IUD costs and doctors protocol

[american_mama]

I am looking into birth control options more seriously than I ever have and have lots of questions about the costs and protocols with IUDs. I am interested in answers for both Paraguard and Mirena.

First, how many visits did it take for you to get your IUD? My midwife schedules three: one to get "cultures" (not sure what that means), then 4 weeks later (why so long?) the actual insertion, then 4 weeks later checking the strings. Seems like a lot of appointments to me.

Second, my midwife inserts them during your period, which I've heard is common. But surely that can't be the end all, be all. What if your period is highly irregular? What if you're breastfeeding and have no idea when to expect your period? What if you get it at a 6 week post-partum visit... very unlikely you'll have a period then. And those women getting insertions at 6 weeks post-partum, which I think are common, probably don't have thr right vaginal cultures on record, right? Plus, out of curiosity, are some people so regular that they can schedule an appointment weeks in advance and have it likely coincide with their period? Or do most people call in when AF arrives and get a next day appointment?

Third, how much did you pay out-of-pocket for your IUD and which type was it? Did this include the office visit or visits AND the device, or were they separate? I called insurance today and there was some confusion, but it seemed likely to be $72 or less. I know many people pay much more.

Fourth, did you get the IUD at your doctor's office the day of insertion or are you given a prescription in advance that is filled at a pharamcy? When I was talking to the phamacy benefits side of my insurance, the representative said it was listed as though I could get it at a pharmacy with a prescription and then bring or have it delivered to my doctor which would be cheaper and easier (in terms of paperwork) for me. I never even considered where the darn thing is procured from, so I will have to make some calls tomorrow to figure that out since it seems to have a big impact on the cost.

And, and I read on another message board that someone wants to have her IUD taken out as soon as its been in long enough for insurance to pay for the removal. Huh? Why would insurnace refuse to do it "too soon"? And does removal cost the same as an office visit? (which, granted, might be a lot if this lady doesn't have insurance).

Thanks! I was really surprised at all the procedures involved in getting an IUD and wondered what others experience was.

[kijip]

I had 1 visit. I already had a recent PAP when I knew I wanted one so a pre-insertion PAP was not necessary. The strings never bugged me so I never needed a post insertion visit. My insurance was going to be way less at the end of the month so I scheduled it ASAP, did not line it up with a period. It's my understanding that if you have had a baby/fully dilated and labored that they don't need to do it only when you have your period. I paid the regular surgical procedure co-pay which was (it's been over 3 years, I don't recall *exactly*) about $100. I had it taken out during a regular annual exam, nothing special but I let them know in advance that I wanted it out. This was for a Mirena, not a Paraguard. The IUD itself was received at my OBGyn office, no need for me to call a Pharmacy. It was my understanding that it was a common enough request that they stocked them both.

[AshleyAnn]

I'm planning to get one (probably paraguard) inserted at my 6 week pp appointment.

1. I think she means she does a regular pap, which cannot be done during your period, then perfers to insert it during your period, and then wants to check everything is ok after insertion. I think it seems like a lot of appointments too. If your pap is current I think you could skip it or maybe request it be inserted at the same appointment

2. Inserting is done during your period because it ensures you are not pregnant and reduces the amount of cramps/discomfort you have because your cervix is already slightly open. Its not a requirement of most doctors - most just give you a pregnancy test and ask when your last period was. [At one time I was regular enough to schedule a doctors appointment around my period months out. Then I got married and they went crazy.]

3. I'm on Tricare so mine will be pretty much covered. My research shows that most doc charge around $200 to $300 to insert one before insurance picks up the tab.

4. Obviously I haven't had one but I have discussed it with my doctor and researched them and not once have I ever heard of picking it up before the procedure. I think some people get a script for pain relief for the cramping.

5. Removing a IUD is simple and quick and I doubt there is a medical billing code for removing an IUD so I don't know why it would cost more than an office visit/physical or be restricted as to when you can have it taken out. I think it also has the same rules as the Norplant did years ago and the cost of removal is included in the cost of insertion to ensure women didn't keep it in for too long b/c they couldn't afford to remove it.

