out what angle you need to take to see if you can fight it.

Most of the people I know who have had the Mirena love it,I know I love mine. I don't even have to think about it. Seriously, the insertion is the worst part and it really isn't that bad. Talk to your doctor find out what her rates are of people wanting it removed because they don't like it and what she thinks and go from there. If I could afford it I'd pay for it to be done out of pocket, but I already know I like it.

Taryn