The birth control implant, most commonly known as Nexplanon, is a small, flexible rod inserted under the skin of the upper arm. It releases the progestin hormone etonogestrel, preventing pregnancy for up to three or five years. While insertion is a quick office procedure, removal is a necessary minor surgical procedure required when the device expires or if the user chooses to discontinue the method. Understanding the financial implications of removal is important, as costs can range dramatically from zero to several hundred dollars.
The Removal Procedure and Baseline Cost
Removal of the implant is a quick medical procedure performed in a healthcare provider’s office. The process involves injecting a local anesthetic, making a tiny incision, and gently retrieving the rod using specialized forceps. The procedure is typically brief, often completed in under five minutes, and the incision usually requires only a small bandage or a single dissolvable suture.
When paying without insurance, the full retail price varies widely based on the provider and location. The baseline cost for a routine, uncomplicated removal generally falls between $164 and $490, covering the provider’s time and necessary sterile supplies. However, in clinical settings like a hospital-affiliated clinic, the total bill before discounts may be higher, potentially reaching $1,500 due to facility fees and overhead costs. This uninsured price represents the maximum potential expense for a simple removal.
Understanding Coverage Under Preventative Care Mandates
For the majority of individuals with private health insurance, the cost of implant removal is legally mandated to be zero. Under the Affordable Care Act (ACA), most non-grandfathered health plans must cover all FDA-approved female contraceptive methods, including the implant, without any cost-sharing. This means the patient is not required to pay a copay, deductible, or coinsurance for the removal procedure.
This zero-cost coverage extends beyond the device itself and is required to cover all associated clinical services, including follow-up, management of side effects, and device removal. To ensure the zero-cost benefit applies, the procedure must be performed by an in-network provider, and the medical billing must use the correct preventative care coding.
Why Out-of-Pocket Costs Still Vary
Despite the federal mandate for zero-cost preventative care, some patients still receive a bill for the removal procedure. One common reason for unexpected charges is receiving care from an out-of-network provider, as the ACA mandate only guarantees zero cost-sharing for services delivered within the plan’s network. Additionally, certain plans, such as those that are “grandfathered” or offered by employers with religious objections, may be exempt from the full range of contraceptive coverage requirements.
Facility choice also plays a significant role in cost variability. Removing the implant in a hospital outpatient clinic, for example, will almost always incur higher facility fees than having the procedure done in a private medical office. A more complex removal is another frequent cause of unexpected costs. If the implant has migrated from its original placement site, the provider may need to use an ultrasound or other imaging to locate it, and these additional diagnostic services may not be covered at 100%. Finally, improper medical coding can cause a bill to be generated if the visit is coded as a diagnostic procedure instead of routine preventative removal.
Options for Reducing Removal Expenses
Individuals who are uninsured, have high-deductible plans, or anticipate unexpected charges have several options to mitigate the cost of removal. The most direct approach is seeking care from organizations that specialize in reproductive health services. Low-cost providers like Planned Parenthood health centers or local community health centers often offer services on a sliding scale based on income or may have grant funding to cover the procedure entirely.
Another strategy is to proactively call the billing department of a private clinic or doctor’s office to inquire about the self-pay or cash price. The negotiated cash price is frequently much lower than the rate billed to an insurance company, especially for a simple procedure. For those with insurance, confirming the procedure’s billing codes with the provider and the insurance company beforehand can prevent billing errors and ensure the zero-cost mandate is applied correctly.