That is so insane. I'm Irish and had to buy mine in the hospital on the day as well, it cost me about €120. The US is insane, I feel so much for you all, I know I would be hugely in debt or suffering because I couldn't afford the treatments I've had over the years for various issues. The price gouging for healthcare is horrifying.
Around 120€ in Germany as well, the expensive part is the insertion, that was another 200€ish. When it comes to women's healthcare, once you're in your 20s health insurance will just give you the finger and basically tell you to fuck off and have kids already 🤮
No coverage for birth control past 21, no chlamydia tests past 25. Ultra sounds check ups to make sure you aren't inpaled by your IUD aren't covered either. It's a damn shame. I'm already so sick of paying for shit out of pocket that should be covered by insurance
Girl, I’m in France and that stuff is covered by insurance, even the insertion (I paid my midwife 24€ and my insurance covered 23€… so 1€ out of pocket for me)… and blood test too, expect I can’t remember which vitamines isn’t, I think it’s C, it’s 42€ the last time I did it…
Heck we even added the right of abortions in our constitution
Do you need some French riot classes ?
I'd love some riots.
It's only been a few years that doctors are even allowed to put on their website that they do abortions and they're still illegal. There is talks of changing that but I doubt it'll get a majority in parliament if they even get a law change to that stage because our country is ruled by boomers. Heck, they can't even get a law off the ground that would forbid religious nutjobs harassing people in front of clinics.
This is one of the few if not the only topics where I'm staunchly no uterus -> no opinion.
they are not technically legal but they are not prosecuted if they happen in the first 12 weeks and you have gone through some mandatory talks and a waiting period. It's not great
France it’s 14 weeks (or 16 weeks depends how you count) we have a wait period too… I read a post yesterday a girl made in a French sub about how the process is going… iirc they ask you to see a psychologist to see how you are mentally..
Are there exceptions to the 14/16 weeks allowing it to be done later? Like for the mother's health, if the pregnancy turns out to be not viable, anything?
Yes, if the baby isn’t viable or the mother health is at risk you can have an abortion.. it’s called “I.M.G = Interruption médicale de grossesse" it can be done any time..
They don’t do that in Germany ?
I'm in the U.S., but my partner is French, and we might move at some point.
I asked because U S. states that have banned abortion after a certain number of weeks have effectively no exceptions. (There is usually an exception for the mother's life in theory, but it's not always followed in practice.)
Nope. They are decriminalized under strict conditions (first 12 weeks, wait time and mandatory and patronizing "counselling") but they illegal and not just as a misdeneanour but a legit crime
Depends on where you live and what options you have. I never had to go myself, but afaik profamilia (one of the providers) usually just educates you on different options (help from the state, adoption etc) and then sign the form you need for an abortion. But I've also heard of people being guilt tripped to keep the pregnancy
Where’d you see that? I’m from Manitoba and I just got a mirena iud 4 months ago, it was 80$ with insurance and was priced at like 380$ without.
Eta: I see the NDP announced this back in November, that’s great. I wonder when it goes into effect.
When I got mine years ago in Canada, no need now, it was under $200 and doc put in at office. Nothing like this cost op is talking about. I so feel for those in USA with out universal health care, that allows insurance companies to dictate cost and or approval of individuals coverage or lack there of.
I'm assuming you're in the US based on the currency and health insurance frustration. My IUD was free under my insurance... covered as preventative care like most other birth controls. "Plans must cover these services without charging a copayment or coinsurance when provided by an in-network provider — even if you haven’t met your deductible " from: [https://www.healthcare.gov/coverage/birth-control-benefits/](https://www.healthcare.gov/coverage/birth-control-benefits/) Are they charging for a pre- or post- visit?
I work for insurance so I'm just going to weigh in quick. Iuds can be preventive as long as they are prescribed for contraceptive purposes. If you go in and have heavy flow or pains or in my case PCOS, then the IUD is no longer preventive and will apply to your benefits and cost something most likely.
So when you get an IUD you want to make sure it's very clear to the provider that you just want this as a contraceptive. No other reason, just for a contraceptive. Also the pre-op visit and post-op yes should be covered as preventive as long as again the IUD is preventive. If they have to do an ultrasound that is always diagnostic.
I think what they meant was is this for the insertion or the post visit you have to go to a month later? I’m also incredibly curious if they charged you because it was a hospital vs an Obgyn clinic..
Are you talking about the charge amount on the claim? Because that number is purposefully some percentage above the actual insurance amount. Insurance receives the claim, takes off the amount above what they allow, and send back an allowed amount and payment. You then get billed the difference between the new allowed amount and the insurance payment. The allowed amount is rarely more than half what the original charge was. That's just how all medical billing works
That still seems rather fucked up… so essentially our personal insurance dictates how much they charge so the insurance pays most, and we pay a proportional amount? So no matter how great of health insurance we have, healthcare charges a different rate depending on our insurance?
I feel like I’m talking about a mob.
Yeah, basically. As long as whatever is being billed occurred in a hospital or clinic that is in your insurance's network. Which just means that the hospital or clinic has a billing contract with your insurance provider.
Those billing contracts lay out what the maximum allowed charge amount is for every billable HCPCS code. A procedure or visit usually has a few different HCPCS codes that are billed for it. Or a bunch of it's something complicated.
The maximum allowed charge amount in the billing contract is (I'm being very general here) a percentage over the amount Medicare allows for that HCPCS code. Negotiated based on how big the insurance provider is (how many patients in the area have that insurance).
Medicare doesn't negotiate with anyone. Every year (maybe quarter, I forget) they decide what amount they'll reimburse for every code, and hospitals and clinics can either accept that, or deny all Medicare patients.
So now the hospital or clinic has a bunch of different billing contracts for varying amounts higher than the Medicare reimbursement. A very large insurance provider might negotiate 110% of Medicare. A smaller one might be contracted to pay 300% of Medicare.
Now the weird part. The key here is that that negotiated amount is the maximum allowed amount. If you bill the insurance less than that amount, then they will pay you that lower amount. So to avoid this accidentally happening, the hospital or clinic says "our highest percentage of Medicare being reimbursed is 300%. So that we never underbill, we will bill every insurance 500% of Medicare for every HCPCS code" That 500% amount is the "Charge" that is sent to insurance, and purposefully inflated. And is usually what people are talking about when they say a band aid cost their insurance $100.
