# Why does insurance cover circ in the US?



## Blu Razzberri (Sep 27, 2006)

I'm from Canada; so our medical 'rules' are different here. OHIP (our universal tax-funded health 'insurance') used to cover circumcision until they realized it wasn't necessary. It got me thinking...

Insurance companies as a whole are only concerned with one thing: their bottom line. I've seen many references to how insurance companies simply decide not to cover someone's lifesaving surgery because it's too costly. So, why is it that they so readily cover un-necessary circumcision??

On a side note: If they stopped covering circ's; they'd have more money to save more people -- but that's never how it works, is it?









*** Please read post #17 before replying. Thanks.


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## attachedmamaof3 (Dec 2, 2006)

As far as I know, many of them have stopped covering it. It's now considered "cosmetic" and the last stats I read say that 1 in 3 boys/men in US are now intact.


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## Blu Razzberri (Sep 27, 2006)

I wonder if anyone here can confirm that...? If you're insured, does your insurance cover circ...?


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## thixle (Sep 26, 2007)

My DD is on Medicaid (state health insurance for children)-- and it does cover circ in our state









We haven't recieved any info on hubby's new health insurance, but I'll be sure to ask as soon as the paperwork comes in.


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## PerkyKP (Nov 15, 2004)

Kaiser covers it, at least a good portion. I was groaning to myself that they could NOT pay for these circs, and then DO pay for doulas, and everyone would be better off!


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## Microsoap (Dec 29, 2005)

Something that irks me is that some parents are all gung-ho for circumcision until they find out their insurance won't pay for it and it has to come out of *their* pockets... then, it's let's leave the boys intact. The almighty dollar (*$$$*) is sometimes a deciding factor.

I guess a win's a win; hopefully, when _they_ grow up to have kids there's more of a chance of future boys being left intact. And if it's not insurance, it's laziness usually involving a dad who does want to circ, a mom who doesn't and the mom says the day can do it _he_ makes the appointment and takes him there. We've read many stories here about boys staying intact that way.


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## PerkyKP (Nov 15, 2004)

Quote:


Originally Posted by *Microsoap* 
involving a dad who does want to circ, a mom who doesn't and the mom says the day can do it _he_ makes the appointment and takes him there. We've read many stories here about boys staying intact that way.

That's what happened with my sister and her boys!


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## nd_deadhead (Sep 22, 2005)

Medicaid does not cover infant circumcision in North Dakota. Neither does my insurer (at least as a state employee), which is Blue Cross/Blue Shield of North Dakota.


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## HeidiAnn67 (Jun 12, 2007)

When I was pregnant with my youngest (he's now 4 1/2), dh called to find out if circ was covered. They told him it WAS NOT. We assumed we'd have to pay for the circ ourselves (this was before I was educated).
They circed him at the hospital and we never got a bill. I'm not sure what happened, but I wonder if they just billed it under "something else".
I know my dr told me outright when I was pregnant with my 2nd son (16 years ago) and my Insurance Co said they would only pay for a 3 day stay instead of a 5 day stay (I was having c-section and they liked to keep you a lot longer back then) that I would have a "fever" after the third day so I could stay. And I was there all 5 days and never got billed for anything, insurance paid for all of it (and I never had an actually fever, but I wonder what my bill to the Ins Co says in regards to that).


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## llamalluv (Aug 24, 2007)

Not all insurance covers it, but most patients don't check their EOB's or hospital bills. The hospital will submit the procedures with codes, so when patients get the bill for their "Labor and Delivery" unless they actually audit the bill, they don't realize they are paying the full amount for the circ. They just grumble about how much they pay for insurance and how much it costs to have a baby, and pay the bill.

Something else to consider is that state law may REQUIRE insurance companies to cover it. So, if you live in a state that does that, you are paying for coverage for cosmetic circumcision, whether you want it or not. The same goes with many other procedures that you probably don't want coverage for, like Port Wine Stain removal in Minnesota. Nice, huh?


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## Microsoap (Dec 29, 2005)

Some insurance only covered "emergency circumcision", some _unscrupulous_ doctors will have their staff commit *insurance fraud* by typing a code out saying it was for "emergency" reasons.

One member her said she was doing data entry and encountered this quite a few times. Sad. Wrong.


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## DahliaRW (Apr 16, 2005)

Medicaid doesn't cover it here, but my private plan (through dh's employer) does. I'd love to see them drop it, seeing as they employ A LOT of people in this area.


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## ruhbehka (Nov 5, 2006)

Medicaid in NC does not cover it! It was a recent change, because of the work of intactivists.


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## hollytheteacher (Mar 10, 2007)

i don't know of any insurance in the us that covers circ ... which is good!


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## Fyrestorm (Feb 14, 2006)

Anthem Blue Cross in CT covers it...I also believe Connecticare does as well. I have written letters but have never gotten any response.

I even asked why they wouldn't cover my tummy tuck since they cover other cosmetic surgery.


