CoverHer - National Women's Law Center

Plan is grandfathered

Grandfathered plans may still cover your birth control, but you may have some out-of-pocket costs. This depends on your specific plan benefit details. To determine what your plan should cover, please review your plan’s benefit details (which can be typically found connected with your insurer’s online portal).

CoverHer does not provide direct financial assistance for birth control. If you are looking for financial support for birth control, these resources may be helpful for you.

https://freethepill.org/online-pill-prescribing-resources/

https://www.bedsider.org/clinics

https://www.nationalfamilyplanning.org/pages/contact/contact-us----find-a-healthcenter

https://www.goodrx.com/how-goodrx-works

https://www.rxassist.org

Check your state/local public health department website for potential resources. You also have the option of enrolling in a HealthCare Marketplace plan during certain times of year or due to certain life events. All these plans are non-grandfathered and are required by the Affordable Care Act to cover preventive services like birth control at 100% of the cost. You can find plans at healthcare.gov.

Age/Dependent Coverage Issue

The National Women's Law Center believes that your age or dependent-status should not result in a denial of coverage. To better address your issue, please reach out to CoverHer by sharing your story.

While there is no legal precedent yet, we believe that these types of exclusions are discriminatory. If you would like to get an attorney, you can also contact the
Legal Network for Gender Equity.

No insurance

CoverHer does not provide financial assistance for birth control. If you need financial support for birth control, these resources may be helpful for you.

https://freethepill.org/online-pill-prescribing-resources/

https://www.bedsider.org/clinics

https://www.nationalfamilyplanning.org/pages/contact/contact-us----find-a-healthcenter

https://www.goodrx.com/how-goodrx-works

https://www.rxassist.org

Check your state/local public health department website for potential resources. You may also enroll in a HealthCare Marketplace plan during certain times of year or due to certain life events. These plans are required by the Affordable Care Act to cover preventive services like birth control with no out-of-pocket costs. You can review plan options at healthcare.gov

My plan is not covering the pill at all

Given the information you provided, your plan should be covering birth control without out-of-pocket costs. Federal guidance confirms that birth control pills – combined, continues, and progestin only – must be covered without out-of-pocket costs.

Plans do not have to cover every pill on the market. Insurance companies can choose to cover some brands and charge for others within a birth control category. (Example: plans may choose to cover a generic drug without cost sharing and impose cost sharing for equivalent brand-name drugs.)

You can see if your medication has equivalents by searching for your medication here and selecting “therapeutic equivalents." Your plan should be able to tell you if there are equivalents for your pill that are covered.

If your plan is not covering your pill without a copay or deductible there should still be a way to get coverage of your prescribed pill through the “waiver” or “exceptions” process.

Waiver/exceptions process - insurer must provide “an easily accessible, transparent, and sufficiently expedient exceptions process that is not unduly burdensome on the individual or a provider” to get no-cost-share coverage of any service or FDA-approved item within the specified method of contraception. If your provider recommends a particular service or FDA-approved item based on a determination of medical necessity, the plan must cover that service or item without cost-sharing.
The waiver process may be different for each plan, but you or your health care provider should be able to call your plan to get more information or get the process started.

If you've asked for a waiver but didn't get a clear answer or if your plan refused your request, you can file an appeal in writing with your plan. The following links provide information and step-by-step instructions on how to appeal, including sample letters that address this issue. Appealing your plan's decision about coverage could result in changes that benefit you and other women in the plan. A successful appeal might also mean that you get coverage or a refund for any money you had to pay out of pocket for birth control.

My pills were previously covered, but now I am seeing out-of-pocket costs

Given the information you provided, your plan should be covering birth control without out-of-pocket costs. This includes coverage of three categories of birth control pill – combined, continuous, and progestin only.

You might start paying for birth control that used to be fully covered if there's a new generic version available or if your plan has changed.

Your plan should have let you know about any changes, but you still have options. You can pay the added cost, switch to a covered pill, or go through a process to get a waiver so that you don't have to pay.

Insurance companies are required to have a process to cover medication without out-of-pocket costs if they cover some pills but not others. The insurer must provide “an easily accessible, transparent, and sufficient expedient exceptions process that is not unduly burdensome on the individual or a provider” to get coverage for that medication without out-of-pocket costs.

If you get denied coverage through the waiver process, you can file an appeal with your plan. This might lead to changes for you and other individuals on the plan, and you might even get a refund for any money you had to pay.
The waiver process may be different for each plan, but you or your health care provider should be able to call your plan to get more information or get the process started.

If you’ve asked about the waiver but got the run-around or if your plan denies your request for a waiver, you may file a written appeal with your plan. This page includes information and step-by-step instruction to appeal, including sample letters specific to this issue. Appealing your plan’s coverage decision might prompt changes for you and other women in the plan, and a successful appeal may result in coverage or a refund for money you’ve paid out of pocket for birth control.

My insurance says I need to try and fail other kinds of birth control before they will cover my pill

Federal guidance allows plans to utilize “reasonable medical management techniques” to determine what methods within a birth control category can be covered. However, requiring individuals to fail first using numerous other methods within the same category or in other contraceptive categories is an example of unreasonable medical management techniques.

If you do find that your plan requires you to try and fail other methods before covering your chosen birth control, we recommend:

Submitting a complaint to Department of Labor
Filing a written appeal with your insurance plan.

Appealing your plan’s coverage might prompt changes for you and others in the plan, and a successful appeal may result in coverage or a refund for money you’ve paid out of pocket for birth control. This page includes information and step-by-step instructions to appeal, including sample letters which should be helpful to you with some modification.

My plan only covers the generic version of my pill, but I need the name brand version

Given the information you provided, your plan should be covering birth control without out-of-pocket costs. This includes coverage three categories of birth control pill – combined, continuous, and progestin only.

Insurance plans don't have to cover every type of birth control pill, and they can choose to cover some pills and charge for others. For instance, they may cover a generic drug without making you pay and charge for a brand-name equivalent. You can find out if your medication has a generic equivalent by searching for it online or asking your plan.

If your plan is not covering your pill without a copay or deductible there should still be a way to get coverage of your prescribed pill through what is called the “waiver” or “exceptions” process. Insurance companies are required to have a waiver process to cover birth control without out-of-pocket costs. The insurer must provide “an easily accessible, transparent, and sufficient expedient exceptions process that is not unduly burdensome on the individual or a provider” to get coverage for that medication without out-of-pocket costs.

If your doctor recommends a particular service or FDA-approved item based on a determination of medical necessity with respect to your care, your plan must cover that service or item without cost-sharing. The waiver process may be different for each plan, but you or your health care provider should be able to call your plan to get more information or get the process started.

