Gynecologists in NYC who will order a Mirena IUD
June 19, 2009 11:10 AM Subscribe
Gynecologists in NYC who will order a Mirena IUD for me?
I'm trying to get a Mirena IUD and am encountering a frustrating loop regarding getting it paid for by my health insurance, which is United Healthcare. Here is the story:
-I am in NYC
-I have not had children
-My gynecologist is willing to implant an IUD and we have decided on the Mirena. The problem is getting it paid for.
-My insurance, United, covers the Mirena - both implantation and paying for the iud itself - 100% as a medical benefit. However.
-My gynecologist's office will not order the actual device because they have had trouble being reimbursed by United at the rate that they are charged by Bayer (who makes the Mirena). They want me to order and pay for the device myself and then seek reimbursement.
-United will not pay for the device unless the doctor's office orders it; they say I cannot just pay for it and then be reimbursed.
I've gone back and forth on this and no one is budging; they both say the alternative is to find a doctor who is willing to order the Mirena, but that they cannot suggest a doctor. This thing is $600 and it is supposed to be covered by my insurance, so I'm trying to avoid just sucking it up and paying.
So my question is, are there any NYC Mefites who have successfully acquired a Mirena and had it paid for by United Health? And if so, would you be willing to share the name of your gynecologist?
I'm trying to get a Mirena IUD and am encountering a frustrating loop regarding getting it paid for by my health insurance, which is United Healthcare. Here is the story:
-I am in NYC
-I have not had children
-My gynecologist is willing to implant an IUD and we have decided on the Mirena. The problem is getting it paid for.
-My insurance, United, covers the Mirena - both implantation and paying for the iud itself - 100% as a medical benefit. However.
-My gynecologist's office will not order the actual device because they have had trouble being reimbursed by United at the rate that they are charged by Bayer (who makes the Mirena). They want me to order and pay for the device myself and then seek reimbursement.
-United will not pay for the device unless the doctor's office orders it; they say I cannot just pay for it and then be reimbursed.
I've gone back and forth on this and no one is budging; they both say the alternative is to find a doctor who is willing to order the Mirena, but that they cannot suggest a doctor. This thing is $600 and it is supposed to be covered by my insurance, so I'm trying to avoid just sucking it up and paying.
So my question is, are there any NYC Mefites who have successfully acquired a Mirena and had it paid for by United Health? And if so, would you be willing to share the name of your gynecologist?
I have been curious about this. My lasy gyn wouldn't give me one because I haven't had kids. Is this the real reason? Is it the insurance that wont pay for this reason.
posted by mokeydraws at 11:24 AM on June 19, 2009
posted by mokeydraws at 11:24 AM on June 19, 2009
Get a prescription for it and have it filled in a pharmacy? I think you can do it that way. You then take the IUD to the doctor's office and then have it inserted.
posted by FergieBelle at 11:35 AM on June 19, 2009
posted by FergieBelle at 11:35 AM on June 19, 2009
mokeydraws -
I was part of a clinical study for Mirena, and have not had children. I partially expelled the Mirena sometime during the first 30 days (likely in the first 2-3 days). Part of the refusal to implant Mirena in women who have not had children has to do with likelihood of expulsion.
I'm now on the Nuvaring, which isn't as convenient, but close!
posted by prettymightyflighty at 12:43 PM on June 19, 2009
I was part of a clinical study for Mirena, and have not had children. I partially expelled the Mirena sometime during the first 30 days (likely in the first 2-3 days). Part of the refusal to implant Mirena in women who have not had children has to do with likelihood of expulsion.
I'm now on the Nuvaring, which isn't as convenient, but close!
posted by prettymightyflighty at 12:43 PM on June 19, 2009
Nulliparous women (that is, women who have not had kids) are more likely to expel the Mirena, but the chance of that happening is slim to none. I had a similar frustrating experience three years ago- I decided I wanted an IUD and my stupid (male) GYN refused. I ended up on Nuvaring, which was wonderful.
This year I learned of a minor medical condition which meant that I needed an IUD, and you wouldn't believe how fast my new GYN had a Mirena inserted. I'm a nulliparious woman (still) with a average to small uterus, and after the first month adjustment period, have had zero problems with it- and no period, either, a side effect for many women on the Mirena. I ended up having to pay some out of pocket, but I think that it was entirely worth it. I loved my Nuvarings, but the Mirena is the best thing since sliced bread!
A family member is an older male primary care physician and he keeps Mirena in stock: he is a big advocate of IUDs and has no problem with inserting them in nulliparous women. His .02 is that he has been inserting Mirenas nearly since they came out in 1990 and in that time, he has had two women have problems with the Mirena- one had nagging pain that wouldn't go away even after a few months, and one had a spontaneous expulsion. The second patient later had a Mirena re-inserted and is doing fine with it.
End of the story is don't overlook primary care physicians who might provide Mirenas. I can't provide location-specific advice, but the MD family member suggests calling around and asking front desks if their doctor(s) insert Mirenas. Do your research on both paragard and mirena and go into the visit informed, so that you know what to ask for and you can clearly articulate your rationale for wanting and IUD over other forms of birth control, and Mirena over Paragard, and, he says, most physicians will respect your choice and provide you the form of birth control you request with no problems.
Once you find a doctor's office that will insert Mirenas, ask the insurance-specific question. Lots of times the front desk personnel will be able to answer insurance related questions better than the doctor, or ask for the office manager.
posted by arnicae at 12:55 PM on June 19, 2009
This year I learned of a minor medical condition which meant that I needed an IUD, and you wouldn't believe how fast my new GYN had a Mirena inserted. I'm a nulliparious woman (still) with a average to small uterus, and after the first month adjustment period, have had zero problems with it- and no period, either, a side effect for many women on the Mirena. I ended up having to pay some out of pocket, but I think that it was entirely worth it. I loved my Nuvarings, but the Mirena is the best thing since sliced bread!
