Office: 535 Ocean Avenue, Portland, Maine 04103     Phone: (207) 518-6000     Fax: (207) 518-6001

IUD Form

Download IUD Purchase Policy (PDF)

Women’s Wellness does not provide IUD’s, our office policy is that the patient prepays for the device.

We then order the IUD and it is shipped to the office, you will then be called to schedule an appointment once it arrives. We cannot guarantee the reimbursement amount that your insurance company will pay towards the IUD device. More than likely there will be a difference in the amount reimburse to you from the insurance company.

There is a handling fee for the office processing this IUD device in the amount of $50.00 that will be added to the cost of the IUD. This will not be reimbursed by your insurance company.

Paraguard IUD: Patient responsibility

  1. Call your insurance company to find out your benefits.
  2. Ask if your insurance company will reimburse you directly if you submit the claim yourself? (Our office does not bill your insurance company and it will need to be inserted elsewhere.)
  3. Call our office and let us know if you would like to proceed.
  4. Sign the IUD purchase policy and fax back to the office.
  5. Send or call in payment to Women’s Wellness.
  6. When the IUD arrives the office will call you to make an appointment.

I have read the above IUD policy and understand that I am responsible for the $50 handling fee and my responsibility in contacting my insurance company to find out the coverage as stated above.

Download IUD Purchase Policy (PDF)