If you get denied coverage through the waiver process, you can file an appeal with your plan. This might lead to changes for you and other individuals on the plan, and you might even get a refund for any money you had to pay.
The waiver process may be different for each plan, but you or your health care provider should be able to call your plan to get more information or get the process started.

The links below include information and step-by-step instructions to appeal, including sample letters specific to this issue. Appealing your plan’s coverage decision might prompt changes for you and others in the plan, and a successful appeal may result in coverage or a refund for money you’ve paid out of pocket for birth control. You may want to look at both letters to see which fits your situation best.

Sample Letter (Generics) – .docx
Sample Letter (Generics)– .pdf
Sample Letter (No Waiver Process)– .docx
Sample Letter (No Waiver Process) – .pdf

My pill was covered, but not the doctor's visit

Given the information you provided, your plan should be covering your doctor’s visit without out-of-pocket costs.

Federal guidance ensures access “to the full range of FDA-approved contraceptive methods including, but not limited to barrier methods, hormonal methods, and implanted devices, as well as patient education and counseling, as prescribed by a health care provider” without cost-sharing (deductibles or copays). This includes coverage of three categories of birth control pill – combined, continuous, and progestin only.

Your plan should have let you know about any changes, but you still have options. You can pay the added cost, switch to a covered pill, or go through a process to get a waiver so that you don't have to pay.

Guidance also confirms that “clinical services” should be covered without co-pays or deductibles. Clinical services include office visits, tests, or procedures associated with birth control counseling, implantation, monitoring, and removal.

Sometimes people see charges for related services/office visits when their doctor or provider's billing department incorrectly codes for those services/visits. When this happens, the insurer cannot recognize the services are preventive and covered at 100%. It might be useful to share this helpful coding guide with your provider or their billing office to be sure that the office visits were coded and billed correctly.

If you do find that your insurance should be covering your birth control but is not, or you get the run around about getting your office visit covered; I’d recommend filing a written appeal with your health insurance plan. Appealing your plan’s coverage might prompt changes for you and others in the plan, and a successful appeal may result in coverage or a refund for money you’ve paid out of pocket for birth control. The links below include information and step-by-step instructions to appeal, including sample letters specific to this issue.

My plan does not cover any form of ring contraceptive without cost sharing

Given the information you provided, your plan should be covering the Ring without out-of-pocket costs.

The ACA ensures access “to the full range of FDA-approved contraceptive methods including, but not limited to barrier methods, hormonal methods, and implanted devices, as well as patient education and counseling, as prescribed by a health care provider” without cost-sharing (deductibles or copays). This includes coverage of the “vaginal contraceptive ring” as a unique method category.

Plans can require that you visit an in-network provider or pharmacy to get coverage without out-of-pocket costs, which can include a mail-order service. They also may charge a co-pay if you pick up more rings at a time than is allowed in your plan. You can find out the specifics of your plan’s network by calling the number on the back of your insurance card or by accessing this information online if your insurance company has a website for clients.

If your plan continues to deny coverage of the Ring, we’d recommend filing an appeal with your plan. The following links provide step-by-step instructions on to appeal, including sample letters specific to this issue. Appealing your plan’s coverage decision might prompt changes for you and other women in the plan, and a successful appeal may result in coverage or a refund for money you’ve paid out of pocket for birth control.

My plan covers the generic ring, but I need the brand name.

The ACA guarantees access to all FDA-approved contraceptive methods, including the Ring, without any cost-sharing. However, some plans may use cost-management techniques to control expenses. This could mean you might have to use a generic version of your preferred method instead of a brand-name option.

However, if your doctor recommends a particular brand or method, you can request a waiver or exception from your plan to receive it without out-of-pocket costs. You should be able to talk to your doctor or your plan to get more information and get the process started.

You may need to use an in-network provider or pharmacy to avoid extra costs, and your plan may limit the number of rings you can pick up at once. If your plan denies your request for a waiver, you can appeal their decision and possibly receive coverage or a refund.

The ACA ensures access “to the full range of FDA-approved contraceptive methods including, but not limited to barrier methods, hormonal methods, and implanted devices, as well as patient education and counseling, as prescribed by a health care provider” without cost-sharing (deductibles or copays). This includes coverage of the “vaginal contraceptive ring” as a unique method category.

If you’ve asked about the waiver but got the run-around or if your plan denies your request for a waiver, you may file a written appeal with your plan. The following links include information and step-by-step instructions on how to appeal, including a sample letter specific to your issue. You may want to look at both types of letters to see which best suits your situation.

Appealing your plan’s coverage decision might prompt changes for you and other women in the plan, and a successful appeal may result in coverage or a refund for money you’ve paid out of pocket for birth control.

I want the Annovera ring, but my plan does not cover it

The ACA guarantees access to all FDA-approved contraceptive methods, including the Ring, without any cost-sharing. However, some plans may use cost-management techniques to control expenses. This could mean you might have to use a generic version of your preferred method instead of a brand-name option.

However, if your doctor recommends a particular brand or method, you can request a waiver or exception from your plan to receive it without out-of-pocket costs. You should be able to talk to your doctor or your plan to get more information and get the process started.

You may need to use an in-network provider or pharmacy to avoid extra costs, and your plan may limit the number of rings you can pick up at once. If your plan denies your request for a waiver, you can appeal their decision and possibly receive coverage or a refund.

The ACA ensures access “to the full range of FDA-approved contraceptive methods including, but not limited to barrier methods, hormonal methods, and implanted devices, as well as patient education and counseling, as prescribed by a health care provider” without cost-sharing (deductibles or copays). This includes coverage of the “vaginal contraceptive ring” as a unique method category.

If you’ve asked about the waiver but got the run-around or if your plan denies your request for a waiver, you may file a written appeal with your plan. The following links include information and step-by-step instructions on how to appeal, including a sample letter specific to your issue.

Appealing your plan’s coverage decision might prompt changes for you and other women in the plan, and a successful appeal may result in coverage or a refund for money you’ve paid out of pocket for birth control.

My plan is covering the ring, but not the related doctor's visit.

Given the information you provided, your plan should cover your doctor’s visit without out-of-pocket costs.

Federal guidance ensures access “to the full range of FDA-approved contraceptive methods including, but not limited to barrier methods, hormonal methods, and implanted devices, as well as patient education and counseling, as prescribed by a health care provider” without cost-sharing (deductibles or copays).

Guidance also confirms that “clinical services” should be covered without co-pays or deductibles. Clinical services include office visits, tests, or procedures associated with birth control counseling, implantation, monitoring, and removal.