A family member is an older male primary care physician and he keeps Mirena in stock: he is a big advocate of IUDs and has no problem with inserting them in nulliparous women. His .02 is that he has been inserting Mirenas nearly since they came out in 1990 and in that time, he has had two women have problems with the Mirena- one had nagging pain that wouldn't go away even after a few months, and one had a spontaneous expulsion. The second patient later had a Mirena re-inserted and is doing fine with it.
End of the story is don't overlook primary care physicians who might provide Mirenas. I can't provide location-specific advice, but the MD family member suggests calling around and asking front desks if their doctor(s) insert Mirenas. Do your research on both paragard and mirena and go into the visit informed, so that you know what to ask for and you can clearly articulate your rationale for wanting and IUD over other forms of birth control, and Mirena over Paragard, and, he says, most physicians will respect your choice and provide you the form of birth control you request with no problems.
Once you find a doctor's office that will insert Mirenas, ask the insurance-specific question. Lots of times the front desk personnel will be able to answer insurance related questions better than the doctor, or ask for the office manager.
posted by arnicae at 12:55 PM on June 19, 2009
In Canada, the Mirena is a prescription, filled like every other. It cost me around $300 CDN about 2 years ago. I walked in with it and handed to my obgyn. (She then screwed up the insertion and redid it with the office's spare, but thats another story).
If you're really, really desperate, maybe an online canadian pharmacy? I just googled, and the first place I found had it for $280.
posted by cgg at 1:44 PM on June 19, 2009
If you're really, really desperate, maybe an online canadian pharmacy? I just googled, and the first place I found had it for $280.
posted by cgg at 1:44 PM on June 19, 2009
I had this issue when I got my Mirena. Apparently, unless the office is dealing with large numbers of them, the cost is very high, higher than what most insurance companies will likely reimburse. I ended up having mine done at Planned Parenthood, which works in much higher volume. They would NOT sell me the device to be implanted at my regular OB/GYN - the whole procedure needed to be done there - but the experience was excellent. (Excellent as can be expected. It wasn't a pleasant day.)
Make sure your OB/GYN's office is willing to help you with any potential follow up or complications from the IUD, though. Mine wasn't, though they didn't make that clear to me before, so I ended up back at Planned Parenthood a couple times until I found a new OB/GYN with less silly policies.
posted by ferociouskitty at 1:56 PM on June 19, 2009
Make sure your OB/GYN's office is willing to help you with any potential follow up or complications from the IUD, though. Mine wasn't, though they didn't make that clear to me before, so I ended up back at Planned Parenthood a couple times until I found a new OB/GYN with less silly policies.
posted by ferociouskitty at 1:56 PM on June 19, 2009
I have been curious about this. My lasy gyn wouldn't give me one because I haven't had kids. Is this the real reason? Is it the insurance that wont pay for this reason.
I asked my gyn about this last year (2008) and she said it was because it was not FDA approved for use in women who had never been pregnant. The Mirena FDA info only mentions clinical trials with women who had been pregnant, so perhaps trials on nulliparous women have not yet been completed.
posted by DiscourseMarker at 2:00 PM on June 19, 2009
I asked my gyn about this last year (2008) and she said it was because it was not FDA approved for use in women who had never been pregnant. The Mirena FDA info only mentions clinical trials with women who had been pregnant, so perhaps trials on nulliparous women have not yet been completed.
posted by DiscourseMarker at 2:00 PM on June 19, 2009
she said it was because it was not FDA approved for use in women who had never been pregnant
This is true. However, it's widely used in nulliparous women around the world, there have been comprehensive studies on its safety and efficacy conducted in other countries, and this is just some kind of craziness on the FDA's part, so lots of doctors go ahead with off-label use and fit their nulliparous patients with it.
posted by Sidhedevil at 2:29 PM on June 19, 2009
This is true. However, it's widely used in nulliparous women around the world, there have been comprehensive studies on its safety and efficacy conducted in other countries, and this is just some kind of craziness on the FDA's part, so lots of doctors go ahead with off-label use and fit their nulliparous patients with it.
posted by Sidhedevil at 2:29 PM on June 19, 2009
Downtown Women's Ob/Gyn, on Broadway in Soho, takes United Healthcare and will give you a Mirena or any other kind of IUD with no problems. They'll warn you that insertion might be painful if you've never had kids, but beyond that you shouldn't have any problems having them get you one.
They're also pretty great as gyn docs in general.
Be prepared to wait on hold for about 20 minutes when trying to get an appointment though :)
posted by Dormant Gorilla at 2:35 PM on June 19, 2009 [1 favorite]
They're also pretty great as gyn docs in general.
Be prepared to wait on hold for about 20 minutes when trying to get an appointment though :)
posted by Dormant Gorilla at 2:35 PM on June 19, 2009 [1 favorite]
Check out Ginger Gillespie, with the East 13th Family Practice. I have United and she's suggested the IUD to me several times. I haven't taken her up on it yet, so I can't be sure that I wouldn't have the same problem, but it's worth a call to the office to see if they have the same insurance reimbursement issues.
posted by amandarose at 4:08 PM on June 21, 2009
posted by amandarose at 4:08 PM on June 21, 2009
This thread is closed to new comments.
posted by Sidhedevil at 11:23 AM on June 19, 2009