Birth Control Not Being Covered Under Insurance

Updated on February 03, 2012
J.S. asks from McHenry, IL
15 answers

I have had the same health insurance for 5 years with my company. Before I got pregnant I was on birthcontrol for 2 years, then decided to start our family. Now that we have our wonderful son we want to wait a little longer before we add another addition. I went to my doctor to get a prescription for nuvaring.

I just got a bill from my doctor's office for just over $500 because my insurance does not cover birth control anymore. No memo to the staff saying hey we are taking away benefits.

Anyone have any advice for me for when i call my insurance person at my company tomorrow.

Obama care says that all insurance companies will be required to cover birth control but not until August 2012.

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So What Happened?

well after talking to all - insurance, doctor and HR . I now know that my company wanted to go cheap so they dont offer any benefits for contraceptive management. whether its the pill, ring or mirena

Featured Answers



answers from Pittsburgh on

At least we're not under Santorum who doesn't believe in birth control....for all...ever.

I'd pay the $500. Maybe technically, you should have asked for a quote of price before you had it done.

Sucks. Sorry. Obama is trying. At least.

11 moms found this helpful

More Answers



answers from Charlotte on

I'll just bet they cover Viagra.



9 moms found this helpful


answers from Salinas on

Sorry for you it isn't August 2012 but just another reason I do not understand why people on here (woman with families for the most part) are constantly saying "repeal Obamacare".
Little changes lead to big ones, universal healthcare for all Americans!

3 moms found this helpful


answers from Chicago on

Illinois already has a law in place regarding contraception coverage. I don't know if this applies to you, but you may want to check it out. This is how ridiculous and short-sided employers are. They won't pay for contraceptives, but will pay for a pregnancy. Go figure.

3 moms found this helpful


answers from Santa Barbara on

Coverage changes all the time, you need to verify these type of things before you have a procedure done.

It sounds like you had an IUD done so that is good for years and worth every penny!! Much less expensive than a baby!

2 moms found this helpful


answers from Raleigh on

Unfortunately, you'll probably have to pay it. However, check with insurance and see if pills are covered instead. Maybe you can switch. Otherwise, go to Planned Parenthood if you have one close by. It's where I went for years for BC when I was under-insured as a student.
You can always call the manufacturer of the Nuvaring and explain to them what happened, and that you want to continue using their product. They may have vouchers or coupons to give you to cover some of the expense.

2 moms found this helpful


answers from Chicago on

You should ALWAYS call your insurance before having any type of medical things done. My Dr's always tell me my portion before doing anything that is costly. Maybe your insurance just doesn't cover that type of birth control (mine doesn't).

2 moms found this helpful


answers from Philadelphia on

The fact that it is bill from your doctors office... and not your pharmacy makes me think it is IUD or something along those lines.....
it is possible the method you got was not covered.... or as Cora mentioned... your deductable.
Coverage can change year to year and it always a good idea to calll and check your coverage....

2 moms found this helpful


answers from Pittsburgh on

Wow - a plug for Mr. Obama's health care plan :). Yup, it will be better for women. And families. If you are certain you never received notification of the change, then I would contact your insurance company. Let them know that you spent this money KNOWING it was a covered benefit. Ask them for documentation that they notified you of the change. If they can't tell them you expect them to pay. And talk to that person's supervisor when they can't help you. And their supervisor until you have someone who can fix it. And get ALL their names, phone extensions and e-mail and document everything. Call every 48 hours until it is resolved (they will tell you someone will get back with you in a few weeks - tell them your physician needs to get paid and keep bugging them). If they provide you with documentation that you were notified (and it could be hidden in those 50 page things they send) I think you are out of luck. Your physician's office might offer you a 'cash' price or work out a payment arrangement with you if that is the case.

2 moms found this helpful


answers from Boston on

Wow. Does your idiot employer not realize that it's cheaper to cover birth control for 20 female members than to pay pregnancy, labor and delivery costs for one? Talk about not grasping the idea of cost vs. benefit and that whole "ounce of prevention = a pound of cure" concept. If I were you I would get a group of female employees (and men with wives of childbearing age) together and complain loudly and repeatedly until your employer changes this coverage option back to something reasonable. Idiots.