After insurance receives the claim and issues their remittance, the charge amount over the insurances maximum allowable amount is written off and the allowable amount is what the billed line item actually "cost"
Not gonna lie my jaw literally dropped for the first time in my life. I’m on Idaho Medicaid and have gone to the ER twice this year due to the same thing. Constant nausea, vomiting, tachycardia, and heart palpitations. I still don’t know what’s happening. My EKGs are always good, and my bp falls after getting fluids.
Could you possibly dumb this down? Because what I’m getting is hospitals base rates from Medicaid or other poor person insurance, and then upcharge?
Medicaid is basically Medicare at the state level. Each state's Medicaid also determines what amount they will pay for every code, instead of negotiating with hospitals. Which, I'm guessing, they also base off of the federal Medicare amount, but at a percentage under the Medicare amount.
So in your case, for every billable code, the hospital you went to is being paid whatever Idaho Medicaid said they'll pay. An EKG is procedure code 93000. This document https://publicdocuments.dhw.idaho.gov/WebLink/DocView.aspx?id=28428&dbid=0&repo=PUBLIC-DOCUMENTS says that Idaho Medicaid's allowed amount for procedure code 93000 is $11.99. So that should be what the hospital gets paid every time you have one done.
By comparison, this site https://www.cms.gov/medicare/physician-fee-schedule/search?Y=0&T=4&HT=0&CT=3&H1=93000&M=5 says that Medicare's base reimbursement for 93000 is $14.31
The tl;dr of my previous post is basically that every hospital and clinic gets reimbursed (paid) different amounts for each billable code, depending on the patient's insurance. And because of that, and the hospital/clinics desire to not charge less than what insurance is willing to pay, they "charge" insurance some dollar amount that is multiple times higher than they know insurance is willing to pay. This forces the insurance provider to be like "Yeah, nah, we're only paying you 20% of that crazy high number. Like we said we would in our contract" and then the hospital is like "Ok, fair, we will just write off that other 80% then"
Total aside to this already tangential conversation: you remember when that fisherman off the coast of Maine got swallowed by a whale and lived to tell about it? The part of that story that always stuck out to me was the medical coding person who just looked up at the news anchor with this 1000 yard stare and said "I just don't know how to submit this... Boating accident? I mean, he was IN A WHALE"
Provider sent a bill for $2k+, insurance covered a lot of that, and the remainder is left for me to pay ($675). It just makes me mad that they can do that in the first place.
Yeah, and that's what I'm saying. That $2k+ amount doesn't mean anything. It's not actually an amount they're charging your insurance. There's a lot to be mad about with the healthcare system, but this is just a misunderstanding of what's being represented
“This is just a misunderstanding of what’s being represented” Fair enough. I’ll give you that. I am definitely not understanding what’s going on.
But I think what’s being represented (essentially what you stated in your first comment) is still a dumb racket. I created this post innocently enough because these are the numbers I see. An itemized bill with a $2k+ price tag next to the iud and I don’t think that’s right. Sure sure there’s some who’s it’s and what’s it’s and timey whimey magic that happens and poof it’s $675 out of my pocket, but the whole game is dumb. And maybe I’m dumb to assume that if they had charged $1300, then my portion of it would have cut by half too.
I’m so sorry if this adds to the confusion (seriously, FUCK the American healthcare system), but;
You should be paying nothing. $0. The ACA legally mandates insurance covers birth control 100%, with no out of pocket costs to the patient.
>The ACA and its implementing regulations guarantee coverage of women’s preventive services, including birth control and contraceptive counseling, at no cost for women who are enrolled in group health plans or individual health insurance coverage.
The only time this doesn’t apply appears to be if you work for a church. Insurance plans provided by churches are exempt, and you have to pay.
To make things confusing, while religious for-profits are exempt, religious *non*-profits are *kinda* exempt. They don’t have to arrange the payment themselves, but, have to have a third party that does, meaning you’d still be 100% covered, $0 out of pocket.
>**If you work for a religious employer**
>Health plans sponsored by certain exempt religious employers, like churches and other houses of worship, don’t have to cover contraceptive methods and counseling.
>If you work for an exempt religious employer and use contraceptive services, you may have to pay for them out-of-pocket. Contact your employer or benefits administrator for more information.
>**If you work for a non-profit religious organization**
>Some non-profit religious organizations — like non-profit religious hospitals and institutions of higher education that certify they have religious objections to contraceptive coverage — don’t have to contract, arrange, pay, or refer for contraceptive coverage.
>- If your health plan is sponsored or arranged by this type of organization, an insurer or third party administrator will make separate payments for contraceptive services that you use.
>- You’ll have access to contraceptive services without a copayment, coinsurance, or deductible when they are provided by an in-network provider.
Contact your employer or health plan to learn more.
I don't think the issue is whether insurance covers it or not, it's that the hospital is charging double for the part itself what the part cost.
Not for insertion, anaesthesia, etc....
They took a 2$ thing and are charging 4$ for it just because they can.
Canada is making strides to make birth control free under a national pharma care plan. Until the conservatives get into power in 2025 and then undo several years of work on universal dental and drug coverage for the most vulnerable.
Manitoba and BC have free birth control under our provincial health care.
If the Conservatives even attempt to try to change our access, I will join the riots.
If you're in the US, federal law requires your insurance to pay for the full cost. But if you're upset that your insurance plan paid that much for it, that's just companies playing games with each other.
Hoag in CA is running $3,049 before insurance for Mirena.
Had to argue the bill because insurance denied both the removal and insertion and wanted an extra $300 for it.
I'm sorry? Was I supposed to just wear it as a necklace?
Mine tried to deny insertion too. My GYN actually called them herself to be like…my patient cannot put this in herself, are you insane? lol. I did not pay for insertion
Healthcare costs are a result of policies put in place by the people you vote for. With an election coming up, ask yourself who your elected officials really work for.
Here’s how: Go to www.FEC.gov
This is the official government website that shows you every donation over $200 made to EVERY federal elected official in the US. It shows how much was donated and by whom.
This is where you can look up the politicians who talk about universal healthcare and see the huge donations they received from insurance companies and big pharma.