Sometimes people see charges for related services/office visits when their doctor or provider's billing department incorrectly codes for those visits. When this happens, the insurer may not recognize the service as preventive and covered at 100%. It might be useful to share this helpful coding guide with your provider or their billing office to be sure that the office visits were coded and billed correctly.

If you do find that your plan should be covering your visit but is not – or get the run-around about getting your services covered – we recommend filing a written appeal with your health insurance plan. Appealing your plan’s coverage might prompt changes for you and others in the plan, and a successful appeal may result in coverage or a refund for money you’ve paid out of pocket for birth control. The following links include information and step-by-step instructions to appeal, including sample letters which should be helpful to you with some modification.

My insurance won't cover the patch without cost-sharing.

Given the information you provided, your plan should be covering the Patch without out-of-pocket cost.

The federal government released guidance ensuring access “to the full range of FDA-approved contraceptive methods including, but not limited to barrier methods, hormonal methods, and implanted devices, as well as patient education and counseling, as prescribed by a health care provider” without cost-sharing (deductibles or copays). This includes coverage of the “patch” as a unique method category.

If you do find that your insurance should be covering your birth control but is not, you can file a written appeal with your health insurance plan. Appealing your plan’s coverage might prompt changes for you and other women in the plan, and a successful appeal may result in coverage or a refund for money you’ve paid out of pocket for birth control. This page includes guidance for filing an appeal with your plan.

My insurance says there is an issue with the billing codes

Sometimes people see charges for related services/office visits when their doctor or provider's billing department incorrectly codes for those visits. When this happens, the insurer may not recognize the service as preventive and covered at 100%. It might be useful to share this helpful coding guide with your provider or their billing office to be sure that the office visits were coded and billed correctly.

If you do find that your plan should be covering your visit but is not – or get the run-around about getting your services covered – we recommend filing a written appeal with your health insurance plan. Appealing your plan’s coverage might prompt changes for you and others in the plan, and a successful appeal may result in coverage or a refund for money you’ve paid out of pocket for birth control. The following links include information and step-by-step instructions to appeal, including sample letters which should be helpful to you with some modification.

My plan won't cover the IUD at all.

Given the information you provided, your plan should be providing coverage for birth control without out-of-pocket costs under the Affordable Care Act's birth control coverage requirement.

The federal government released guidance ensuring access “to the full range of FDA-approved contraceptive methods including, but not limited to barrier methods, hormonal methods, and implanted devices, as well as patient education and counseling, as prescribed by a health care provider” without cost-sharing (deductibles or copays). This includes coverage of at least one type of IUD with progestin and coverage of the copper IUD. The guidance also confirmed that coverage includes “clinical services” that should also be covered without co-pays or deductibles.

If your insurance should be covering your birth control but is not, or you get the run around about getting your IUD covered, you can file a written appeal with your health insurance plan. Appealing your plan’s coverage might prompt changes for you and other women in the plan, and a successful appeal may result in coverage or a refund for money you’ve paid out of pocket for birth control. This page includes information and a sample appeal letter specific to the IUD, which should be helpful for you.

My plan won't cover the type of IUD I want without cost-sharing.

Given the information you provided, your plan should be covering birth control without out-of-pocket costs.

Federal guidance ensures access to the full range of FDA-approved contraceptive methods, as prescribed by a health care provider. Plans may use “reasonable medical management techniques” to control costs. This means that plans do not have to cover every IUD on the market, and can choose to cover some brands and charge for others. However, guidance states that a plan must accommodate any individual whose provider recommends a particular drug (generic or brand-name) if medically necessary.

If your plan is not covering the IUD recommended by your doctor without a copay or deductible there should still be a way to get coverage of that IUD through what is called the “waiver” or “exceptions” process.

In this situation insurance companies must provide “an easily accessible, transparent, and sufficiently expedient exceptions process that is not unduly burdensome on the individual or a provider” to get coverage of that medication without out-of-pocket costs. The waiver process may be different for each plan, but you or your health care provider should be able to call your plan to get more information or get the process started.

While there are times when a plan can charge copays or deductibles, this does not apply to the copper IUD. Because Paragard IUD is the only medication currently available in the “copper IUD” category, plans must cover Paragard IUD specifically without out-of-pocket cost. The most recent guidance made it very clear that plans must “cover without cost sharing the full range of FDA-identified methods” and cannot “impose cost sharing” on a whole method category even though they may be covering other methods.

If your insurance should be covering your birth control but is not, or you get the run around about getting your IUD covered, you can file a written appeal with your health insurance plan. Appealing your plan’s coverage might prompt changes for you and others in the plan, and a successful appeal may result in coverage or a refund for money you’ve paid out of pocket for birth control. The following links includes information and a sample appeal letter specific to the IUD, which should be helpful for you.

I received a bill for an ultrasound, doctor's visit, or other service that was related to my IUD.

Given the information you provided, your plan should cover your doctor’s visit and/or related service without out-of-pocket costs.

Federal guidance ensures access “to the full range of FDA-approved contraceptive methods including, but not limited to barrier methods, hormonal methods, and implanted devices, as well as patient education and counseling, as prescribed by a health care provider” without cost-sharing (deductibles or copays).

Guidance also confirms that “clinical services” should be covered without co-pays or deductibles. Clinical services include office visits, tests, or procedures associated with birth control counseling, implantation, monitoring, and removal.

Sometimes people see charges for related services/office visits when their doctor or provider's billing department incorrectly codes for those visits. When this happens, the insurer may not recognize the service as preventive and covered at 100%. It might be useful to share this helpful coding guide with your provider or their billing office to be sure that the office visits were coded and billed correctly.

If you do find that your plan should be covering your visit but is not – or get the run-around about getting your services covered – we recommend filing a written appeal with your health insurance plan. Appealing your plan’s coverage might prompt changes for you and others in the plan, and a successful appeal may result in coverage or a refund for money you’ve paid out of pocket for birth control. The following links include information and step-by-step instructions to appeal, including sample letters which should be helpful to you with some modification.

My provider/the billing office won't change the billing codes for my IUD/ related service so that my insurance will cover it without cost sharing

This is a situation CoverHer is working diligently to address. To better support you, please share your story using the form below and someone will be in contact with you soon.

My insurance won't cover the shot.

Given the information you provided, your plan should be covering the shot without out-of-pocket costs.