[nfowife]

I also got my IUD in one visit. I just called to my OB ahead of time and said I wanted to get an IUD and could they get pre-auth from my insurance provider and they did. They said they might have to do a second appt. but they were able to do it at my pap appt. I was 7 month pp and had not yet had my period back (I was nursing) and it wasn't a problem. I don't have a co-pay so there was no cost to me associated with it.
I have Mirena and am very satisfied. Insertion didn't hurt at all, no issues with it, and I'm not pregnant so so far, so good!
I did not have to get a prescription filled. Just had to get the pre-auth from my insurance company that my OB took care of.

[Nooknookmom]

I had a consultation visit and insertion visit. No pre auth w/ my ins. Everything is in-house (Kaiser). I have Mirena.

So far no preggo, but I swear it affects my hormone levels, I have been a moody mess since insertion. Not as bad as the pill but close.

I don't like any BC but at this point it's necessary!

[baileygirl]

I have Paraguard and had it inserted about 6 weeks pp. I only had 1 appointment and they did an ultrasound during the appointment to make certain it was inserted properly. I didn't have any follow up appointments from there. I didn't have my period at the time (6 week pp), so that wasn't an issue. With my insurance I had to pay a $20 co pay and I didn't deliver the IUD to the dr or anything like that. No clue on the cost to remove it, but I couldn't imagine it would cost much more then a drs visit.

[SnuggleBuggles]

I did have 3 appts. but that's b/c I was due for a check up. Insertion and string checks were other appts..

I had it done during my pd with ds1 but had it done postpartum (8w) with ds2 and still didn't have my pd. It was not an issue. Insertion is easier during it b/c you are more dilated naturally.

$600 b/c insurance didn't cover it. :(

Removal was same as office visit.

Beth

[Seitvonzu]

i had 3 appointments i think... regular, insertion, and i did go in to have them check it. so far so good-- i've had it about a year.

i think it cost something like 50 dollars out of pocket? it would have been something counted against my deductible (not a regular office copay thing)...i'd already had my appendix out so, deductible met! i figured it was the time to get it, since you always hope you WON'T meet the deductible in the future. between the device and the office visits i was told something like 600 before insurance.... it would have been around 300 if i hadn't already met my individual deductible!

[o_mom]

I had mine put in about 6 months PP. I was still EBF with no periods. I didn't have any appointment beforehand for cultures, but I have heard of people having this. I did have the follow-up appointment. That last one screwed up some of my insurance claims for the rest of the year as they billed the follow-up visit as 'routine care' which has a benefit limit on our policy. I would ask the billing dept in detail how they bill the three visits and talk to the insurance on how that might affect other benefits.

I was told that putting it in during a period was for two reasons. First, to have the cervix more open and second was to make sure you were not pregnant. Since I was EBF, they had me take a blood pregnancy test a couple days prior to the insertion. If I was having periods, they said to call the first day of my period and they would schedule it then.

My OOP expense was less than $100. I'm not sure exactly, but I know they had me pay upfront my percentage based on the billed amount, which of course was more than what I owed based on the allowed amount. We have good insurance, though, so my coinsurance was 10%. There was a copay for the follow-up visit as well.

The doctor's office had the Mirena, but they are a fairly large practice, so I'm sure they stock them. A solo or midwife might not do them often enough to keep some on hand.

No idea on removal, mine is still in.

[elephantmeg]

I had the 3 appointments-they did cultures at my 6 wk pp apt, then did the insertion at 10 wks pp then did a recheck a week or 2 later. My insurance didn't cover it and it was $700+. A friend has insurance that covers it and it was $40.