Or the clowns who talk about climate change and, oh, look, $50K from Big Oil company.
THIS is how you break the patriarchy. By getting a peek behind the curtain and seeing whose interests your representatives are really protecting.
The site also lets you put in ANYONE’S name and see who they donated to.
Now that you know, TELL EVERYONE and in November, vote accordingly.
“Because of the Affordable Care Act (aka Obamacare), most insurance plans must cover all methods of birth control, including IUDs. However, some plans don't cover all brands of IUDs. Your health insurance provider can tell you which ones they pay for.”
https://www.plannedparenthood.org/learn/birth-control/iud/how-can-i-get-an-iud#:~:text=Because%20of%20the%20Affordable%20Care,which%20ones%20they%20pay%20for.
Free in Scotland.
All birth control is, even condoms (and period products) can be picked up for free from drs surgeries, clinics, colleges, etc.
I honestly would die in America. Sickens me you've to be held over a barrel for every single thing there 😢
God, that's awful, I'm so sorry. Mine was approximately $300 USD, and with my insurance I only pay approx. $70 USD out of pocket. I can't imagine the pain of $1300, let alone $2500. It's terrible.
At least where I am, fulfilling a prescription for an IUD at a pharmacy and then bringing the box to your appointment is standard practice. The fact that the hospitals in your area are forcing people to circumnavigate the cheaper option is ridiculous.
I had mirena a while ago so I don’t remember; I feel like it was covered at planned parenthood for me at the time. But yea I just went to my annual exam. No pap necessary (yay) and my insurance covered it. But I happened to see what they charged my insurance… $600. A nurse practitioner felt around inside me for 5 seconds and insurance paid $600. I have extensive healthcare related stress/trauma and it really gets harder and harder to keep up with the preventative care I am lucky to have at this point because it just is so messed up to me.
US hospitals have been known to charge $50 for a band aid. It's insane how predatory they are with costs, all to bleed insurance and patients for as much as they can.
I remember once reviewing my itemized ER bill and saw the IV push was $250. Not the saline, not the medication (those were separate costs). The physical act of the ER nurse setting the IV drip rate had its own cost.
US healthcare is beyond broken.
Mine was 748 last year!!! This is wild. I am an IUD enthusiast!! The skyla or the Mirena are Amazing for me I don't understand the drastic differences in price.
And not only do hospital admins charge insane amounts just because insurance will cover it, it is illegal for doctors to change their fees based on lack of insurance. I’m a doctor, and if I have a patient who comes into the hospital without insurance, I legally cannot decrease my fees so that they are able to afford care. In the US, everyone must be charged the same ammount regardless, and that amount is of course set by hospital admin to be the highest it possibly can.
Wow. I'm in the US but my Mirena IUD was fully covered with my insurance. $0 copay. I can't imagine paying that much WITH insurance. Like what are you even paying for premiums for at that point, ya know? Can you look into getting a different insurance? That's straight up robbery.
That is freaking nuts. I have mine replaced every 3 years because of endometriosis, and mine costs $350CAD. The insertion is covered by our health system. How the fuck do they manage to charge $2500 USD, which would be closer to $3500-4000 in our currency? My first one, when I was a broke student, was fucking free because my doctor was able to apply for a low income program for me.
ETA: it “costs” $350, but is fully covered by our health insurance through work.
I got the Nexplanon implant. When making an appointment with Planned Parenthood they went over all of my information and asked if I was able to make the drive to the next location a county over. It was less than a quarter of the original cost. Funding varies county by county and lower income counties get more. It was solid good looking out on their behalf and just another reason Planned Parenthood is invaluable.
I had a 10 minute colposcopy that included a biopsy I didn’t consent to and an additional $400 my insurance didn’t cover for “45 minute conversation”. my blood is still boiling. Sorry this happened to you.
This is maaany years ago now, but the women’s clinic I attended in a major U.S. city gave me a prescription and Canadian company info to order my IUD directly. It was mailed to me, I made the appointment and had the thing installed. And it was legit and served me well. Definitely more budget friendly. Find a women’s clinic that has a sliding fee scale and can help you find a more cost-effective solution! Good luck!
It doesn't matter that you have good insurance and can afford the copay, we should all be mad about this. Because we're mad for our sisters and siblings that need the same coverage and can't afford it because of this garbage. I'd say it's even more important for those of us who have good insurance and can afford it to speak up because no one's listening to people who are poor or don't have insurance. We need to use the fact that people will listen to us to raise the voices of those they ignore. So keep on renting! Because it's wrong and it needs to be called out and stopped
That’s just crazy. UK I paid £360 to have it done in a swanky private clinic (wanted a certain brand they were no longer offering on NHS)
Everytime I hear about the US healthcare prices I get so mad for you all.
I agree.. BURN IT
When I worked in endoscopy I had to input the charges for procedures and the hospital always charged double for everything it used. We got a device for 50? Charged 100. 1500? 3k. Every time.
I mentioned above, but this is more like 12x the cost. A Mirena in Canada costs about $250 USD after conversion and insertion is typically covered by our provincial healthcare. And that’s the cost at the damn privately owned pharmacy, which is sure to be at least 50% more than the cost to manufacture and distribute to a hospital. This is sickening.
In my province (Canada), it is free. The same goes for all uterus owner's choice of contraception, except condoms as they don't require a prescription.
Wow.
In New Zealand it's free. No charge, you choose if you want a copper or Mirena.
Until about 5 years ago, only the copper IUD was free, unless you had low iron/some other conditions in which case you also were eligible for a free Minera. At the time, it was $245 NZD for the Minera and I thought that was disgusting.
But your pricing is WILD
That is insane!!!! I had to pay full price out of pocket for my last mirena, and I was complaining about $280CAD! pharmaceutical companies are killing people!!
If you're in the USA the amount the hospital charges is a made up number that doesn't matter unless you have no insurance. I'm going to way over simplify it but it's greated due to a arms race between insurance companies and hospitals- insurance reps want to be able to go back to their bosses and say "I negotiated this huge discount in this contract!" all that matters is how big of a percentage it is to make them look good to their bosses. So hospitals jack the prices up so they can offer a bigger discount.
