Does the office provide the Nexplanon, Paragard, Mirena or other IUD device?
Yes our office does provide consultation for the prescription for an IUD and the Nexplanon (birth control rod). Once the prescription is issued from the office and the patient has signed authorization then both of those are sent to benefit authorization to determine your insurance coverage for the device. There are 2 ways that a medical birth control device can be covered-medical or pharmacy. If your device is covered under a medical benefit then your device can be shipped directly to you or your pharmacy for insertion at the office. If your device is only covered under a pharmacy benefit then the patient would need to negotiate payment directly with the pharmacy and then file for reimbursement with their insurance as our office does not purchase medical devices on behalf of patients. Unfortunately since we are not a pharmacy and we don't bill these devices we are not able to verify before the benefit verification directly (as we do not have the device codes to request this information from your insurance since we don't provide them) there is no way to advise patient's prior to benefit verification (i.e. prior to our office issuing the prescription and sending it out) as to what their insurance may cover.
When it comes to understanding the difference between your medical and pharmacy benefits when it comes to birth control devices the issue is really who puts up the money up front for your device--not a difference in the pricing for your device. If you have coverage under a medical benefit then the device can be sent straight from the pharmacy to the doctor's office or the patient (typically for our office we request it go to the patient or patient's pharmacy) because your insurance is covering it under the medical part of your policy like it does physician's services and it does not have to go through your pharmacy benefits plan. In this way the device can be provided directly. If you only have coverage for the device under your pharmacy benefit then the process is different because in that case it is being covered like a drug--not a medical service. In these types of policy the insurance is covering the issuance of the prescription and the insertion of the device as a medical benefit but the device itself as a drug. So in these cases the patient would have to purchase their device and then request reimbursement directly from their insurance via their pharmacy benefit. In the case of pharmacy benefit coverage it is patient responsibility to get their device unless the doctor's office is willing to buy the device on behalf of the patient and then bill your insurance for reimbursement. Because of the costs of these birth control devices (typically >$1000) we do NOT buy devices on behalf of patients and do not participate in buy and bill programs. If you only have coverage (after benefit verification once your prescription is sent in after your visit) then you would either need to buy the device and bill your insurance or go to an office that does participate in the buy and bill program. We commonly refer patients that only have this type of coverage for their devices to Planned Parenthood.
Why does the office not participate in the buy and bill program?
Our office participated in the buy and bill program for almost 6 years. However during that time the office accumulated almost $5,000 worth of devices that patients decided after we had ordered them to go with a different contraceptive method (and we are not allowed to return the devices nor sell them to another patient and we cannot bill the insurance for reimbursement unless the patient actually implants the device).
Can you advise me if I have coverage for the device under medical or buy and bill prior to my visit?
Unfortunately since we are not a pharmacy and we don't bill these devices we are not able to verify before the benefit verification directly (as we do not have the device codes to request this information from your insurance since we don't provide them) there is no way to advise patient's prior to benefit verification (i.e. prior to our office issuing the prescription and sending it out) as to what their insurance may cover. Our office does not even collect information on your pharmacy benefits since we are not a pharmacy. However you as the patient can contact your insurance prior to your visit to inquire directly from your pharmacy benefits manager what your coverage is for each device and if you have coverage under medical or only pharmacy (i.e. buy and bill). Keep in mind however that your insurance company may require the device's HCPCS code to provide you with this information--that is not information that our office maintains since we don't bill for devices however once your prescription is issued you can get that type of billing information directly from the device manufacturer or benefits authorization.