[khalloc]

I got Mirena after I had my son. I dont remember having any cultures or anything like that but after my 2 week post-partum appointment, we talked about the IUD and made an appointment for it. I think they preferred to wait 8 weeks after giving birth to put the IUD in. I went back to have the IUD put in after I was about 8 weeks post-partum with my son. I did have to go back 6 weeks after that to have the strings checked. But that appointment wasnt necessary. I think you could skip it if you werent having problems with the strings. I didnt have any issues with them.

I didnt pay anything for the IUD, insurance took care of it. I may have had to pay a $15 co-pay.

[pb&j]

One visit for the insertion, one visit about 6 weeks later to check that everything was in the right place.

I did stop by the day before the insertion to pick up a cytotec tablet - they have you place it by your cervix the night before so that your cervix is soft and insertion is easier. And they had me take a urine pg test just prior to insertion.

The Dr's office had the device there. Total cost for the two visits, cytotec, device, and insertion was just my $20 visit copay. I think a lot of it depends on how the Dr's office bills for it. When I had my prior one removed by my GP (different doc), it was also just a $20 copay.

[amandabea]

Three visits. Paid $450 OOP for the device (Paraguard). Can't recall if I also had to pay my $20 co-pays -- I'm sure I made at least one or two, but not three.

[american_mama]

Keep the info. coming, ladies! I just got off the phone with the midwife's office staff and all I can say is what nonsense. I have talked twice to them and once with insurance, and each keeps telling me to ask the other what it will cost. Maybe there is one fee for the device and another for insertion, maybe not. Maybe it differs by IUD type, maybe not. I need the procedure codes to know for sure, but I have to stop by the office to pick up the procedure codes (ridiculous - they can't read a few numbers to me over the phone?). I must read the informational brochures "very carefully" since that is part of their protocol. Good grief, I am a BBBer. With the research I have done, I think I could write it by now.

What I want which the reception staff seems reluctant to do is have a consultation with my darn midwife about which option would be better for my particular medical situation and to pick the IUD based on that, not reading a generic brochure without input from my provider. I am willing to come in for THAT (not so willing to come in to pick up brochrues and procedure codes) and they can even bill my stupid insurance for it and make some money rather than my midwife and I playing inefficient phone tag and her not getting paid for her trouble.

I am due for an annual exam, but my midwife works part-time and only schedules a certain number of annual exams (because, you know, they are SO time consuming). The next one is mid-November and that's a $15 copay. But for an appointment for just cultures (which is not a normal pap, but a chlamydia/gonorrhea/step B culture) is quicker and can be done sooner, but comes with a $30 copay. Ok, the money difference is minor, but out of curiosity, I asked what if I come in for my annual but have the cultures for an IUD done then too? What's my copay then? Uhh, confusion. Depends on how it's billed. She doesn't know. Who DOES know? Why is it so hard to figure out how much I might be paying for a fairly expensive yet common birth control device?

BTW, my midwife practices with an obgyn and I think their patient load is as full as a 2 person office can be. I have insurance from the largest employer in my town. So I don't think anything about what I want is unusual and is probably something they do every week. I don't understand why the rigamarole.

[Piglet]

I have the Mirena. I had my 6 week PP appointment after DD was born. Did a pap at that time and got the script for the IUD. I picked up the IUD and went back within a few weeks to get it inserted. My dumb luck is that my strings got lost so I actually made a follow up appt to make sure the Mirena wa still in place. I then had an US to confirm that 1) the IUD is in place but 2) the strongs are lost... not great news?! Fortunately as long as it is in place I don't have to worry about getting it out for 5 years and DD is just 2 right now.

Moos-wise, it has been the best of all the BC's I have been on. WAY better than Depo (evil drug) and much better than any BCP I tried. I get very bad mood swings and virtually zero drive when on BC and have not experienced much of either on Mirena.

I think you might be "unique" in that you are getting it done well past PP. I think your office sounds more in tune with PP patients, which might explain all the various appointments. Had you been PP, they would simlpy have booked your 6 week visit/pap, your insertion and your follow up.