On January 10, 2022, the federal government released guidance ensuring access “to the full range of FDA-approved contraceptive methods including, but not limited to barrier methods, hormonal methods, and implanted devices, as well as patient education and counseling, as prescribed by a health care provider” without cost-sharing (deductibles or copays). This includes coverage of the “shot” as a unique method category.

If your insurance should be covering your birth control but is not, you can file a written appeal with your health insurance plan. Appealing your plan’s coverage might prompt changes for you and other women in the plan, and a successful appeal may result in coverage or a refund for money you’ve paid out of pocket for birth control. The following links includes guidance for filing an appeal with your plan.

Sample Letter (Birth Control) - .docx
Sample Letter (Birth Control) - .pdf

I am being billed for a doctor's appointment related to my shot.

Given the information you provided, it seems that your plan should be providing coverage for your doctor’s visit without out-of-pocket costs under the Affordable Care Act's birth control coverage requirement.

Federal guidance confirms that contraceptive coverage includes “clinical services” that should also be covered without co-pays or deductibles. Clinical services includes office visits, tests, or procedures associated with contraceptive counseling, initiation of contraceptive use, and follow-up care (for example, management and evaluation as well as changes to, and removal or discontinuation of, the contraceptive method).

Often, we see people get charged for related services/office visits when their provider or their provider's billing department incorrectly lists the billing codes for those services/visits. When this happens, the insurance company does not recognize that the services are preventive and therefore must be covered at 100% of the cost. It might be useful to share this helpful coding guide with your health care provider or their billing office to be sure that the office visits were coded and modified correctly according to how your appointments occurred.

If you do find that your insurance should be covering your birth control but is not, or you get the run around about getting your IUD or related services covered, I’d recommend filing a written appeal with your health insurance plan. Appealing your plan’s coverage might prompt changes for you and other women in the plan, and a successful appeal may result in coverage or a refund for money you’ve paid out of pocket for birth control. The following links include information and step-by-step instruction to appeal, including sample letters which should be helpful to you with some modification.

Sample Letter (Birth Control) - .docx
Sample Letter (Birth Control) - .pdf

My insurance covers the shot through a pharmacy benefit

Given the information you provided, it seems that your plan should be providing coverage for your shot without out-of-pocket costs under the Affordable Care Act's birth control coverage requirement.

On January 10, 2022, the federal government released guidance ensuring access “to the full range of FDA-approved contraceptive methods including, but not limited to barrier methods, hormonal methods, and implanted devices, as well as patient education and counseling, as prescribed by a health care provider” without cost-sharing (deductibles or copays). This includes coverage of the “shot” as a unique method category. The currently applicable guidelines also confirms that contraceptive coverage includes “clinical services” that should also be covered without co-pays or deductibles. Clinical services includes office visits, tests, or procedures associated with contraceptive counseling, initiation of contraceptive use, and follow-up care (for example, management and evaluation as well as changes to, and removal or discontinuation of, the contraceptive method).

Plans can also choose to cover the shot as a medical benefit or as a pharmacy benefit. A plan may cover the shot under pharmaceutical benefits, which can require that you go to specific pharmacies to get coverage. The provider who prescribed your shot may be able to help you navigate this or you may be able to ask your plan which specialty pharmacy you should use and what form they need to complete the request.

If your shot is covered under your medical benefits, you may need to find an in-network provider who has the shot on-hand. Often Title X clinics purchase birth control in bulk for dispensing to patients on a low-cost basis. You may want to check with one of these providers in your area to see if they are in your plans network and if your shot will be covered by insurance. The website ww.familyplanning.org has a searchable database that may be helpful for you. If there is not a provider within your plan’s network that carries the shot please let us know.

If your insurance should be covering your birth control but is not, or you get the run around about getting the shot, you can file a written appeal with your health insurance plan. Appealing your plan’s coverage might prompt changes for you and other women in the plan, and a successful appeal may result in coverage or a refund for money you’ve paid out of pocket for birth control. The following links include guidance for filing an appeal with your plan.

Sample Letter (Birth Control) - .docx
Sample Letter (Birth Control) - .pdf

My insurance is not covering the implant

Given the information you provided, it seems that your insurance company should be providing coverage for birth control without out-of-pocket costs under the Affordable Care Act's birth control coverage requirement.

On January 10, 2022, the federal government released guidance ensuring access “to the full range of FDA-approved contraceptive methods including, but not limited to barrier methods, hormonal methods, and implanted devices, as well as patient education and counseling, as prescribed by a health care provider” without cost-sharing (deductibles or copays). Nexplanon is the only FDA approved birth control method in the “implantable rod” category and therefore must be covered without out of pocket costs. This includes coverage of at least one type of birth control implant. The guidance also confirmed that coverage includes “clinical services” that should also be covered without co-pays or deductibles. 

If your insurance should be covering your birth control but is not, you can file a written appeal with your health insurance plan. Appealing your plan’s coverage might prompt changes for you and other people in the plan, and a successful appeal may result in coverage or a refund for money you’ve paid out of pocket for birth control. The following links includes information and a sample appeal letter specific to the implant, which should be helpful for you for the implant.

Sample Letter (Birth Control) - .docx
Sample Letter (Birth Control) - .pdf

My insurance is not covering the insertion/removal of my implant

Given the information you provided, it seems that your plan should be providing coverage for insertion/removal of your implant without out-of-pocket costs under the Affordable Care Act's birth control coverage requirement.

On January 10, 2022, the federal government released guidance ensuring access “to the full range of FDA-approved contraceptive methods including, but not limited to barrier methods, hormonal methods, and implanted devices, as well as patient education and counseling, as prescribed by a health care provider” without cost-sharing (deductibles or copays). The guidance also confirmed that coverage includes “clinical services” that should also be covered without co-pays or deductibles. Clinical services include office visits, tests, or procedures associated with implant counseling, implantation, monitoring, and removal.

Often, we see people get charged for related services/office visits when their provider or their provider's billing department incorrectly lists the billing codes for those services/visits. When this happens, the insurance company does not recognize that the services are preventive and therefore must be covered at 100% of the cost.

Here is a link to the Bixby Center for Global Reproductive Health quick coding guide for LARC or long acting birth control like IUDs. It might be useful to share the WPSI coding guide with your health care provider or their billing office to be sure that the office visits were coded and modified correctly according to how your appointments occurred.

If your insurance should be covering your birth control but is not, you can file a written appeal with your health insurance plan. Appealing your plan’s coverage might prompt changes for you and other people in the plan, and a successful appeal may result in coverage or a refund for money you’ve paid out of pocket for birth control. The following links include information and a sample appeal letter specific to the implant, which should be helpful for you for the implant

Sample Letter (Birth Control) - .docx
Sample Letter (Birth Control) - .pdf

My insurance won't cover the cost of the female condom without cost-sharing

Given the information you provided, it seems that your plan should be providing coverage for the female condom without out-of-pocket costs under the Affordable Care Act's birth control coverage requirement.

