First introduced in 2002, Essure is a device meant for permanent female sterilization. However, some women may want to have the device removed because of complications or because they want to have children. Essure removal and reversal require surgery and although, in theory, health insurance should cover it, there are instances where it wouldn’t. Here’s what they are and why.
Please note, it’s important to realize that when we say “Essure removal”, we’re using it as a general term that describes the overall procedure that takes Essure out of the body. We’re not referring to surgery where the female reproductive organs are removed from the body, nor are we referring to the specific Essure reversal surgery.
Does Insurance Cover Essure Removal?
Since 2012, all health insurance plans (both private and those bought through an Obamacare marketplace) are required to cover all of the birth control options approved by the Food and Drug Administration (FDA). This includes the implantation of Essure.
However, this all changes when it comes to removing Essure from the body. Most health insurance providers will not cover this surgical procedure and if they do, in the majority of cases, the coverage is only partial. Reimbursement rates seem to vary from 0 to 50 percent.
This is because it depends on whether the surgery is elective or not. An elective surgery, which is a procedure that isn’t necessary, will not be covered by health insurance. In particular, an Essure reversal surgery is considered to be a fertility treatment because the patient restores her ability to fall pregnant. Most insurers don’t cover fertility treatments.
So When Might Insurance Cover Essure Removal?
Essure is difficult to remove and the coils can break during the removal. Any metal and polyester fibers that are left behind in the body can then cause pain and inflammation. For that reason, if the implant urgently needs to be removed because it’s causing severe side effects and complications, surgeons will perform a hysterectomy or salpingectomy.
This ensures that Essure is definitely removed from the body, minimizing the risk of leaving fragments that may cause further complications.
When Essure is removed from the body in this way, your health insurance is more likely to cover the costs. But this isn’t always a guarantee. Sometimes, a hysterectomy is considered to be an elective procedure and in this case, it won’t be covered by insurance.
There are other factors which may affect your health insurance coverage, including:
- Health insurance agents giving you the wrong information in regards to your insurance policy as they don’t fully understand the procedures involved.
- Health insurance agents being given the wrong treatment codes.
- If the treatment isn’t performed in a hospital and instead, was at a private medical facility or clinic.
What Can I Do if My Insurance Doesn’t Provide Enough Coverage?
It’s important that you understand your insurance policy. Contact your insurance company and ask them to be sure as there are often many loopholes. You need to provide them with the correct treatment codes so they can check whether that type of treatment will be covered by your insurance.
If you find that your health insurance company isn’t providing you with enough coverage although your Essure implant has been causing you adverse complications, there are steps you can take to ensure you get the compensation you deserve.
Many women are filing lawsuits against Bayer, Essure’s manufacturer, for negligent design. It’s currently being argued that Bayer was aware of the device’s suspected malfunctions and failed to alert their consumers. Further reports found that the pharmaceutical company failed to disclose 16,047 complaints to the FDA and encouraged their doctors to pressure women into having the procedure despite not being properly trained to insert Essure.
As Essure was promised to be a safe, effective and permanent form of birth control, it’s unfair that you should have to pay for the implant to be removed - especially if you’ve been suffering from debilitating complications. Some women have even experienced significant, negative side effects. A lawsuit is the best way to ensure you get get the justice you deserve. But it’s vital you choose the right lawyer to represent your case.
At Coxwell & Associates, our team of qualified lawyers are experienced in a variety of personal injury cases, including Essure lawsuits. We’ve been helping Mississippians for over 35 years and we can not only help you claim compensation for your injuries, but we can also protect other women from using Essure.
If you’ve suffered from the adverse side effects of Essure and/or had to have corrective surgery, you might be eligible to file a lawsuit. We offer free case consultations. Click the button below to speak to our team about your case or check out our free download about Essure risks.
Disclaimer: This blog is intended as general information purposes only, and is not a substitute for legal advice. Anyone with a legal problem should consult a lawyer immediately.