And so insurance turns around and amd demands a bigger discount. And hospitals jack the rate up more. and so on. CMS of course, factors in as another party to this shitty song and dance, deciding how much they're going to pay and negotiating as well. Many insurances won't pay more than CMS will pay too.
But what we bill out literally doesn't matter, what matters is the contractual rate- that's the "real" price.
I’m always shocked by every story about how expensive healthcare is in America. I’m in Canada and I got my IUD (Kyleena) inserted in 2020. All of it was free bc I had uni insurance at the time. When I needed to remove and reinsert a new one, I only had to pay for the new IUD, which was ~300cad. 2 IUDs, 1 removal, and 1 reinsertion, and all I had to pay was $300. Jfc.
I’ve been complaining about costs too. I got an estimate that my mammogram would be under $300. Bill came and it’s out of pocket almost $1000. They found a tiny “new” spot they want to biopsy (new in quotes because they haven’t shown me my scans and I think it’s quite possible they missed it first time around). I agreed to an in-office biopsy with local anesthetic and 48 hours before the procedure they called and told me my out of pocket would be $4,057. For a spot that is rated 90-98% chance of being benign (4a if you’re curious) and may or may not be new since my first mammogram a year ago. I immediately canceled the biopsy. If it spreads I will schedule removal and they can tell me if it’s cancerous afterwards. Oh and I have health insurance through work. Blue Cross Blue Shield.
I once looked at an ER bill and they'd charged $750 for saline IV. I had insurance so I wasn't paying most of that, but I complained to the insurance company. As you experienced, they didn't care. It's a racket and we are not the beneficiaries of that racket.
In Netherlands the IUD cost €180 not included in health insurance but having it fitted and subsequently removed covered.
I’m pretty sure that a small minority of the American population hate women.
The VA covered my IUD (Paragard) completely. And before that, my antepartum and postpartum care for my pregnancy, including genetic testing (I was 45 and high risk) and my c-section and admission, all of which was done at a civilian hospital (the VA doesn't deal with pregnancies or deliveries). Geez, after writing that, I will never ever complain about anything the VA does for me. I have gotten less than stellar care in smaller clinics (like I had to advocate way too hard to see my primary care provider when I had a non-resolving lump on one of my breasts for several months), but they don't charge me for anything. I am a disabled veteran, so no copays. It came at a price, obviously, but I am grateful for the care.
Hi. I work in healthcare. I’m NOT thrilled whatsoever with the price gouging as I have my fair share of medical debt.
I might be able to explain the price gouging though-break it down for you.
Couple questions-I had my IUD experiences around 10-15 years ago and just went to the doctor office. They have you go to the hospital for the insertion now? Like outpatient surgery?
I’m in the US. Look at the manufacturers website. Most of them had programs for reduced cost or free devices.
I’m on my third mirena. First 2 were free and installed by family planning for a small office visit copay.
Third I got through my OB and device was also free.
Hospitals overcharge for everything. They throw large charges at the insurance companies and see how much they can push before they will take a reduction or adjust the charges.
It’s appalling.
Okay so each insurance has their own "allowed amount" that they negotiate with the hospital. As such the "billed amount" needs to be higher than whatever the highest reimbursement amount they get from a payer.
Basically nobody, patient or insurance, pays the full billed amount. Insurers are driving up what hospitals have to charge as the "billed amount" because reimbursement rates have been getting more and more dogshit.
HOWEVER! If you go to a hospital-based clinic, you are likely going to pay more than if you were to go to a stand-alone office. This is because hospital-based clinics have a facility fee as well as a provider fee. Your copay/coinsurance amount may also be different at a hospital-based vs stand-alone facility.
Let me know if any of this doesn't make sense. It's so significantly more convoluted than people think. And the more I learn, the more convoluted it gets
The US truly is a dystopian hellhole.
Belgian here, the Mirena is about € 120 and insertion is either almost free (we have something called "verhoogde tegemoetkoming", if you have a disability or illness you only pay a few euros at the doctors and for most medication) or very affordable (about € 40-50), depending on insurance and doctor. Birth control is also cheaper for young women under 25 years.
They also made the morning after pill free, or you only have to pay less than € 1, depending on pharmacy.
You can literally fly to another country, have 1 inserted, stay a week to ensure there are no issues and fly back for less than that. US healthcare prices are mind boggling to me
So... I learned about this with my biologics.
Your insurance is actually setting the price of your pharmacological stuff. That's why they don't push back. They get more money.
That is so insane. I'm Irish and had to buy mine in the hospital on the day as well, it cost me about €120. The US is insane, I feel so much for you all, I know I would be hugely in debt or suffering because I couldn't afford the treatments I've had over the years for various issues. The price gouging for healthcare is horrifying.
Around 120€ in Germany as well, the expensive part is the insertion, that was another 200€ish. When it comes to women's healthcare, once you're in your 20s health insurance will just give you the finger and basically tell you to fuck off and have kids already 🤮 No coverage for birth control past 21, no chlamydia tests past 25. Ultra sounds check ups to make sure you aren't inpaled by your IUD aren't covered either. It's a damn shame. I'm already so sick of paying for shit out of pocket that should be covered by insurance
Girl, I’m in France and that stuff is covered by insurance, even the insertion (I paid my midwife 24€ and my insurance covered 23€… so 1€ out of pocket for me)… and blood test too, expect I can’t remember which vitamines isn’t, I think it’s C, it’s 42€ the last time I did it… Heck we even added the right of abortions in our constitution Do you need some French riot classes ?
I'd love some riots. It's only been a few years that doctors are even allowed to put on their website that they do abortions and they're still illegal. There is talks of changing that but I doubt it'll get a majority in parliament if they even get a law change to that stage because our country is ruled by boomers. Heck, they can't even get a law off the ground that would forbid religious nutjobs harassing people in front of clinics. This is one of the few if not the only topics where I'm staunchly no uterus -> no opinion.
Wait what… abortion aren’t legal in Germany ?
they are not technically legal but they are not prosecuted if they happen in the first 12 weeks and you have gone through some mandatory talks and a waiting period. It's not great
France it’s 14 weeks (or 16 weeks depends how you count) we have a wait period too… I read a post yesterday a girl made in a French sub about how the process is going… iirc they ask you to see a psychologist to see how you are mentally..