On January 10, 2022, the federal government released guidance ensuring access “to the full range of FDA-approved contraceptive methods including, but not limited to barrier methods, hormonal methods, and implanted devices, as well as patient education and counseling, as prescribed by a health care provider” without cost-sharing (deductibles or copays).

If your insurance should be covering your birth control but is not, you can file a written appeal with your health insurance plan. Appealing your plan’s coverage might prompt changes for you and other people in the plan, and a successful appeal may result in coverage or a refund for money you’ve paid out of pocket for birth control. The following links includes information and a sample appeal letter specific to the implant, which should be helpful for you for the implant.

Sample Letter (Birth Control) - .docx
Sample Letter (Birth Control) - .pdf

I can't get my prescription for female condoms filled at any pharmacy in my area

If you’ve been unable to find FC2 at your local pharmacy, there are several ways to get your prescription filled:

With your prescription, your pharmacy should be able to order FC2 so that you can pick up when available. All pharmacies can stock FC2.
Get FC2 filled through a mail-order that can be delivered to your home or pharmacy of choice (details about mail order should be available to you in your plan documents).
Visit the FC2 website for additional options.

If your pharmacy is refusing to provide FC2, or make it available to you, please contact CoverHer using the questions below.

My insurance won't cover my sterilization surgery at 100% of the cost.

Given the information you provided, it seems that your plan should be providing coverage for birth control without out-of-pocket costs under the Affordable Care Act's birth control coverage requirement.

On January 10, 2022, the federal government released guidance ensuring access “to the full range of FDA-approved contraceptive methods including, but not limited to barrier methods, hormonal methods, and implanted devices, as well as patient education and counseling, as prescribed by a health care provider” without cost-sharing (deductibles or copays). This includes coverage of “sterilization surgery."

If your plan is not covering your surgery without a copay or deductible there should still be a way to get coverage of your prescribed surgery through what is called the “waiver” or “exceptions” process. In this situation insurance companies must provide “an easily accessible, transparent, and sufficiently expedient exceptions process that is not unduly burdensome on the individual or a provider” to get no-cost-share coverage of any service or FDA-approved item within the specified method of contraception. If an individual’s provider recommends a particular service or FDA-approved item based on a determination of medical necessity with respect to that individual, the plan must cover that service or item without cost-sharing. The waiver process may be different for each plan, but you or your health care provider should be able to call your plan to get more information or get the process started.

If you do find that your insurance should be covering your sterilization surgery but is not, or you get the run around about getting your surgery or related services covered, you can file a written appeal with your plan. Appealing your plan’s coverage might prompt changes for you and other women in the plan, and a successful appeal may result in coverage or arefund for money you’ve paid out of pocket for birth control. The following links include information and a sample appeal letter specific to sterilization, which should be helpful for you.

Sample Letter (Sterilization) - .docx
Sample Letter (Sterilization) - .pdf

I am being billed for an appointment/service related to my sterilization surgery.

Given the information you provided, it seems that your plan should be providing coverage for birth control without out-of-pocket costs under the Affordable Care Act's birth control coverage requirement.

On January 10, 2022, the federal government released guidance ensuring access “to the full range of FDA-approved contraceptive methods including, but not limited to barrier methods, hormonal methods, and implanted devices, as well as patient education and counseling, as prescribed by a health care provider” without cost-sharing (deductibles or copays).

Previous guidance also confirms that coverage includes “clinical services” that should also be covered without co-pays or deductibles. Clinical services include office visits, tests, or procedures associated with ring counseling, implantation, monitoring, and removal.

Often, we see people get charged for related services/office visits when their provider or their provider's billing department incorrectly lists the billing codes for those services/visits. When this happens, the insurance company does not recognize that the services are preventive and therefore must be covered at 100% of the cost. It might be useful to share this helpful coding guide with your health care provider or their billing office to be sure that the office visits were coded and modified correctly according to how your appointments occurred.

If you do find that your insurance should be covering your birth control but is not, or you get the run around about getting your surgery or related services covered, it may be helpful to submit a written appeal with your health insurance plan. Appealing your plan’s coverage might prompt changes for you and other women in the plan, and a successful appeal may result in coverage or a refund for money you’ve paid out of pocket for birth control. The following links include information and step-by-step instruction to appeal, including sample letters which should be helpful to you.

Sample Letter (Sterilization) - .docx
Sample Letter (Sterilization) - .pdf

I am being told the billing code for my bilateral salpingectomy isn't preventive.

Given the information you provided, it seems that your plan should be providing coverage for bilateral salpingectomy without out-of-pocket costs under the Affordable Care Act's birth control coverage requirement.

On January 10, 2022, the federal government released guidance ensuring access “to the full range of FDA-approved contraceptive methods including, but not limited to barrier methods, hormonal methods, and implanted devices, as well as patient education and counseling, as prescribed by a health care provider” without cost-sharing (deductibles or copays). This includes coverage of “sterilization surgery.” Previous guidance also confirms that coverage includes “clinical services” that should also be covered without co-pays or deductibles. Clinical services include office visits, tests, or procedures associated with birth control counseling, implantation, monitoring, and removal. This includes anesthesia and related pre-op appointments.

Every preventive service has a unique preventive service billing code that indicates to the insurance company that the service is one they need to cover under the ACA’s requirement. A helpful coding guide can be found here (relevant pages 23-25).

CPT-code 58661 (Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/ or salpingectomy)) and ICD-10 code Z30.2 (Encounter for sterilization are the appropriate codes for the bilateral salpingectomy) are the appropriate codes for this procedure. We have seen many people have a bilateral salpingectomy coded this way (correctly) and still be denied by insurance. In these cases, insurance plans will claim that CPT code 58661 is not preventive, which is false. We have drafted a template appeal letter specifically for this issue which I have attached. Please let me know if you want us to review your letter before you send it in; we are happy to help any way we can. If your insurance (or provider) is insisting that the code is diagnostic, it might be useful to share this information with your provider and make it clear that because the purpose of the surgery is sterilization, you insurance should be covering it without cost sharing. There is also an option for your provider or the billing office to attach Modifier 33 to the CPT code. This modifier indicates that the services are preventive, even if the procedure does not have a unique preventive service code. Information about Modifier 33 can be found on page 5 of the coding guide linked above.

