Ambetter and IUD

Hey all.

Me and my wife have Ambetter total care from the healthcare marketplace.

Last month my wife got the Mirena IUD inserted by her normal OBGYN. We spoke to the receptionist who called a few days before the procedure to verify our insurance information. She told us it would be covered, but that she was going to speak to the insurance for us and there was any copay or anything needed upfront she'd call back in a few hours. We never got a call back, and assumed the IUD was covered since as far as we were aware all FDA approved contraceptives are covered with no cost. The day of the insertion then came came and she got the IUD and we left.

Now, around 3 and 1/2 weeks later I logged into the insurance portal to view the EOB and saw that Ambetter says we owe over $1100 for the IUD. It looks like it was coded right and all, using the billing code J7298 for the IUD itself. And the other services related to the procedure including her blood tests and stuff like 'surgical trays' were covered 100%. Reading all that, I thought that this had to be an error, so I had my wife log on to her OBGYN patient portal, but the charge is on their too.

I've spent the last hour looking through all the benefit documents, but they say that they cover all contraceptives including hormone IUD's, copper IUD's, and pills. I also looked on the insurance company formulary list and the Mirena IUD is a tier 0 drug, which it states are covered with no copay. So am I missing something? Everything I can find both withhin in our plan documents and legally say that it's covered, and even our evidence of coverage documents says, verbatim, "Family planning/contraception benefits are covered under preventive care, without cost sharing, when provided by a network provider and when the care is legal under applicable law". Her OBGYN is 100% in network, and they've covered other services no problem so that's definitely not the issue.

Any advice? Should I be calling the OBGYN or the insurance company tomorrow, or both? I've never dealt with anything like this before so I'm a little lost.

submitted by /u/Glacerose
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