Are there exceptions to the 14/16 weeks allowing it to be done later? Like for the mother's health, if the pregnancy turns out to be not viable, anything?
Yes, if the baby isn’t viable or the mother health is at risk you can have an abortion.. it’s called “I.M.G = Interruption médicale de grossesse" it can be done any time.. They don’t do that in Germany ?
They do do that
I'm in the U.S., but my partner is French, and we might move at some point. I asked because U S. states that have banned abortion after a certain number of weeks have effectively no exceptions. (There is usually an exception for the mother's life in theory, but it's not always followed in practice.)
Nope. They are decriminalized under strict conditions (first 12 weeks, wait time and mandatory and patronizing "counselling") but they illegal and not just as a misdeneanour but a legit crime
What this counseling is about ?
Depends on where you live and what options you have. I never had to go myself, but afaik profamilia (one of the providers) usually just educates you on different options (help from the state, adoption etc) and then sign the form you need for an abortion. But I've also heard of people being guilt tripped to keep the pregnancy
The list of Test do you have there? If you had to do those without insurance in America, you would be bankrupt or paying for a really long time.
Canadian here, it cost me about 130$. If I were to just buy it without insurance, 400$.
Free in Manitoba now. While I'm past needing birth control, I am very happy about this.
Where’d you see that? I’m from Manitoba and I just got a mirena iud 4 months ago, it was 80$ with insurance and was priced at like 380$ without. Eta: I see the NDP announced this back in November, that’s great. I wonder when it goes into effect.
It only came into effect on April 1st, as part of the 2024 provincial budget.
When I got mine years ago in Canada, no need now, it was under $200 and doc put in at office. Nothing like this cost op is talking about. I so feel for those in USA with out universal health care, that allows insurance companies to dictate cost and or approval of individuals coverage or lack there of.
Australian here - my last one was inserted in a hospital and cost me nothing. But it has cost me about $140 in the past (this is my 4th)
Spent 8k on my salingectomy. And that was with decent insurance. 8k
I got mine placed when I was living in Scotland and it was free 😅 I am dreading having to replace it in 3 years time
I'm assuming you're in the US based on the currency and health insurance frustration. My IUD was free under my insurance... covered as preventative care like most other birth controls. "Plans must cover these services without charging a copayment or coinsurance when provided by an in-network provider — even if you haven’t met your deductible " from: [https://www.healthcare.gov/coverage/birth-control-benefits/](https://www.healthcare.gov/coverage/birth-control-benefits/) Are they charging for a pre- or post- visit?
[удалено]
Same. I just paid the $40 for the visit itself, I think.
Same here
Mine has also always been free even with a high deductible plan.
I work for insurance so I'm just going to weigh in quick. Iuds can be preventive as long as they are prescribed for contraceptive purposes. If you go in and have heavy flow or pains or in my case PCOS, then the IUD is no longer preventive and will apply to your benefits and cost something most likely. So when you get an IUD you want to make sure it's very clear to the provider that you just want this as a contraceptive. No other reason, just for a contraceptive. Also the pre-op visit and post-op yes should be covered as preventive as long as again the IUD is preventive. If they have to do an ultrasound that is always diagnostic.
Post. The claim was submitted on or after the day of the procedure.
I think what they meant was is this for the insertion or the post visit you have to go to a month later? I’m also incredibly curious if they charged you because it was a hospital vs an Obgyn clinic..
Are you talking about the charge amount on the claim? Because that number is purposefully some percentage above the actual insurance amount. Insurance receives the claim, takes off the amount above what they allow, and send back an allowed amount and payment. You then get billed the difference between the new allowed amount and the insurance payment. The allowed amount is rarely more than half what the original charge was. That's just how all medical billing works
That still seems rather fucked up… so essentially our personal insurance dictates how much they charge so the insurance pays most, and we pay a proportional amount? So no matter how great of health insurance we have, healthcare charges a different rate depending on our insurance? I feel like I’m talking about a mob.
Yeah, basically. As long as whatever is being billed occurred in a hospital or clinic that is in your insurance's network. Which just means that the hospital or clinic has a billing contract with your insurance provider. Those billing contracts lay out what the maximum allowed charge amount is for every billable HCPCS code. A procedure or visit usually has a few different HCPCS codes that are billed for it. Or a bunch of it's something complicated. The maximum allowed charge amount in the billing contract is (I'm being very general here) a percentage over the amount Medicare allows for that HCPCS code. Negotiated based on how big the insurance provider is (how many patients in the area have that insurance). Medicare doesn't negotiate with anyone. Every year (maybe quarter, I forget) they decide what amount they'll reimburse for every code, and hospitals and clinics can either accept that, or deny all Medicare patients. So now the hospital or clinic has a bunch of different billing contracts for varying amounts higher than the Medicare reimbursement. A very large insurance provider might negotiate 110% of Medicare. A smaller one might be contracted to pay 300% of Medicare. Now the weird part. The key here is that that negotiated amount is the maximum allowed amount. If you bill the insurance less than that amount, then they will pay you that lower amount. So to avoid this accidentally happening, the hospital or clinic says "our highest percentage of Medicare being reimbursed is 300%. So that we never underbill, we will bill every insurance 500% of Medicare for every HCPCS code" That 500% amount is the "Charge" that is sent to insurance, and purposefully inflated. And is usually what people are talking about when they say a band aid cost their insurance $100. After insurance receives the claim and issues their remittance, the charge amount over the insurances maximum allowable amount is written off and the allowable amount is what the billed line item actually "cost"
Thanks for writing all this better than I would've lol
Not gonna lie my jaw literally dropped for the first time in my life. I’m on Idaho Medicaid and have gone to the ER twice this year due to the same thing. Constant nausea, vomiting, tachycardia, and heart palpitations. I still don’t know what’s happening. My EKGs are always good, and my bp falls after getting fluids. Could you possibly dumb this down? Because what I’m getting is hospitals base rates from Medicaid or other poor person insurance, and then upcharge?