If you do find that your insurance should be covering your bilateral salpingectomy but is not, or you get the run around about getting your surgery or related services covered, you can file a written appeal with your health insurance plan. Appealing your plan’s coverage might prompt changes for you and other women in the plan, and a successful appeal may result in coverage or a refund for money you’ve paid out of pocket for birth control. The links below includes information and a sample appeal letter specific to billing code issues for bilateral salpingectomies, which should be helpful for you. I would check out both the letters to see which one you think makes the most sense for your situation.

Sample Letter (Sterilization) - .docx
Sample Letter (Sterilization) - .pdf
Sample Letter - (Bilateral Salpingectomy – Billing code issue) - .docx
Sample Letter - (Bilateral Salpingectomy – Billing code issue) - .pdf

Medical management issue:Another issue to be aware of is that plans are allowed to practice “reasonable medical management” within each of the 18 FDA-approved contraceptive methods. This means they can cover one type of surgery but not another, such as choosing to cover tubal ligation and not bilateral salpingectomy.

However, if your plan is practicing medical management here, there should still be a way to get coverage of your prescribed surgery through what is called the “waiver” or “exceptions” process. In this situation insurance companies must provide “an easily accessible, transparent, and sufficiently expedient exceptions process that is not unduly burdensome on the individual or a provider” to get no-cost-share coverage of any service or FDA-approved item within the specified method of contraception. If an individual’s provider recommends a particular service or FDA-approved item based on a determination of medical necessity with respect to that individual, the plan must cover that service or item without cost-sharing. The waiver process may be different for each plan, but you or your health care provider should be able to call your plan to get more information or get the process started. We also have specific language for appeal letter if your plan does not have a waiver process in place (many plans don’t, and it’s a violation of the ACA) please reach out for a copy of that template letter if you need it.

My insurance says they only cover tradition tubal ligations and not bilateral salpingectomies.

Given the information you provided, your plan should be providing coverage for bilateral salpingectomy without out-of-pocket costs under the Affordable Care Act's birth control coverage requirement.

On January 10, 2022, the federal government released guidance ensuring access “to the full range of FDA-approved contraceptive methods including, but not limited to barrier methods, hormonal methods, and implanted devices, as well as patient education and counseling, as prescribed by a health care provider” without cost-sharing (deductibles or copays). This includes coverage of “sterilization surgery.” Previous guidance also confirms that coverage includes “clinical services” that should also be covered without co-pays or deductibles. Clinical services include office visits, tests, or procedures associated with birth control counseling, implantation, monitoring, and removal. This includes anesthesia and related pre-op appointments.

Plans are allowed to practice “reasonable medical management” within each of the 18 FDA-approved contraceptive methods. This means they can cover one type of surgery but not another, such as choosing to cover tubal ligation and not bilateral salpingectomy.

However, if your plan is practicing medical management here, there should still be a way to get coverage of your prescribed surgery through what is called the “waiver” or “exceptions” process. In this situation insurance companies must provide “an easily accessible, transparent, and sufficiently expedient exceptions process that is not unduly burdensome on the individual or a provider” to get no-cost-share coverage of any service or FDA-approved item within the specified method of contraception. If an individual’s provider recommends a particular service or FDA-approved item based on a determination of medical necessity with respect to that individual, the plan must cover that service or item without cost-sharing. The waiver process may be different for each plan, but you or your health care provider should be able to call your plan to get more information or get the process started.

The links below include information and a sample appeal letter specific to billing code issues for bilateral salpingectomies, which should be helpful for you. I would check out both the letters to see which one you think makes the most sense for your situation.

Sample Letter (Sterilization) - .docx
Sample Letter (Sterilization) - .pdf
Sample Letter (No Waiver Process) - .docx
Sample Letter (No Waiver Process) - .pdf

Billing code issues: Another issue we want to make you aware of is billing code issues. Every preventive service has a unique preventive service billing code that indicates to the insurance company that the service is one they need to cover under the ACA’s requirement. A helpful coding guide can be found here (relevant pages 23-25

CPT-code 58661 (Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/ or salpingectomy)) and ICD-10 code Z30.2 (Encounter for sterilization are the appropriate codes for the bilateral salpingectomy) are the appropriate codes for this procedure. We have seen many people have a bilateral salpingectomy coded this way (correctly) and still be denied by insurance. In these cases, insurance plans will claim that CPT code 58661 is not preventive, which is false. We have drafted a template appeal letter specifically for this issue which I have attached. Please let me know if you want us to review your letter before you send it in; we are happy to help any way we can. If your insurance (or provider) is insisting that the code is diagnostic, it might be useful to share this information with your provider and make it clear that because the purpose of the surgery is sterilization, you insurance should be covering it without cost sharing. There is also an option for your provider or the billing office to attach Modifier 33 to the CPT code. This modifier indicates that the services are preventive, even if the procedure does not have a unique preventive service code. Information about Modifier 33 can be found on page 5 of the coding guide linked above.

My insurance won't cover Phexxi at 100% of the cost and says I need to try other methods first.

Federal guidance confirms that if an individua’s provider determines that a particular service or FDA-approved, cleared, or granted contraceptive product is medically appropriate for a specific individual, a plan must cover that service or product for that individual without out-of-pocket costs. This is true even if the service or product is not specifically identified in the current FDA Birth Control Guide (as with Phexxi).

The law allows plans to use “reasonable medical management techniques” to cover certain products within a specified category of contraception. This means that not every brand within a unique method of contraception has to be covered by your plan without out-of-pocket costs. Still, your plan must defer to the determination of your provider. If your doctor determines that a method – like Phexxi - is medically necessary, then your plan must cover it.

Additionally, plans CANNOT require individuals to fail first using other contraceptive methods or products before covering the method recommended by your provider.

If you do find that your insurance should be covering your birth control but is not, you can file a written appeal with your health insurance plan. Appealing your plan’s coverage might prompt changes for you and other women in the plan, and a successful appeal may result in coverage or a refund for money you’ve paid out of pocket for birth control. The following links include guidance for filing an appeal with your plan.

Sample Letter (Birth Control) - .docx
Sample Letter (Birth Control) - .pdf

My insurance won't cover the cost of EC without cost-sharing

Given the information you provided, it seems that your plan should be providing coverage for EC without out-of-pocket costs under the Affordable Care Act's birth control coverage requirement. Emergency birth control, such as Plan B, is considered to be one of the many FDA-approved birth control methods that are covered under the preventive care benefit.

If you do find that your insurance should be covering your birth control but is not, you can file a written appeal with your health insurance plan. Appealing your plan’s coverage might prompt changes for you and other women in the plan, and a successful appeal may result in coverage or a refund for money you’ve paid out of pocket for birth control. The following links include guidance for filing an appeal with your plan.

