IUD impasse with Capital Women's Care - is this run-around common or just me?

[Anonymous]

I would like to know if anyone else has had the saga I've had in my quest to get an IUD.

I'm in a catch-22 situation with my OB/Gyn (Dr. Band / Dr. Tyau of Capital Women's Care) because all of the CWC offices require the Mirena IUDs be ordered through CVS by the patient (they help coordinate the paperwork). Apparently, this policy just started March 1st - before that, their office ordered the IUD for patients.

But, my insurance (BlueCross BlueShield - a *very* common insurer) requires the IUD be ordered by the physician's office putting it in.

I've called a number of the CWC offices and confirmed they all have the same policy. I have a call into the CWC mothership - er, I mean, head office to let them know that this catch-22 situation is a crazy disservice to their patients.

Initially, I thought I'd seek a provider that I could get the IUD through while not having to switch to a new OB. I made an appointment with Planned Parenthood - who said they took BlueCross BlueShield. Just being careful, I called BCBS the day of the appt to double check. They didn't have Planned Parenthood of Metropolitan DC in their system and said I needed the providers name in order for them to check. I called PP and they told me that they don't list by providers, insisting that they take BCBS - well "almost" all BCBS policies. Granted, this is another circular issue in our crazy health care system but it has put me at a dead-end for an alternate path to get an IUD through PP.

At this point, I've canceled my appt with PP since I can't be sure anyone there or at BCBS knows whether or not it will be covered through them.

I'm soooooo frustrated - why does this have to be such a saga? Why does getting an IUD have to be this hard?

Right now, I'm mostly angry with CWC and would love to tell them to stick it and find a new OB/Gyn. But, is this a common policy? If so, does that mean that there are others out there like me who are in this frustrating catch-22 position?

And, if you have any recommendations for a new OB/gyn for me, I'm certainly in the market at this point!!

[Anonymous]

Not sure if this will be helpful or not because perhaps my doctor has gone to a new policy in 2010 as well but I can tell you that I had my Mirena inserted in October 2009. GW medical faculty assoc obgyn practice (I see Dr. Gaba but i've yet to see one there during a pregnancy/childbirth that I didn't like) called my insurance for me and got the authorization and then ordered it for me so it was there in time for my appointment.

[Anonymous]

That's not a new policy by CWC -- I went through the same frustration a year ago (I have CareFirst BlueChoice).

I had a heck of a time finding a Dr's office that would order the IUD, but finally learned that BirthCare, the birthing center in Alexandria (that also provides routine gyn care) will order it in the way that my insurance covered. It was my first experience with them but they were great, and I look forward to keeping them as my regular doc in the future. The location is a bit out of the way, but metro-accessible and driveable. Good luck!

[Anonymous]

I had it inserted in August 2008, only to find out that my BCBS (through my employer at the time) wouldn't cover any of it because it apparently hadn't been preauthorized and the full charge was sent back to me - about $300. I sucked it up and paid it, figuring I wouldn't be paying co-pays on the Pill for X number of years.

I don't know why Mirena leads to such a run-around - the insurance-hater in me thinks it's because it's such an amazing invention and that if it were offered more widely and cheaply, everyone who is a candidate for it would stop paying for the Pill and other birth control prescriptions/devices and jump on the Mirena boat.

My only other advice might be to call a local CVS and see what the pharmacist can do to help you - surely they've done this at least once in the past 6 weeks... right?

[Anonymous]

Funny, I got mine at BirthCare too.

I think the problems have something to do with insurances not reimbursing properly or sometimes at all for the IUDs -- at which point, the MD is screwed, because they can't exactly send it back for a refund after the fact, you know?

I have heard of places that make you pay them up front for the IUD and then they will bill your insurance and if the insurance reimburses them, they will in turn reimburse you. You could ask CWC about this.

Basically, I suspect CWC and other providers WANT us to be pissed about this so we consumers complain enough to get the shady insurance practices fixed.

Also, if you try Planned Parenthood again, ask them if they can tell you their provider *number* -- I have had luck tracking providers down on the phone with insurance companies this way. The provider number is much more foolproof than names, telephone numbers, or other things the insurance company reps will tell you they "need."

