Essure Problems 

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Letter to Medicaid Offices to request termination of Essure Coverage

We are asking for your help in distributing this letter to every US State Medicaid Department. Feel free to copy and paste the text below and use it directly, or write your own. You can also use this pre written letter and add on your own personal experience with Essure if you’d like.

Dear Medical Assistance Program:

As you may be aware, the Connecticut Medical Assistance Program has ceased covering the costs of permanent implantable contraceptive occlusion devices (Essure) effective July 1, 2018.  This decision was based upon a recent mandate by the Federal Food & Drug Administration (FDA) which restricted the sales of Essure due to concerns about harmful medical side effects. Connecticut Medical Assistance Program (CMAP) noted the  procedure will no longer be covered under the Healthcare Common Procedure Coding System (HCPCS) code A4264-Intratubal occlusion device, but that other birth control devices would remain covered. 

Additionally, Current Procedure Terminology (CPT) code 58565-Hysteroscopy sterilization will be end-dated for dates of service, July 1, 2018 and the CPT code will be changed to a “no” under the payment type column on the Connecticut Medical Assistance Program, ensuring that this  procedure will not be covered by CMAP. Presumably, this decision was based not only upon the recent FDA mandate regarding update labeling reflecting the Black Box Warning for the device, but also due to the significant sums of monies expended by CMAP in treating adverse symptoms and injuries associated with the device.  This includes the significant costs of covering removal surgeries and hysterectomies to remove the Essure devices and treat/correct medical conditions caused by the Essure devices.

We urge your state’s Medical Assistance Program to follow the example set by Connecticut and to cease covering the costs of implanting the Essure Sterilization Device. Your coverage of the Essure Sterilization device has created a host of problems for the women implanted. First, most of the devices were implanted following the delivery of a child for which the mother was covered for a limited amount of time during her pregnancy.  Coverage frequently expired prior to the timing of the HSG confirmation test to provide confirmation that the Essure devices were properly placed, that the Fallopian tubes were occluded and that Essure could be relied upon for sterilization. According, numerous women could not afford and accordingly did not undergo the HSG confirmation test and were unaware if the devices were properly placed and were effective.

Additionally, thousands of women have experienced serious health issues caused by the device and have been left without coverage and a means of having the devices removed. It is unethical for a Medical Assistance Program to pay for a medical device to be implanted, without adequate recourse for a patient who experiences health issues caused by the device without adequate measures in place to cover device removal. Further, for women who remain covered under their state’s Medicaid program who suffer long- term health issues caused by the device, Medicaid will bear the costs of ongoing medical treatment.

For the foregoing reasons, we respectfully request you terminate coverage for all tubal occlusion sterilization devices, effective immediately.

Here is a list of the directors of each state's Medicaid department. Please reach out to them or search online to get an email address to send your letter, or send it my snail mail!