Sample Letter (Birth Control) - .docx
Sample Letter (Birth Control) - .pdf

Insurance says I can not get maternity coverage because I am a dependent on my parent's plan

We believe denying maternity coverage to dependents is discriminatory. If this is your experience, we encourage you to share your story using the prompts below. Any information you provide will help us better advocate for people like you.

If you may be interested in seeking out an attorney, you can contact the Legal Network for Gender Equity here.

My insurance says they won't cover the cost of maternity care.

Given the information you provided, it seems that your plan should be providing coverage for maternity care without out-of-pocket costs under the Affordable Care Act's preventive service coverage requirement.

This guide has information about services that should be covered in a well woman visit. This FAQ notes that prenatal care is included in well-woman coverage. Specifically for prenatal services, healthcare.gov describes what types of services should be covered.

If you do find that your insurance should be covering your birth control but is not, you can file a written appeal with your health insurance plan. Appealing your plan’s coverage might prompt changes for you and other women in the plan, and a successful appeal may result in coverage or a refund for money you’ve paid out of pocket for birth control. The following links include guidance for filing an appeal with your plan.

Sample Letter (General Preventive Services) - .docx
• Sample Letter (General Preventive Services) - .pdf
Sample Letters (Well-Woman Visits) - .pdf
Sample Letters (Well-Woman Visits) - .pdf

I am being charged for prenatal care visits.

Given the information you provided, it seems that your insurance company should be providing coverage for certain prenatal care without out-of-pocket costs under the Affordable Care Act's preventive service coverage requirement.

This guide has information about services that should be covered in a well woman visit. This FAQ notes that prenatal care is included in well-woman coverage. Specifically for prenatal services, healthcare.gov describes what types of services should be covered.

If you do find that your insurance should be covering your services, the links below include guidance for appealing to your insurance company for the required coverage.

Sample Letter (General Preventive Services) - .docx
Sample Letter (General Preventive Services) - .pdf
Sample Letters (Well-Woman Visits) - .pdf
Sample Letters (Well-Woman Visits) - .pdf

My insurance will not cover the cost of a breast pump

Given the information you provided, it seems that your plan should be providing coverage for breastfeeding supplies and services without out-of-pocket costs. This includes breast pumps. Plans can require that you have a prescription from your health care provider, that you use an in-network pharmacy or supplier, and that you purchase a specific type of pump to get coverage without out-of-pocket costs. Our breastfeeding coverage toolkit has more information about coverage for breastfeeding services and supplies, including information about filing an appeal if your plan should be providing coverage without out-of-pocket costs. You may also access instructions for filing an appeal using the following links:

My insurance will not cover lactation consultations

Given the information you provided, it seems that your plan should be providing coverage for breastfeeding services and supplies without out-of-pocket costs. However, plans can require that you see an in-network provider to get coverage without out-of-pocket costs. If your plan does not have in-network lactation consultants that can provide a particular service available to you, then your plan must cover the item or service when performed by an out-of-network provider. Your plan cannot impose cost-sharing with respect to the item or service.

If your insurance has no in-network lactation providers available, and they refuse to cover an out-of-network provider, you can file an appeal to get coverage for out-of-network services. The following links (or our breastfeeding coverage toolkit) has more information about coverage for breastfeeding services and supplies and about filing an appeal.

Sample Letter (Lactation Consultation) - .docx
Sample Letter (Lactation Consultation) - .pdf

My insurance says that I need to see an in-network lactation consultant, but there are no in-network lactation consultants

Given the information you provided, it seems that your plan should be providing coverage for breastfeeding services and supplies without out-of-pocket costs. However, plans can require that you see an in-network provider to get coverage without out-of-pocket costs. If your plan does not have in-network lactation consultants that can provide a particular service available to you, then your plan must cover the item or service when performed by an out-of-network provider. Your plan cannot impose cost-sharing with respect to the item or service.

If your insurance has no in-network lactation providers available, and they refuse to cover an out-of-network provider, you can file an appeal to get coverage for out-of-network services. The following links (or our breastfeeding coverage toolkit) has more information about coverage for breastfeeding services and supplies and about filing an appeal.

Sample Letter (Lactation Consultation) - .docx
Sample Letter (Lactation Consultation) - .pdf

My insurance won't cover my well woman visit

Given the information you provided, it seems that your plan should be providing coverage for well-woman visits without out-of-pocket costs. This guide has information about services that should be covered in a well woman visit.

If you do find that your insurance should be covering your services, the links below contain guidance for appealing to your insurance company for the required coverage and sample appeal letters.

Sample Letters (Well-Woman Visits) - .docx
Sample Letters (Well-Woman Visits) - .pdf

My insurance won't cover my external male condoms

The updated Women’s Preventive Services guidelines specifies that external condoms (sometimes called “male condoms”) are covered by the ACA without out-of-pocket costs, just like other forms of birth control. You should be able to get a prescription for external condoms from your health care provider. In some states, you can be prescribed contraceptives through a pharmacist.

Unfortunately, the ACA birth control benefit only extends to anyone who can or may become pregnant, including adolescent and adult women, nonbinary people, and trans men. As a result, cis-men will not have access to the $0 cost provision.

If you find that your pharmacy does not have prescription condoms available, they should be able to order them for later pickup.

Exemption for religious employer/university

Organizations with religious, or moral objections to birth control may choose to become exempt from the ACA’s birth control requirement. For more information about the exemption, go here.

CoverHer does not provide direct financial assistance for birth control. If you are looking for financial support for birth control, these resources may be helpful for you.

Check your state/local public health department website for potential resources. You also have the option of enrolling in a HealthCare Marketplace plan during certain times of year or due to certain life events. These plans are required by the Affordable Care Act to cover preventive services like birth control at 100% of the cost. You can find plans at healthcare.gov.

Has Medicaid, lives in non-expansion state

This part of the health care law does not apply to Medicaid plans, so they are not required to cover all birth control methods without out-of-pocket costs. However, most Medicaid plans do cover many forms of birth control without cost. The best way to know which types of birth control are covered by your plan is to visit your plan’s patient web site or contact your plan’s patient customer service representatives.

You might also visit www.nationalfamilyplanning.org to find a family planning clinic near you that might be able to help you navigate your plan’s coverage, or access low-cost/no-cost options for birth control. There are also assistance programs available for many birth control methods, including the IUD. You can visit www.rxassist.org to get more information or talk with your health care provider.