[Anonymous]

I used Reiter Hlll Johnson and Nevin and they ordered it for me, no questions asked.

[Anonymous]

I got mine at Washington Hospital Center- Faculty Practice- Dr. Renuka. They ordered it. CareFirst covered it without issue.

[Anonymous]

BCBS Federal here. Got the copper IUD in April 2009 from Dr. Malcolm DeSouza in Spring Valley in DC. He has you pay $300 up front and whatever insurance covers, you get back. I ended up getting $100 back (so I had to pay $200). But the process re ordering the IUD was easy. I just made my appt and he had it there. I'm sure its the same for Mirena as the copper IUD...insurance is just weird about it, which is why doctors are weird too...they don't want to be out the money.

[Anonymous]

I went through something similar with my OB. They would put it in, but required the patient to order it and have it shipped to their office. My insurance, also CareFirst, would not cover it unless ordered directly by the physician. I went to Planned Parenthood instead and it was fully covered - I just paid an office visit copay.

[Anonymous]

Anonymous wrote:That's not a new policy by CWC -- I went through the same frustration a year ago (I have CareFirst BlueChoice).

I had a heck of a time finding a Dr's office that would order the IUD, but finally learned that BirthCare, the birthing center in Alexandria (that also provides routine gyn care) will order it in the way that my insurance covered. It was my first experience with them but they were great, and I look forward to keeping them as my regular doc in the future. The location is a bit out of the way, but metro-accessible and driveable. Good luck!

I got my IUD from the midwives at Birthcare and had no idea that getting an IUD could be a problem. I second the recommendation to call them.

[Anonymous]

This is an insurance problem. BCBS is screwing the MDs by not reimbursing them the cost of the device. That is why they make you order it. But, CWC is also being really unhelpful. They should at least give you the option of paying up front and getting reimbursed (though that is a hassle for them too).

If you work for the feds, complain and maybe the policy can get fixed in the next open season.

[Anonymous]

Some CWC offices are getting around this by ordering from web-based pharmacies that get the Mirenas and Paragard IUD from countries other than the US. Then they don't care what the insurance company pays them because they are getting these at a very reduced price, hundreds less. BUT, you are now getting a medical device that is not approved by the US FDA. This puts patients at risk because coming from other countries, the product's identity, purity, source, handling, and storage cannot be verified. Using these overseas pharmacies can risk receiving unsafe and ineffective counterfeits, even if they appear the same. And the physician can save hundreds of dollars on the non-FDA approved product, but charges you and your insurance the same price as a US FDA-approved product. Please be careful and ask to see the box and insert with ENGLISH language only. If you think you had an unapproved IUD inserted in the past five years, go back and talk to your doctor about a fda-approved replacement at no charge. Click here to read the FDA warning: http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm219837.htm

[Anonymous]

Anonymous wrote:This is an insurance problem. BCBS is screwing the MDs by not reimbursing them the cost of the device. That is why they make you order it. But, CWC is also being really unhelpful. They should at least give you the option of paying up front and getting reimbursed (though that is a hassle for them too).

If you work for the feds, complain and maybe the policy can get fixed in the next open season.

I'm an OB and this is exactly what is happening. I'd love to offer my patients the Mirena but I loose money on every one i insert. Literally, i pay $$ out of my pocket.

[Anonymous]

I hate insurance companies. I work for a medical lobby shop in DC and here's what I suspect. Dumb insurance companies have one group covering "devices" and another covering "drugs". They pay very little for most pill Rx (lets say 12$ for a generic for most women). They see this "device" is an Expensive 300!!! gasp, and so try not to cover. At no time do they say...well 300/12 is X so it is COST EFFECTIVE to cover this thing! I find it in my work all the time. They are silo-ed. This is just my hypothesis. I hate insurance companies.

[Anonymous]

I had the same problem with my doctors office. It was an insurance issue. My OBs office wouldn't order IUDs because of what they were reimbursed but my insurance wouldn't cover it unless it was ordered by a doctors office. I went to Planned Parenthood instead.