As women continue to experience Essure complications at high rates, more and more patients are beginning to investigate the idea of having their birth control implants removed.
In this article, our experienced attorneys discuss the current state of medical research and practice on Essure removal, as well as the attempts of individual doctors who have been tasked with reversing the “permanent and irreversible” procedure. Then, we’ll turn to a general introduction on getting insurance to cover a removal or reversal procedure. To skip straight to information on your insurance options, click here.
Can Essure Birth Control Be Reversed?
That depends on your definition of “reversal.”
There is no universally agreed-upon method for removing Essure implants. Several clinics have cropped up across the country offering their own innovative solutions to the problem.
Some emerging strategies are designed to reverse the Essure procedure, without removing the uterus or Fallopian tubes. Tubal anastomosis, for example, involves reconnecting the Fallopian tubes after the Essure implants are removed. Salpingotomy, in which a small incision is made in the Fallopian tube to pull the coil out, is another option.
Sadly, thousands of women have opted to undergo hysterectomy procedures, in which the uterus and Fallopian tubes are removed entirely. Needless to say, all of these procedures come with their own significant risks that can lead to complications requiring further medical treatment. In salpingotomy, for example, coils have been known to break, leaving metal fragments behind inside the Fallopian tube.
Essure Removal Proves Difficult For Doctors & Patients
Unfortunately, few doctors have any idea how to remove Essure implants, despite removal being an increasingly common request from thousands of women who have experienced severe side effects. Nationwide, only around 30 physicians have removed enough Essure implants to be considered “experienced” in the procedure, according to a recent report in Modern Healthcare. The vast majority of physicians, on the other hand, are going on guess-work and luck.
Dr. Julio Novoa, an OB/GYN in Texas, says that most doctors are poorly-equipped to remove the implants safely. “You have a lot of doctors making mistakes removing them,” Novoa, a consultant for Essure Problems, told Modern Healthcare.
This is not a small problem. Botched removal attempts can leave fragments of the metal implants inside a patient’s body, leading to ongoing pain and other significant complications. In some cases, pieces of a partially-removed implant have migrated away from the fallopian tubes, piercing internal organs.
When pressed for comment, Bayer spokesperson Rose Talarico advised Modern Healthcare to check the physician instruction packet that accompanies every package of Essure implants. While these instructions elaborate on multiple procedures that can be attempted to remove the devices, repeated warnings also dissuade removal in the first place. Essure is “intended to be left in place permanently,” the packet cautions, noting that the implantation procedure is “permanent and irreversible.”
Lack Of Data On Removing Essure
The viability of the removal techniques described in Bayer’s promotional materials has also been criticized. In one section, Bayer outlines using “gentle traction” to tease the implants out. Dr. Novoa likened this process to “grabbing a Slinky and trying to pull it when it’s attached to cement.”
The relative merits of various removal techniques have not been adequately studied, says Dr. Shawn Tassone, another OB/GYN. Tassone hasn’t been able to find any “good data” on which removal methods will work best. That leaves individual doctors to make their own attempts at removal and “come[…] up with a system that seems to have worked.”
In other words, it’s a process of trial and error.
If anything is clear, the healthcare establishment is struggling to deal with the fallout of a true public health crisis, a controversy exacerbated by what appears to be a lack of reliable information. Hundreds of thousands of women have experienced debilitating side effects after being implanted with Essure. Many turn to their doctors for a removal procedure, but find physicians who have no idea how to tackle the problem.
Hopefully, this situation will turn around in the future. The US Food & Drug Administration is currently working with Bayer to improve physician training materials.
Essure & Insurance: A Basic Guide To A Complex Problem
It’s an unfortunate fact that, since Essure was designed to be a permanent contraceptive option, medical researchers have thus far neglected to study reversing the implant’s effects with any rigor.
Now, we’ll turn to an associated issue – getting an insurance company to pay for your Essure removal procedure. The short answer to the question of whether or not your insurance company will cover an Essure removal is “maybe.” Whether or not an insurer will cover Essure removal is a matter of what procedure you plan to undergo, what insurance company you have and how vigorous your physician is in fighting your insurer for approval.