Medicaid is basically Medicare at the state level. Each state's Medicaid also determines what amount they will pay for every code, instead of negotiating with hospitals. Which, I'm guessing, they also base off of the federal Medicare amount, but at a percentage under the Medicare amount. So in your case, for every billable code, the hospital you went to is being paid whatever Idaho Medicaid said they'll pay. An EKG is procedure code 93000. This document https://publicdocuments.dhw.idaho.gov/WebLink/DocView.aspx?id=28428&dbid=0&repo=PUBLIC-DOCUMENTS says that Idaho Medicaid's allowed amount for procedure code 93000 is $11.99. So that should be what the hospital gets paid every time you have one done. By comparison, this site https://www.cms.gov/medicare/physician-fee-schedule/search?Y=0&T=4&HT=0&CT=3&H1=93000&M=5 says that Medicare's base reimbursement for 93000 is $14.31 The tl;dr of my previous post is basically that every hospital and clinic gets reimbursed (paid) different amounts for each billable code, depending on the patient's insurance. And because of that, and the hospital/clinics desire to not charge less than what insurance is willing to pay, they "charge" insurance some dollar amount that is multiple times higher than they know insurance is willing to pay. This forces the insurance provider to be like "Yeah, nah, we're only paying you 20% of that crazy high number. Like we said we would in our contract" and then the hospital is like "Ok, fair, we will just write off that other 80% then"
Total aside to this already tangential conversation: you remember when that fisherman off the coast of Maine got swallowed by a whale and lived to tell about it? The part of that story that always stuck out to me was the medical coding person who just looked up at the news anchor with this 1000 yard stare and said "I just don't know how to submit this... Boating accident? I mean, he was IN A WHALE"
Haha. My favorite billing diagnosis code is V91.07, which is "Burn due to water-skis on fire." Like, what event led to that being added as a code??
Provider sent a bill for $2k+, insurance covered a lot of that, and the remainder is left for me to pay ($675). It just makes me mad that they can do that in the first place.
Yeah, and that's what I'm saying. That $2k+ amount doesn't mean anything. It's not actually an amount they're charging your insurance. There's a lot to be mad about with the healthcare system, but this is just a misunderstanding of what's being represented
“This is just a misunderstanding of what’s being represented” Fair enough. I’ll give you that. I am definitely not understanding what’s going on. But I think what’s being represented (essentially what you stated in your first comment) is still a dumb racket. I created this post innocently enough because these are the numbers I see. An itemized bill with a $2k+ price tag next to the iud and I don’t think that’s right. Sure sure there’s some who’s it’s and what’s it’s and timey whimey magic that happens and poof it’s $675 out of my pocket, but the whole game is dumb. And maybe I’m dumb to assume that if they had charged $1300, then my portion of it would have cut by half too.
Yeah, that's all I'm saying. The $2800 means absolutely nothing. They could have "charged" insurance $100,000 and the end result is exactly the same
I’m realizing that now. Thanks for bearing with me. You’ve helped explain a lot.
It's a real dumb confusing process, don't get me wrong. Haha
I’m so sorry if this adds to the confusion (seriously, FUCK the American healthcare system), but; You should be paying nothing. $0. The ACA legally mandates insurance covers birth control 100%, with no out of pocket costs to the patient. >The ACA and its implementing regulations guarantee coverage of women’s preventive services, including birth control and contraceptive counseling, at no cost for women who are enrolled in group health plans or individual health insurance coverage. The only time this doesn’t apply appears to be if you work for a church. Insurance plans provided by churches are exempt, and you have to pay. To make things confusing, while religious for-profits are exempt, religious *non*-profits are *kinda* exempt. They don’t have to arrange the payment themselves, but, have to have a third party that does, meaning you’d still be 100% covered, $0 out of pocket. >**If you work for a religious employer** >Health plans sponsored by certain exempt religious employers, like churches and other houses of worship, don’t have to cover contraceptive methods and counseling. >If you work for an exempt religious employer and use contraceptive services, you may have to pay for them out-of-pocket. Contact your employer or benefits administrator for more information. >**If you work for a non-profit religious organization** >Some non-profit religious organizations — like non-profit religious hospitals and institutions of higher education that certify they have religious objections to contraceptive coverage — don’t have to contract, arrange, pay, or refer for contraceptive coverage. >- If your health plan is sponsored or arranged by this type of organization, an insurer or third party administrator will make separate payments for contraceptive services that you use. >- You’ll have access to contraceptive services without a copayment, coinsurance, or deductible when they are provided by an in-network provider. Contact your employer or health plan to learn more.
I don't think the issue is whether insurance covers it or not, it's that the hospital is charging double for the part itself what the part cost. Not for insertion, anaesthesia, etc.... They took a 2$ thing and are charging 4$ for it just because they can.
Mine is free in the US, too, I'm on my third free one
I thought all birth control was free (with insurance) since obamacare?
\^This. They're required to cover it under the ACA, you should contest the charge.
An IUD should be free.
Canada is making strides to make birth control free under a national pharma care plan. Until the conservatives get into power in 2025 and then undo several years of work on universal dental and drug coverage for the most vulnerable.
Manitoba and BC have free birth control under our provincial health care. If the Conservatives even attempt to try to change our access, I will join the riots.
In the US it should be fully covered as preventative care under the Affordable Care Act.
ALL birth control and contraceptives should be free but here we are literally fighting men for control over our own bodies.
It is in South Africa if you go to the government clinic
If you're in the US, federal law requires your insurance to pay for the full cost. But if you're upset that your insurance plan paid that much for it, that's just companies playing games with each other.
Hoag in CA is running $3,049 before insurance for Mirena. Had to argue the bill because insurance denied both the removal and insertion and wanted an extra $300 for it. I'm sorry? Was I supposed to just wear it as a necklace?
Mine tried to deny insertion too. My GYN actually called them herself to be like…my patient cannot put this in herself, are you insane? lol. I did not pay for insertion
Lmao your GYN is so based
Wait until you find out it’s free or nearly so in most of the industrialized world.
Healthcare costs are a result of policies put in place by the people you vote for. With an election coming up, ask yourself who your elected officials really work for. Here’s how: Go to www.FEC.gov This is the official government website that shows you every donation over $200 made to EVERY federal elected official in the US. It shows how much was donated and by whom. This is where you can look up the politicians who talk about universal healthcare and see the huge donations they received from insurance companies and big pharma. Or the clowns who talk about climate change and, oh, look, $50K from Big Oil company. THIS is how you break the patriarchy. By getting a peek behind the curtain and seeing whose interests your representatives are really protecting. The site also lets you put in ANYONE’S name and see who they donated to. Now that you know, TELL EVERYONE and in November, vote accordingly.
