I’ve seen approximately fifteen IUD placements from my experiences in shadowing in the family planning department at Bellevue and working in the NYC Free Clinic. While this doesn’t make me an expert by any means, I have learned that IUD placement can be a bit painful (and I have the pains in my hand from patient squeezes to prove it). With that knowledge, I decided I wanted to get my IUD placed while I was at home in California during a holiday break so that I could have a full week to recover under the watchful eyes of a doting loving mother who could get me a heating pad when required. This strategy represents an abundance of caution. Most people after an IUD placement just have mild cramping that gets better within 24 hours. But, I was a baby and wanted to be treated as one.
When I saw my ob/gyn in California, she informed that it can take 6-8 weeks to get the IUD because it has to be ordered from the pharmacy and approved by insurance. She also informed me that she prefers to place the IUDs when women are on their period (to ensure they are not pregnant and because, not at all validated by evidence, it is less painful). She also wanted me to do a full STI screening a week before the placement despite the fact that it was not indicted in my history. We negotiated and she agreed given my limited time course (I was only going to be home for break for a week) that she would perform the STI screening on a Monday, receive results by Wednesday, place my IUD on Thursday and ignore the timing of my menstrual cycle. This made sense given the fact that my current method of contraception made getting pregnant less likely than having a tubal ligation and that I had very unpredictable periods with the method of contraception I was using (yay implant!).
Weeks went by and I did not receive any phone calls from my ob/gyn office. I finally called the office a month before I was scheduled to come home for break and they informed me that I had missed a phone call from my insurance company two months ago and the IUD had not been ordered. The insurance company had not left a voicemail and no one from my ob/gyn office had thought to let me know that I needed to give my insurance company a call back. I tried calling back the insurance company, could not get through for five days, and finally contacted someone who informed me that the IUD would not be ready for my holiday trip back home. My California plan for mission IUD was terminated.
This summer I decided to try again, this time in NYC. Student Health Services at NYU does not provide IUDs so I received recommendations from them on different providers. Many of the recommended providers did not have openings available for months but I finally made an appointment, a month from my phone call, at an NYU outpatient practice very close to where I live. Victory! I was so close to that sweet-sweet contraception! WRONG!
After my appointment with a wonderful NP, she informed me that they would order the IUD from the pharmaceutical company and would call me once it had arrived to arrange an appointment. Then, two months went by. The ob/gyn office called and stated that my insurance company would not pay for my IUD ahead of time. They informed me that I could purchase the IUD out-of-pocket and apply for a reimbursement from my insurance company instead.
At this point in my odyssey to an IUD, I would like to stress that I am on the health insurance plan provided for NYU medical students. I will now name this insurance company, in all caps, in case you want to write an angry letter to them, UNITED HEALTHCARE. I also was getting my IUD at an NYU-affiliated practice that should thus, one would think, logically, be able to provide services for the insurance offered to their own medical students. While I could not receive an exact quote from the pharmacy, I was told that the Mirena would cost about $700-800 dollars out-of-pocket not including insertion fees. Let me also be very clear, I am a poor medical student who does not have this much money to burn without a guarantee of reimbursement. So, I emailed my insurance company and asked for a guarantee in writing that they would reimburse me for the procedure as guaranteed under the Affordable Care Act. The following is an exact transcript:
“If the procedure is performed with an In-network provider and if the procedure and diagnosis codes billed by the provider meet the healthcare guidelines then it will be considered under your preventive care benefits at 0 cost to the insured. Nothing is a guarantee of coverage.”
There was also some mumbo-jumbo about ordering from the right insurance-approved pharmacies and the entire email was all very confused. Given the fact that I was unwilling to shell out the cash without a full guarantee of reimbursement, I had to find a different healthcare provider.
This brings me to the current day. I now have two appointments, two and a half months away at a Planned Parenthood that will require me to miss school twice and travel a far distance by myself to get an IUD which should have been covered by my in-network provider over a year ago. I’ll keep you posted. It hasn’t been placed yet so there’s still room for another hiccup. But also, god bless Planned Parenthood.
I consider myself fairly health literate and I even have fairly good health insurance plans. I know the procedure of placing an IUD fairly well and am able to advocate for myself in a medical setting. I am a medical student after all. If I had been slightly less well informed or slightly less committed to this desired form of contraception, getting this IUD would be impossible. As it stands right now, getting an IUD still feels like a herculean task. My heart breaks for the patients who don’t have the knowledge, time or patience to work their way through this obnoxiously cumbersome and inefficient system.
Lastly, I am taking away an appointment at a federally qualified health center from someone who might not be able to go to a private practice because my in-network ob/gyn providers have proven to be consistently incapable of providing this basic service to their patients. This is a shame. This shame belongs to my two insurance companies and the healthcare practices, including an NYU-affiliated practice, all of whom have prioritized system processes over the well-being of their patients. I am going to be on clerkships soon providing care to my patients within this system. I hope that I can help advocate for change in the health system in which I work so that patients seeking healthcare do not have to face such extreme challenges. Lastly, as I think should be obvious by now, I want to end with this plea. FUND PLANNED PARENTHOOD. Because apparently no one else will place your IUD even if you have insurance.