Understanding Insurance Billing For Nexplanon: A Comprehensive Guide

Nexplanon is a prescription birth control device that is used to prevent pregnancy. It is a hormonal birth control method that is inserted into the arm. The cost of Nexplanon can vary depending on factors such as insurance coverage and treatment plans. Nexplanon is typically billed as a medical benefit, which means that the drug and procedure are covered under the same benefit. However, in rare cases, it may be billed as a pharmacy benefit, where the drug is covered separately from the procedure. It is important to verify insurance coverage before purchasing Nexplanon, as costs can vary depending on the insurance plan and specific coverage.

Nexplanon as a medical benefit

Nexplanon is a prescription birth control device that is used to prevent pregnancy. It is a hormone implanted beneath the skin that is released slowly over up to 3 years to prevent ovulation. Nexplanon is covered by most health care plans and can be covered as either a medical benefit or a pharmacy benefit.

If Nexplanon is covered as a medical benefit, it means that both the drug and the procedure are covered under the same benefit. This is the most common form of coverage for Nexplanon. It can be purchased from specialty distributors, and the practice can then bill the insurance carrier for the procedure and implant.

To determine if Nexplanon is covered as a medical benefit, contact your insurance carrier and provide all relevant patient information. You may be asked for additional details, including appropriate codes and product-related information. You can also ask your healthcare provider to verify your insurance coverage and determine if Nexplanon is covered as a medical benefit.

If Nexplanon is covered as a medical benefit, you will typically pay the scheduled copay for the entire outpatient procedure, including the cost of the Nexplanon implant. However, it is important to note that insurance coverage can vary from patient to patient, and there may be other out-of-pocket costs associated with the product and procedure.

In rare cases, Nexplanon may be covered as a pharmacy benefit, which means the drug is covered separately from the procedure. In these instances, the copay cost of Nexplanon will vary.

Nexplanon as a pharmacy benefit

Nexplanon is a prescription birth control medication for women. It is covered by most healthcare plans and can be covered as a medical benefit or a pharmacy benefit.

If Nexplanon is covered as a pharmacy benefit, it means that the drug is covered separately from the procedure. After the pharmacy benefit is determined, a specialty pharmacy can deliver Nexplanon to the practice. The specialty pharmacy will bill the insurance plan for Nexplanon and ship patient-specific Nexplanon to the office. The office will then schedule the patient for the procedure. Once the procedure takes place, the practice will bill the insurance carrier for the procedure.

Nexplanon is available through six specialty pharmacies as a pharmacy benefit. Through the assignment of benefit (AOB) process, Nexplanon is paid for by the insurance plan. The specialty pharmacy will ship Nexplanon to the healthcare provider's office for the procedure, and there is no out-of-pocket cost to the healthcare provider.

Nexplanon as a medical benefit

If Nexplanon is covered as a medical benefit, it means that both the drug and the procedure are covered under the same benefit. A practice may purchase Nexplanon from specialty distributors to maintain an in-office inventory. The practice will then bill the insurance carrier for the procedure and implant.

Nexplanon is available through two specialty distributors as a medical benefit. Through the Buy-and-Bill process, healthcare providers who have completed the Clinical Training Program can order Nexplanon from a specialty distributor. The healthcare provider can then bill the insurance carrier for Nexplanon and the insertion procedure.

Nexplanon and the Affordable Care Act

Nexplanon is a prescription birth control device that is inserted into the arm to prevent pregnancy. The cost of Nexplanon depends on several factors, including insurance coverage and treatment plans. The Affordable Care Act (ACA) has made it mandatory for insurance plans to cover one type of birth control from each of the 18 FDA-approved categories without charging a co-payment or co-insurance. This means that Nexplanon, as an arm implant, may be covered by insurance with no out-of-pocket expense to the patient.

However, it is important to note that insurance coverage varies from patient to patient, and it is advisable to verify each patient's insurance coverage before purchasing Nexplanon. In some cases, prior authorization from the insurance provider may be required for coverage. Additionally, patients may still be responsible for other costs associated with the product, such as insertion and removal procedure fees.

The cost of Nexplanon without insurance is around $1,030.64 to $1,536.80, but it can vary depending on the clinic. The removal cost for Nexplanon also depends on insurance coverage and the charges of the doctor's office, typically ranging from $0 to $300.

Medicaid also covers the cost of Nexplanon, but only 25 states offer coverage for family planning services. Planned Parenthood and other organizations also provide low-cost or free Nexplanon implants, ensuring access to birth control that fits different budgets.

Nexplanon costs without insurance

Nexplanon is a prescription birth control device that is inserted into the arm to prevent pregnancy. The cost of Nexplanon without insurance varies depending on factors such as the clinic chosen, the doctor's fees, and the patient's income.

The list price of Nexplanon is $981.56 without insurance, but patients will also have to pay for the initial appointment with a healthcare professional and the insertion and removal procedures. The total cost of Nexplanon without insurance can range from $1,030.64 to $2,200, with insertion costing up to $800 and removal costing up to $300.

However, there are ways to reduce the cost of Nexplanon. Planned Parenthood, for example, offers Nexplanon for free or at a reduced price based on income. Additionally, Medicaid and some other government programs may cover the full cost of Nexplanon.

It is important to note that the cost of Nexplanon may vary depending on the patient's location and the specific clinic or doctor they choose. It is always a good idea to contact the clinic or doctor beforehand to get an accurate estimate of the total cost.

Nexplanon costs with insurance

Nexplanon is a prescription birth control device that is used to prevent pregnancy. The cost of Nexplanon with insurance depends on several factors, including the specific insurance plan and the type of coverage.

Most healthcare plans cover Nexplanon as either a medical benefit or a pharmacy benefit. In rare cases, insurance may consider Nexplanon a pharmacy benefit, in which case the copay cost will vary. Typically, Nexplanon is covered as a medical benefit, meaning that the drug and procedure are covered under the same benefit. In this case, insured customers will pay the scheduled copay for the entire outpatient procedure, including the cost of the Nexplanon implant.

The cost of Nexplanon without insurance is, on average, $1,536.80 for one 68mg implant, including the cost of outpatient implantation at a clinic. However, Nexplanon prices can vary depending on the clinic.

The list price for one rod (for up to 3 years of continuous pregnancy prevention) of Nexplanon is $1,092.48. However, most women will not pay the list price and it is likely that the cost of Nexplanon with insurance will be less than the cost of the drug without insurance.

Medicare-eligible patients may be able to get partial or full coverage of their Nexplanon implant, although it would be covered as a medical rather than a pharmacy benefit. On the other hand, Medicaid almost always pays the full cost of the implant.

It is important to verify each patient's insurance coverage as it can vary from patient to patient. Patients should also be aware that they may be required to get prior authorization from their insurance provider before receiving Nexplanon.

Frequently asked questions