(Most) Insurers Are Required To Cover Essure Placement
Since 2012, all insurance plans (both private and those purchased through an Obamacare marketplace) are required to cover the full roster of birth control options approved by the Food & Drug Administration. That mandate includes the placement of Essure, a permanent birth control implant that secured the FDA’s pre-market approval in 2002. While some old insurance policies were “grandfathered” in without the contraceptive mandate, most insurance plans today must cover Essure implant placement and follow-up care without asking patients to contribute co-payments.
More recent rules from the Trump Administration have changed the picture somewhat, allowing insurers and employers to refuse coverage for contraception when it conflicts with their “religious beliefs” or “moral convictions.” Despite the revision, it remains true that the majority of major insurance companies are required, by law, to cover Essure implants.
Surgeon Says Getting Insurance Coverage Is Difficult
That all changes when we start to consider removing or reversing the placement of Essure implants, according to A Personal Choice, one of the nation’s leading fertility surgeon practices.
Dr. Charles Monteith, Medical Director at A Personal Choice, has been reversing tubal ligation procedures for nearly a decade. When Essure patients began to approach him with debilitating side effects, he turned to focus on developing techniques to reverse hysteroscopic tubal sterilization, the class of medical procedures under which Essure falls. Dr. Monteith says he decided, after years of successful practice as an OBGYN, to “help those who other doctors would not or could not help.”
Essure patients were at the top of the list. But that also means that Dr. Monteith has extensive experience in helping patients fight for insurance coverage for their removal and reversal procedures. Unfortunately, Dr. Monteith reports that only a portion of his patients have been able to secure coverage for Essure reversal procedures.
In the majority of these successful cases, the coverage has only been partial. The highest reimbursement rate Dr. Monteith has seen was around 50% of the procedure’s total cost. Based on Dr. Monteith’s experience, Essure patients should expect to pay at least 50% of the removal procedure’s cost.
How Much Does Essure Reversal Cost?
Obviously, the cost of an Essure reversal procedure can vary dramatically.
The North Carolina Center for Reproductive Medicine, which offers a procedure known as tubocornual implantation to remove Essure implants, lists a price of $6,250.
Tubocornual implantation, or anastomosis, involves removal of the blocked fallopian tube section. Then the end of the Fallopian tube is sewn back into a hole created in the uterus.
A Personal Choice advertises an Essure reversal surgery fee of $7,500, but this fee will increase to $7,900 on April 1, 2019.
We have also seen much lower prices (around $1,800) floating around, but the reputability of these clinics cannot be confirmed.
Removal Vs. Reversal Procedures
In the end, your health insurance coverage will depend primarily on the type of procedure you’re undergoing. Before we move further, we should distinguish two different ways Essure can be taken out:
- More invasive procedures, in which the Fallopian tubes are removed (either partially or entirely), are known as Essure removal procedures. Hysterectomy and salpingectomy (in which the Fallopian tubes are removed) are two common examples.
- Operations in which the implants are removed, but the reproductive organs are reconstructed afterward, are called Essure reversal procedures. When successful, reversal procedures allow women to become pregnant. This operation is usually referred to as a tubouterine implantation. Most insurance providers consider these operations, which have continued fertility as a goal, to be cosmetic procedures.
This distinction drives us directly into our first problem. As Dr. Monteith notes, the majority of health insurance companies consider Essure reversal surgeries to be elective procedures undertaken for fertility purposes. Most insurers don’t cover fertility treatments at all. As a result, it’s unlikely that a reversal procedure will be covered by your insurance company.
Another problem, noted by Shawn Tassone, MD, is that some newer Essure reversal procedures, including Tassone’s own method, are not yet recognized by health insurance providers.
Medically-Necessary Essure Removal
Removal procedures, on the other hand, are usually performed to stop the debilitating symptoms and side effects to which Essure implants have been linked. That goal places Essure removal procedures outside the category of “fertility treatments,” so some insurers will recognize the medical necessity of an Essure removal operation when a patient’s symptoms are properly-documented.
Thus, operations like a hysterectomy or salpingectomy, when performed in a hospital, could be covered. But that’s not a guarantee. Hysterectomy procedures, for example, are often considered elective, unless the operation is performed on a doctor’s orders to remove uterine cancer or stop internal bleeding.
As a result, many insurance companies will deny an initial request for hysterectomy coverage, forcing physicians to appeal the insurer’s initial decision. The Essure Problems website is filled with stories of women who were denied coverage for a hysterectomy procedure, even though an implant had perforated their vital organs.
Hoping to have an Essure removal procedure covered by insurance? You could be in for a fight.