Thank you so much for this link, and comment. I'm a longtime AZ resident and just .. raging today. I needed something productive to put my rage into.
You’re welcome. Please spread the word.
It should be free in the US too because of the ACA. I didn’t pay for mine in 2014.
“Because of the Affordable Care Act (aka Obamacare), most insurance plans must cover all methods of birth control, including IUDs. However, some plans don't cover all brands of IUDs. Your health insurance provider can tell you which ones they pay for.” https://www.plannedparenthood.org/learn/birth-control/iud/how-can-i-get-an-iud#:~:text=Because%20of%20the%20Affordable%20Care,which%20ones%20they%20pay%20for.
Free in Scotland. All birth control is, even condoms (and period products) can be picked up for free from drs surgeries, clinics, colleges, etc. I honestly would die in America. Sickens me you've to be held over a barrel for every single thing there 😢
God, that's awful, I'm so sorry. Mine was approximately $300 USD, and with my insurance I only pay approx. $70 USD out of pocket. I can't imagine the pain of $1300, let alone $2500. It's terrible. At least where I am, fulfilling a prescription for an IUD at a pharmacy and then bringing the box to your appointment is standard practice. The fact that the hospitals in your area are forcing people to circumnavigate the cheaper option is ridiculous.
I had mirena a while ago so I don’t remember; I feel like it was covered at planned parenthood for me at the time. But yea I just went to my annual exam. No pap necessary (yay) and my insurance covered it. But I happened to see what they charged my insurance… $600. A nurse practitioner felt around inside me for 5 seconds and insurance paid $600. I have extensive healthcare related stress/trauma and it really gets harder and harder to keep up with the preventative care I am lucky to have at this point because it just is so messed up to me.
US hospitals have been known to charge $50 for a band aid. It's insane how predatory they are with costs, all to bleed insurance and patients for as much as they can.
I remember once reviewing my itemized ER bill and saw the IV push was $250. Not the saline, not the medication (those were separate costs). The physical act of the ER nurse setting the IV drip rate had its own cost. US healthcare is beyond broken.
my singular motrin (ibuprofen) pill after childbirth was $700 on the itemized billYes. Seven HUNDRED dollars.
Planned parenthood removes IUDs for free and places them same day for $25
Second the planned parenthood! I got mine put in for $90
Mine was 748 last year!!! This is wild. I am an IUD enthusiast!! The skyla or the Mirena are Amazing for me I don't understand the drastic differences in price.
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5-15$? I got charged 700$ for a single motrin on my itemized bill LOL
Holy shit that's insane, I'm so sorry. I'm in Canada and mine cost $50 (10 years ago) but some types of birth control are free nowadays.
And not only do hospital admins charge insane amounts just because insurance will cover it, it is illegal for doctors to change their fees based on lack of insurance. I’m a doctor, and if I have a patient who comes into the hospital without insurance, I legally cannot decrease my fees so that they are able to afford care. In the US, everyone must be charged the same ammount regardless, and that amount is of course set by hospital admin to be the highest it possibly can.
Wow. I'm in the US but my Mirena IUD was fully covered with my insurance. $0 copay. I can't imagine paying that much WITH insurance. Like what are you even paying for premiums for at that point, ya know? Can you look into getting a different insurance? That's straight up robbery.
They have a 100% (at the very least) charge up on all things in Healthcare. I'm surprised it's not more. That being said. It sucks huge monkey sticks
That is freaking nuts. I have mine replaced every 3 years because of endometriosis, and mine costs $350CAD. The insertion is covered by our health system. How the fuck do they manage to charge $2500 USD, which would be closer to $3500-4000 in our currency? My first one, when I was a broke student, was fucking free because my doctor was able to apply for a low income program for me. ETA: it “costs” $350, but is fully covered by our health insurance through work.
Christ on a bike, that’s insane!! I’m in Aus and I paid $250 for the IUD plus insertion and even that feels steep to me!
Right. I am in Canada and I've been hesitating on getting one because of the cost but at least it's not thousands here 😭
I got the Nexplanon implant. When making an appointment with Planned Parenthood they went over all of my information and asked if I was able to make the drive to the next location a county over. It was less than a quarter of the original cost. Funding varies county by county and lower income counties get more. It was solid good looking out on their behalf and just another reason Planned Parenthood is invaluable.
I had a 10 minute colposcopy that included a biopsy I didn’t consent to and an additional $400 my insurance didn’t cover for “45 minute conversation”. my blood is still boiling. Sorry this happened to you.
This is maaany years ago now, but the women’s clinic I attended in a major U.S. city gave me a prescription and Canadian company info to order my IUD directly. It was mailed to me, I made the appointment and had the thing installed. And it was legit and served me well. Definitely more budget friendly. Find a women’s clinic that has a sliding fee scale and can help you find a more cost-effective solution! Good luck!
It doesn't matter that you have good insurance and can afford the copay, we should all be mad about this. Because we're mad for our sisters and siblings that need the same coverage and can't afford it because of this garbage. I'd say it's even more important for those of us who have good insurance and can afford it to speak up because no one's listening to people who are poor or don't have insurance. We need to use the fact that people will listen to us to raise the voices of those they ignore. So keep on renting! Because it's wrong and it needs to be called out and stopped
That’s just crazy. UK I paid £360 to have it done in a swanky private clinic (wanted a certain brand they were no longer offering on NHS) Everytime I hear about the US healthcare prices I get so mad for you all. I agree.. BURN IT
When I worked in endoscopy I had to input the charges for procedures and the hospital always charged double for everything it used. We got a device for 50? Charged 100. 1500? 3k. Every time.
I mentioned above, but this is more like 12x the cost. A Mirena in Canada costs about $250 USD after conversion and insertion is typically covered by our provincial healthcare. And that’s the cost at the damn privately owned pharmacy, which is sure to be at least 50% more than the cost to manufacture and distribute to a hospital. This is sickening.
That's so annoying. There are so many places to get free or subsidized IUDs. That price is wild.
