Private Health Insurance
We understand that dealing with insurance companies can be difficult particularly in times of stress. Many commercial insurance plans cover the Mifeprex*(mifepristone) regimen. You may wish to go to State Payer Policies for information specific to your state; however, everyone has different coverage, so it is important that you check directly with your insurance company to find out if Mifeprex is covered under your plan. For most patients, the office visits and lab tests will be covered and so will the medication. You will be responsible for any co-payments or deductibles that normally apply under your health insurance policy. There is usually a number on the back of your insurance card that you can call to check on your benefits. Your doctor or clinic might also be able to help you determine what level of coverage your policy provides.
Federal law only requires state Medicaid programs to cover abortion, including Mifeprex, in cases of rape or incest, or when the woman’s life is in danger. However, some states go beyond the minimum coverage set by the federal guidelines, and cover abortions, including Mifeprex, in other circumstances. The following states currently provide broader coverage for abortion services; click on the state to get more specific information.
- New Jersey
- New Mexico
- New York
- West Virginia
Since it takes time to determine whether you qualify and to enroll in Medicaid, if you are not currently enrolled in Medicaid, you should ask about your eligibility for expedited enrollment or presumptive eligibility. These procedures allow pregnant women who do not have health insurance and who meet Medicaid income and asset limits to be enrolled in Medicaid more quickly than under the regular procedures. You should check with your State Medicaid program for more information.
For resources on Medicaid funding for abortions you may wish to visit State Law Resources.
Some providers charge a sliding scale for their services, depending on your ability to pay. To locate a provider in your area you may wish to contact:
- National Abortion Federation (NAF), www.prochoice.org, or 1-800-772-9100
- Planned Parenthood Federation of America (PPFA), Planned Parenthood Federation of America, Inc., or 1-800-230-PLAN
- Abortion Care Network (ACN), www.abortioncarenetwork.org, 1-202-419-1444.
If you contact a provider through NAF, PPFA or ACN ask them if they have a sliding scale based on ability to pay. There is also an organization called the National Network of Abortion Funds (NNAF), which raises funds for women who cannot afford abortions.
Please note the following:
• All codes supplied by us are for informational purposes only and represent no statement or guarantee that these codes will be appropriate or that reimbursement will be made in a particular situation.
• It is always the provider’s responsibility to determine and submit appropriate codes, charges, and modifiers for services that are rendered.
• All coding and reimbursement information is subject to change without notice, and specific payers may have their own coding and reimbursement requirements and policies. Before filing any claims, providers should verify current requirements and policies with the payer. We also recommend that providers stay current with National Correct Coding Initiative (NCCI) coding manual narratives and edits.
• Current Procedural Terminology (CPT) codes are copyrighted 2016 by the American Medical Association, all rights reserved. No fee schedules, basic units, relative values, or related listings are included in the CPT. The AMA assumes no liability for the data contained therein. Applicable FARS/DFARS restrictions apply to government use. Payments may be subject to reduced payment when multiple procedures are performed on the same day.