Medicare, short-term/Americorps plan, or international/traveler’s insurance

These plans do not have to comply with the ACA’s birth control coverage requirement.

CoverHer does not provide direct financial assistance for birth control. If you need financial support for birth control, these resources may be helpful for you:

https://freethepill.org/online-pill-prescribing-resources/

https://www.bedsider.org/clinics

https://www.nationalfamilyplanning.org/pages/contact/contact-us----find-a-healthcenter

https://www.goodrx.com/how-goodrx-works

https://www.rxassist.org

Check your state/local public health department website for potential resources. You also have the option of enrolling in a HealthCare Marketplace plan during certain times of year or due to certain life events. These plans are required by the Affordable Care Act to cover preventive services like birth control at 100% of the cost. You can find plans at healthcare.gov.

TRICARE

Unfortunately, the ACA’s requirement that health insurance plans cover birth control without out-of-pocket costs does not apply to TRICARE. 

Active-Duty Service Members (ADSMs) get their prescriptions – including birth control – covered without out-of-pocket costs.  However, other people on TRICARE (such as dependents) could be charged co-pays for birth control and other prescriptions depending on where they pick up the prescription. 

For details about what those co-pays could be – and other aspects of TRICARE’s coverage requirements for non-ADSMs, we recommend that you contact TRICARE (for more information on prescription co-pays, visit:http://www.tricare.mil/pharmacycosts).  You can also appeal incorrect charges or co-pays by going to: http://www.tricare.mil/Resources/Appeals.aspx.

Needs more help or want to share your story?

If you would like us to get into contact about your situation or you need more help, please fill out the information below and we will attempt to contact you within 3 business days.

In addition to helping people get coverage of preventive services, we advocate for insurance reform and for better guidance from government agencies about the Affordable Care Act. It is helpful to us in our advocacy if we are able to share data and stories of plans violating the ACA. We are very appreciative of any and all information you can provide. Note that if we do share stories, all information will be shared ANONYMOUSLY - without any identifying information.

Needs more help or want to share your story?

You have been directed to this page because we need a little more information from you in order to provide the best resources. If you would like us to get into contact about your situation or you need more help, please fill out the information below and we will attempt to contact you within 3-5 business days.You have been directed to this page because we need a little more information from you in order to provide the best resources. If you would like us to get into contact about your situation or you need more help, please fill out the information below and we will attempt to contact you within 3-5 business days.

In addition to helping people get coverage of preventive services, we advocate for insurance reform and for better guidance from government agencies about the Affordable Care Act. It is helpful to us in our advocacy if we are able to share data and stories of plans violating the ACA. We are very appreciative of any and all information you can provide. Note that if we do share stories, all information will be shared ANONYMOUSLY - without any identifying information.

Full Name*

Email*

State of Residence*

How much are you being billed or told you will have to pay for your preventive service? If you are being charged for birth control pills, please indicate how much per month/per refill you are being charged (e.g. $35 per month for a 1 month supply or $80 per month for a 3 month supply).

How much are you being billed or told you will have to pay for your preventive service?

What is the name of your insurance provider and/or plan name?*

Description of the problem:*

Please include any relevant documents. It is helpful to use to have:

1. A copy of your plan benefits details (a booklet outlining what your plan does and does not cover)
2. Appeal denial letters
3. Any communications between you and your insurance provider (such as screen shots of chat messages, letters, etc.)

Please include any relevant documents. It is helpful to use to have: 1. A copy of your plan benefits details (a booklet outlining what your plan does and does not cover) 2. Appeal denial letters 3. Any communications between you and your insurance provider (such as screen shots of chat messages, letters, etc.)

Accepted file types: pdf, doc, docx, jpg, png, Max. file size: 50 MB.

All Topics

Helping people access essential preventive health services

CoverHer Hotline Webform

Step 2: Determine Type of Insurance Plan

Religious employer/university

Step 3: Grandfathered Status

Medicaid

ACA likely applies to your plan

Type of service

Birth control pills

The ring

IUD

The shot

The implant

Female condom

Permanent birth control (sterilization surgery)

Contraceptive Gel (Phexxi)

Emergency contraception

Prenatal care/maternity coverage

Breastfeeding/Chestfeeding/Lactation support

Well woman visit

Plan is grandfathered

Age/Dependent Coverage Issue

No insurance

My plan is not covering the pill at all

My pills were previously covered, but now I am seeing out-of-pocket costs

My insurance says I need to try and fail other kinds of birth control before they will cover my pill

My plan only covers the generic version of my pill, but I need the name brand version

My pill was covered, but not the doctor's visit

My plan does not cover any form of ring contraceptive without cost sharing

My plan covers the generic ring, but I need the brand name.

I want the Annovera ring, but my plan does not cover it

My plan is covering the ring, but not the related doctor's visit.

My insurance won't cover the patch without cost-sharing.

My insurance says there is an issue with the billing codes

My plan won't cover the IUD at all.

My plan won't cover the type of IUD I want without cost-sharing.

I received a bill for an ultrasound, doctor's visit, or other service that was related to my IUD.

My provider/the billing office won't change the billing codes for my IUD/ related service so that my insurance will cover it without cost sharing

My insurance won't cover the shot.

I am being billed for a doctor's appointment related to my shot.

My insurance covers the shot through a pharmacy benefit

My insurance is not covering the implant

My insurance is not covering the insertion/removal of my implant

My insurance won't cover the cost of the female condom without cost-sharing

I can't get my prescription for female condoms filled at any pharmacy in my area

My insurance won't cover my sterilization surgery at 100% of the cost.

I am being billed for an appointment/service related to my sterilization surgery.

I am being told the billing code for my bilateral salpingectomy isn't preventive.

My insurance says they only cover tradition tubal ligations and not bilateral salpingectomies.

My insurance won't cover Phexxi at 100% of the cost and says I need to try other methods first.

My insurance won't cover the cost of EC without cost-sharing

Insurance says I can not get maternity coverage because I am a dependent on my parent's plan

My insurance says they won't cover the cost of maternity care.

I am being charged for prenatal care visits.

My insurance will not cover the cost of a breast pump

My insurance will not cover lactation consultations

My insurance says that I need to see an in-network lactation consultant, but there are no in-network lactation consultants

My insurance won't cover my well woman visit

My insurance won't cover my external male condoms

Exemption for religious employer/university

Has Medicaid, lives in non-expansion state

Medicare, short-term/Americorps plan, or international/traveler’s insurance

TRICARE

Needs more help or want to share your story?

Needs more help or want to share your story?

Sample Appeal Letters

Need more help or want to share your story?

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