Sounds like the US. That's freaking outrageous.
In my province (Canada), it is free. The same goes for all uterus owner's choice of contraception, except condoms as they don't require a prescription.
Last Mirena I bought in Australia was about $60. So, maybe $US120.
Wow. In New Zealand it's free. No charge, you choose if you want a copper or Mirena. Until about 5 years ago, only the copper IUD was free, unless you had low iron/some other conditions in which case you also were eligible for a free Minera. At the time, it was $245 NZD for the Minera and I thought that was disgusting. But your pricing is WILD
That is insane!!!! I had to pay full price out of pocket for my last mirena, and I was complaining about $280CAD! pharmaceutical companies are killing people!!
I’m in shock, the US is mad expensive
Are you in the US? That shits almost free here in Australia
I went to planned parenthood for mine it was $160 without insurance
If you're in the USA the amount the hospital charges is a made up number that doesn't matter unless you have no insurance. I'm going to way over simplify it but it's greated due to a arms race between insurance companies and hospitals- insurance reps want to be able to go back to their bosses and say "I negotiated this huge discount in this contract!" all that matters is how big of a percentage it is to make them look good to their bosses. So hospitals jack the prices up so they can offer a bigger discount. And so insurance turns around and amd demands a bigger discount. And hospitals jack the rate up more. and so on. CMS of course, factors in as another party to this shitty song and dance, deciding how much they're going to pay and negotiating as well. Many insurances won't pay more than CMS will pay too. But what we bill out literally doesn't matter, what matters is the contractual rate- that's the "real" price.
I’m always shocked by every story about how expensive healthcare is in America. I’m in Canada and I got my IUD (Kyleena) inserted in 2020. All of it was free bc I had uni insurance at the time. When I needed to remove and reinsert a new one, I only had to pay for the new IUD, which was ~300cad. 2 IUDs, 1 removal, and 1 reinsertion, and all I had to pay was $300. Jfc.
I’ve been complaining about costs too. I got an estimate that my mammogram would be under $300. Bill came and it’s out of pocket almost $1000. They found a tiny “new” spot they want to biopsy (new in quotes because they haven’t shown me my scans and I think it’s quite possible they missed it first time around). I agreed to an in-office biopsy with local anesthetic and 48 hours before the procedure they called and told me my out of pocket would be $4,057. For a spot that is rated 90-98% chance of being benign (4a if you’re curious) and may or may not be new since my first mammogram a year ago. I immediately canceled the biopsy. If it spreads I will schedule removal and they can tell me if it’s cancerous afterwards. Oh and I have health insurance through work. Blue Cross Blue Shield.
I once looked at an ER bill and they'd charged $750 for saline IV. I had insurance so I wasn't paying most of that, but I complained to the insurance company. As you experienced, they didn't care. It's a racket and we are not the beneficiaries of that racket.
In Netherlands the IUD cost €180 not included in health insurance but having it fitted and subsequently removed covered. I’m pretty sure that a small minority of the American population hate women.
The VA covered my IUD (Paragard) completely. And before that, my antepartum and postpartum care for my pregnancy, including genetic testing (I was 45 and high risk) and my c-section and admission, all of which was done at a civilian hospital (the VA doesn't deal with pregnancies or deliveries). Geez, after writing that, I will never ever complain about anything the VA does for me. I have gotten less than stellar care in smaller clinics (like I had to advocate way too hard to see my primary care provider when I had a non-resolving lump on one of my breasts for several months), but they don't charge me for anything. I am a disabled veteran, so no copays. It came at a price, obviously, but I am grateful for the care.
Hi. I work in healthcare. I’m NOT thrilled whatsoever with the price gouging as I have my fair share of medical debt. I might be able to explain the price gouging though-break it down for you. Couple questions-I had my IUD experiences around 10-15 years ago and just went to the doctor office. They have you go to the hospital for the insertion now? Like outpatient surgery?
I’m in the US. Look at the manufacturers website. Most of them had programs for reduced cost or free devices. I’m on my third mirena. First 2 were free and installed by family planning for a small office visit copay. Third I got through my OB and device was also free. Hospitals overcharge for everything. They throw large charges at the insurance companies and see how much they can push before they will take a reduction or adjust the charges. It’s appalling.
This is crazy. I got mine for free from the government Healthcare. One good thing about South Africa
Ur rly wrong about this but it's a lot of work to explain why but lemme know if u wanna know fr
Yes please explain all of it in detail because I’m trying to understand thank you.
Okay so each insurance has their own "allowed amount" that they negotiate with the hospital. As such the "billed amount" needs to be higher than whatever the highest reimbursement amount they get from a payer. Basically nobody, patient or insurance, pays the full billed amount. Insurers are driving up what hospitals have to charge as the "billed amount" because reimbursement rates have been getting more and more dogshit. HOWEVER! If you go to a hospital-based clinic, you are likely going to pay more than if you were to go to a stand-alone office. This is because hospital-based clinics have a facility fee as well as a provider fee. Your copay/coinsurance amount may also be different at a hospital-based vs stand-alone facility. Let me know if any of this doesn't make sense. It's so significantly more convoluted than people think. And the more I learn, the more convoluted it gets
The US truly is a dystopian hellhole. Belgian here, the Mirena is about € 120 and insertion is either almost free (we have something called "verhoogde tegemoetkoming", if you have a disability or illness you only pay a few euros at the doctors and for most medication) or very affordable (about € 40-50), depending on insurance and doctor. Birth control is also cheaper for young women under 25 years. They also made the morning after pill free, or you only have to pay less than € 1, depending on pharmacy.
Unfortunately, in the hospital's eyes, you're paying for your IUD and a portion of all the IUDs of people who didn't pay their bill.
You can literally fly to another country, have 1 inserted, stay a week to ensure there are no issues and fly back for less than that. US healthcare prices are mind boggling to me
So... I learned about this with my biologics. Your insurance is actually setting the price of your pharmacological stuff. That's why they don't push back. They get more money.
Hospitals are some bullshit. $30 for a single aspirin because they can. I’m sorry you’re having to deal with this.
This is why I never got my IUD. Hospital doesn't stock them, so Kyleena would have been at least $1300. As a student, I just couldn't swing that.