Billed for IUD procedure

I can really use some help understanding if I'm being billed properly, as I was under the belief that this entire procedure should be covered by my insurance. TIA!

My IUD had reached its expiration date so I scheduled an appointment with my in-network OBGYN (established patient, she inserted this first IUD) to strictly remove the expired IUD and insert a new one (same brand). I'm insured through my employer and have confirmed that my plan is non-grandfathered and ACA compliant. I was under the assumption that this means my visit for contraceptive care is considered preventative and I would have no patient responsibility. See ref

At the DOS, upon check in, I was asked for a urine sample for a pregnancy test. Afterward, my doctor comes to see me and we do not discuss anything other than her asking if I had any trouble with the current IUD to which I reply "no." She removes the expired IUD, but fails to properly place the first replacement IUD (which is confirmed through an ultrasound check). She then has to proceed with an ultrasound guided placement of the second IUD, which is correctly placed. I'm asked to schedule a follow up appointment 1 month afterward to ensure the IUD placement is still correct. At this appointment, I let her know that I haven't been able to feel the string. She claims that we should no longer be doing string checks and she intentionally cut it short as it's a risk of accidentally getting yanked out like if you use a tampon (Is this really the new guidance???). So as she can't confirm the placement of the IUD by sight (because no string), she of course has to check the placement again via ultrasound. Placement is still good, we're in the clear.

I'm now getting billed for patient responsibility out-of-pocket costs (I have not yet hit my plan's deductible). It's as follows for the IUD removal/insertion visit:

99214 – Office O/P Est Mod: $30 copay patient balance

81025 – Urine Pregnancy Test: $5.17 balance / 81002 Urinalysis Nonauto W/O Scope: $2.09 balance

76998 – US GUIDE INTRAOP (ultrasound guidance): $350 charge adjusted to $53.56 patient balance

Bill for followup IUD check:

99213 – Office O/P Est Low 20 Min: $30 copay

76830 – Transvg US Non-OB (ultrasound IUD placement check): $422.73 charge adjusted to $117.53 patient balance

I understand that the ultrasounds might be outside of the covered scope of contraceptive care, but what I thought was going into a 100% covered service is now costing me $238.35?? Only the price of the IUD device itself seems to be coming at no cost to me? I've already gone back and forth with my insurance and the billing department. Billing says everything is coded properly and insurance says everything is processed properly. I'm now questioning if it was even appropriate to be billed for an office visit, at least for the first removal/insertion planned procedure. There was no E/M service to speak of yet billing claims the visit is not considered preventative care so it has to be coded as diagnostic. But shouldn't I just not be billed at all for a visit? I've now been scouring the legal language of the ACA and FAQs, and additionally found this helpful bit regarding being charged for the pregnancy test:

"On July 28, 2022, the Departments issued FAQs about Affordable Care Act Implementation Part 54 (FAQs Part 54) on additional aspects of contraceptive coverage, reiterating and clarifying the types of items and services required to be covered under PHS Act section 2713 and its implementing regulations. Specifically, these FAQs explained that plans and issuers are required to cover, without any cost sharing, items and services that are integral to the furnishing of a recommended preventive service, such as anesthesia necessary for a tubal ligation procedure or pregnancy tests needed before provision of certain forms of contraceptives, such as an intrauterine device (also known as an IUD), regardless of whether the item or service is billed separately."

I'm confused at this point on what my next course of action should be (or otherwise if this does all check out and I just have to pay for everything)…unless the provider has truly coded/billed things incorrectly (double dipping, or dishonest billing??), my insurance says the only thing to do is appeal the claim. Any advice is greatly appreciated.

submitted by /u/Tiny-Planter
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