2 moms found this helpful


answers from Washington DC on

Check carefully. It may be that the insurer covers BC pills or other specific forms of birth control but not the ring you mention. Unless your employer has a religious reason not to cover BC, I would be surprised if there were absolutely zero coverage of all forms of BC. It may be lousy coverage but that would be better than none. You may have to change the form of BC in order to get some coverage.

Also, it's possible that someone in the doctor's office wrote a wrong coding number on the forms they submit to insurance. Double check that too. A single wrong digit typed by someone in the doctor's office can cause insurers to reject a claim from a doctor's office and it can be very tough to get things "recoded" and sent back through both the doctor and the insurer. Ask specifically what the code is for this ring and what the code was on the forms the doctor's office sent. Unfortunately these days the patient must ask about and track these kinds of administrative details herself. I had to spend about four phone calls to get a wrongly coded form corrected and sent to the insurer again --though the fault was with the doctor's office. Insurers will not help you; they will insist the doctor's office must correct it, and even then the insurers will argue with you over it. But check!!

1 mom found this helpful


answers from Washington DC on

Well what did you get? Is it possible like an IUd for the insurance we jut got rid was covered, but I had to pay the deductible of $1000. so net effect was not being covered. It would have at least met my deductible for the year though.
I am waiting until August when it is covered. Remember churches are exempt forever and many quasi religious groups get an extra year(like a catholic hospital or many add on catholic charities)



answers from Chicago on

Before I had my daughter in 2010 I was on Nuvaring for years, and the insurance I had covered it, but also had a maintenance program (where if I ordered 3 months worth, then I only had to pay for 2 - I did it through Walgreens & picked it up at Walgreens - wasn't mail order). After my daughter I went back on the ring for a while, but was having some issues, so my doctor suggested going off for 3 months and then going back on, well, in the meantime I lost my job and was placed on my husband's insurance...when I went to order the new nuvaring, I was told his insurance didn't cover it - when we called the insurance company they said it was b/c they only cover oral contraceptives...well, there were medical reasons I was on nuvaring & we asked if we had a doctor write in to tell them why if they would cover it (most will make exceptions if a doctor says there's a valid reason to do something differently than how the insurance company prefers), but we were told no. We had to contact my husband's HR and talk to them about it - they had no idea the plan was written this way & said they would fix if for 2012...but now we're TTC again, so it doesn't matter - I've been off bc since April though because of his company...
I had GREAT insurance w/my daughter - I had an HMO (I know a ton of people hate them, but I never had an issue) - all I had to pay was my $10 co-pay for my first OB visit & then I needed to see a specialist for a level 2 US so I had to pay a $30 co-pay, but that was it - they covered EVERYTHING else - including my several trips to L&D before I was in labor (b/c of pre-eclampsia issues) and my actual stay with them which started on a Monday and went to Friday evening and I had a C-section and they covered my daughter's part of the stay too even though she was added to my hubby's insurance b/c the HMO considered it part of the maternity claim! Now, on my hubby's insurance I will need to meet a deductible before everything will be covered - and I will need to pay $30 for EACH OB visit! Are you kidding me?! I will be high risk b/c I had pre-eclampsia and a C-Section last time...UGH!!! Stupid Obama care!!!


answers from Kansas City on

hmmm, yes, insurance sucks. i had my son in 2006 (same job) and i paid $100 total. 50 for my initial exam, then 50 for the emergency room visit. EVERYTHING else was covered- prenatal care, even my c-section (yes, i realize how incredibly blessed we were). now i would have a $5000 deductible, AND the premium rates almost doubled. also one big reason we have not had another child. ridiculous.

just wanted to say that even without insurance, the generic pill is $12 per month at our walgreens. so it isn't the end of the world...but i do feel your pain.



answers from Seattle on

Well there us very little you can do if you have already received the services... Though $500 seems a bit steep for an exam and a prescription...
If your exam included your annual pap make sure the bill was coded correctly, our state for example already has a law in place that requires coverage of an annual preventative exam even if the plan excludes preventative or reproductive care - make sure you know the exceptions and fine print! In that case you can always ask for a corrected bill and resubmit your claim.
I personally have crappy insurance as well and can't wait for the new law to take effect!

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