[Octobermommy]

5. Removing a IUD is simple and quick and I doubt there is a medical billing code for removing an IUD so I don't know why it would cost more than an office visit/physical or be restricted as to when you can have it taken out. I think it also has the same rules as the Norplant did years ago and the cost of removal is included in the cost of insertion to ensure women didn't keep it in for too long b/c they couldn't afford to remove it.

There is a billing code for removing an IUD, it costs more than insertion (although it really shouldn't b/c there is usually less time involved) and there are no rules about not charging for removal. Every doctor charges for removal, at least every one I know of and insurance including medicaid pay for removal.

[Tondi G]

I spoke with my doctor at my regular annual exam so I was having a Pap then anyways.... maybe she did cultures then?. I came in the day after my period arrived... just called and they did a squeeze you in visit. Came in, had the insertion that hurt like hell. I was hurting and almost fainted so my OB sent me down for an Ultrasound to make sure it was inserted correctly. It was in the right place so they sent me on my way. I paid out of pocket cause my insurance doesn't cover implanted contraceptives. It was almost $800 plus the $130 for the insertion and office visit and co-pay. When I had it removed it cost me the co-pay, a removal fee ... I think it was 250 bucks to get the damn thing out. Best thing I ever did having it removed! I had a Paragard and will never get an IUD ever again!

Good Luck

[mommyp]

We did consultation at my PP visit, so then I had two appts, one for insertion and one for string check (that was optional). I only had to pay the co-pays for the visits. I had it put in about 4 mo. PP, so I hadn't had a period yet, it was fine, uncomfortable, but not bad. I have Mirena, it was provided to me at the office at my visit. I don't know about removal yet, it's still in.

[mom2beofboy/girltwins]

Sorry so long.....I know you didn't really ask about experiences with Mirena other than from a office visit/cost standpoint, but I wanted to share my experience with you. I have had really bad migraines for years and after a visiting the neurologist ended up realizing they were hormonally related and being caused by the hormones in the BC pills. Only way to get rid of them was to get on non-hormonal BC. Mirena seemed to be the best choice. Usually suggested for women who have already had a child but my gyn didn't have an issue with me using it anyway. Went in for one appt where it was inserted in the office (only paid an office visit co-pay and they had the IUD there). Unbeliveably painful - cramping so bad I thought I was going to throw up. Afterwords they were like, oh yeah, some people have some cramping... (thanks for the heads up). Continual issues with it after that, eventually led to PID. Had to take a plethora of antibiotics to make sure they got rid of the infection and I had the thing removed. I think a PP said getting it removed was the "best thing I ever did" and I totally agree. A friend mentioned she wanted to get one last year after she had her first baby and I reminded her of my experience. She figured it was just a fluke and maybe becuase I hadn't had kids yet and decided to get one anyway. Hurt her like h*ll to get it put in also. She also only had to pay a office visit co-pay for hers. Fast forward..... at her annual this year the dr noticed he couldn't see the strings or whatever anymore and got concerned that it wasn't in her anymore. She had to have an ultrasound scheduled and they ended up seeing that it way inside her where it didn't belong. She had been unprotected BC wise for who knows how long and to make it worse if she had happened to get preg while that was going on the dr told her she could not have continued the pregnancy. She had to have laproscopic surgery scheduled to remove the thing and she's still waiting to find out if she's going to have to foot the whole bill becuase somewhere along the line in this whole mess her insurance stopped covering IUD and their removals. Nice, huh? She's done alot of looking into this since it happened to her and it turns out it happens alot. It's not in Mirena's literature because they only report statistics based on their trials, not real life. Also according to her gyn, they're not required to report this incident with the product because it didn't result in a pregnancy. Even nicer!! Anyway, regardless of what it costs just really look into this before you decide to have it done. I know there's probably lots of people that have used it without issue, but I think there's quite a few that have problems too. I eventually turned to Nuvaring - lower hormones at a continual does, so I didn't have as much migrane problems. I never had an issue with it and really liked it as BC.