Medicare-iuds/Depo provera/birth control

[insurancebenefit]

 ::)Does anyone know if Medicare will cover birth control specifically an IUD?  I understand that Medicare will only consider the charges if medical necessity is proven. How difficult is it to persuade Medicare to consider codes that  are not a covered benefit? The provider indicates the patient would be in great distress if she becomes pregnant and is confident that she can provide supporting documentation if needed.

[Michele]

I am not aware of birth control being a covered benefit under Medicare.  I know that in some cases when birth control is not a covered benefit it may be covered if there is a medical reason. Personally I do not believe you can "persuade" Medicare to consider a non covered benefit.  They have pretty straight forward guidelines on what is covered and what is not. 

[insurancebenefit]

Thanks for the input. To clear up the term persuade was mearly implying that I would be willing to submit medical records supporting the medical necessity. I thought someone here may advise to try and get a pre auth in place. And then be prepared to submit appeals in reply to the initial denial.

I have a very concerned provider who I trust when she says that if this girl gets pregnant she will be putting to much stress on her body.

This to me indicates medical necessity. The patient has no other insurance. The office takes very few Medicare patients.  Therefore I don't know have a real gauge on how procedures are treated that to the average patient would not be a necessity.

One other part of this they may have to do this while the patient is sedated-more like a surgery. How would that change for this Medicare claim?

At this time I have and the  provider and her medical assistant have been actively trying to get funding for the device/or a way for this patient to get birth control without affecting her budget in order to comply with Medicares wishes. But ultimately her insurer should provide this.

[Michele]

I completely understand the need as I have experienced a personal situation similar.  However in my experience with Medicare I will be surprised if they will cover it.  They are very black and white as to what is covered and what is not.  In my experience they don't look at things at a case by case basis.  So unfortunately I'm not sure what to tell you on where to go.  Have you tried just calling the provider contact center and asking if it's covered with medical necessity?

[PMRNC]

Medical necessity for birth control would be for oral contraception only. The MH factor/distress for an IUD or other contraceptive device would not suggest medical necessity since you are still prescribing for "contraception".