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## minkajane (Jun 5, 2005)

Tricare (military health insurance) covers neonatal circumcision, with no justification required. This is so much worse than an independant insurance agency paying for circ - *YOUR TAX DOLLARS ARE PAYING FOR MGM!!!!!*


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## Blu Razzberri (Sep 27, 2006)

Ok, so if many insurance companies cover circumcision; wouldn't it be wise to write letters with information to the president of the insurance company (or wherever they make their decisions); and send them information proving it's totally cosmetic and they don't have to cover it? If information is provided that other insurance companies don't cover it (perhaps even, by name); they'd seriously consider not covering it, right? Afterall, why pay for something they don't have to, when it puts more money back into their pockets...?


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## phreedom (Apr 19, 2007)

Medicaid covers it here. For some reason though it has to be done as an outpatient (at least at our hospital). If the parents have medicaid and want it done in the hospital they pay $200 dollars. I don't know why that is, and I dont' know if that is some sort of co-pay or it that covers the entire thing.

I don't think my private insurance (at the time...I was not on my husbands) covers it. When I first got pregnant, I had to pay my OB a fee for my prenatal care (in installments). The itemized list listed circumcision as costing $600.00 (if you chose to have it done) out of pocket. I can't imagine that being a co-pay. If it is, that is utterly insane.

I'm not sure if my husbands insurance covers it.


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## llamalluv (Aug 24, 2007)

duplicate. oops.


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## llamalluv (Aug 24, 2007)

Quote:


Originally Posted by *Fyrestorm* 
Anthem Blue Cross in CT covers it...I also believe Connecticare does as well. I have written letters but have never gotten any response.

I even asked why they wouldn't cover my tummy tuck since they cover other cosmetic surgery.

Three "cosmetic" surgeries that I KNOW are covered by the Arizona welfare health care system: circumcision, gastric bypass, and "excess" skin removal after a large weight loss. You have to "manipulate" the system for the last two, but you can get the state to pay for it, and there are doctors willing to help you. I'm not at all surprised that circumcisions are paid for by many states.


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## llamalluv (Aug 24, 2007)

Quote:


Originally Posted by *Blu Razzberri* 
Ok, so if many insurance companies cover circumcision; wouldn't it be wise to write letters with information to the president of the insurance company (or wherever they make their decisions); and send them information proving it's totally cosmetic and they don't have to cover it? If information is provided that other insurance companies don't cover it (perhaps even, by name); they'd seriously consider not covering it, right? Afterall, why pay for something they don't have to, when it puts more money back into their pockets...?

You are assuming that state law doesn't REQUIRE insurance companies to cover it.


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## MamaVolpe (Feb 27, 2006)

I have worked for two insurance co. and circ is often an option that employers can purchase for their employees. The company itself may not offer circ to all policys but some states mandate the coverage and some employeers option to have that additional coverage. It is the same for gastric bypass, some employers pay extra for those coverage options.


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## mack (Sep 5, 2007)

Quite recently, Federal Employee's Blue Cross/Blue Shield stopped covering it, I believe due to the change of heart from the American Assosiation of Pediatritions who no longer recommend it. So that's a pretty big company saying "NO". I wonder if the companies that still cover it are just behind the ball and have the change in the works, now that they have the backing of the AAP in refusal.


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## stever_45723 (Feb 21, 2006)

I just checked the federal BC/BS that my partner carries, and it does indeed cover RIC. I don't know whether different agencies in the country have different coverage policies. THe government also allows different levels of coverage. It is ppossible that on the lower level coverage policies RIC is not covered, but it certainly is on my partner's policy.


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## delphiniumpansy (Mar 1, 2007)

I normally don't post here because I have girls but I do recall from when I was preg the first time that our insurance does not pay for circumcision. Blue Cross of WA does not consider it medically necessary.


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## Night_Nurse (Nov 23, 2007)

Can anyone please explain why government *would* mandate that insurance cover circ???? I've never known that. I know the government stepped in an made ins. co. give minimum stays for vag & c-sec births, but I didn't know circs must be covered in some states. I'm wondering why.


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## fruitful womb (Nov 20, 2004)

Quote:


Originally Posted by *Night_Nurse* 
Can anyone please explain why government *would* mandate that insurance cover circ???? I've never known that. I know the government stepped in an made ins. co. give minimum stays for vag & c-sec births, but I didn't know circs must be covered in some states. I'm wondering why.

Night_Nurse,
Could it possibly be because the vast majority of the government are circumcised themselves and are pro-MGM? And purposely perpetuate circumcision for the sake of their own ego's?

Just a thought.


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## Night_Nurse (Nov 23, 2007)

Quote:


Originally Posted by *fruitful womb* 
Night_Nurse,
Could it possibly be because the vast majority of the government are circumcised themselves and are pro-MGM? And purposely perpetuate circumcision for the sake of their own ego's?

Just a thought.

Maybe. I just thought the govt would only mandate something if there was a real need.
Now I may be preaching to the choir here, but I don't think there is a real "need" for RIC.


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## abiyhayil (Feb 8, 2008)

Do you know how to find out if your state mandates coverage?


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## Eben'sMama (Jun 29, 2006)

In California, most private ins companies don't cover it (BC/BS, Pacificare, etc.), I believe. I also know for a fact that Medi-Cal (state health coverage) does NOT pay for circ, as it is considered medically unnecessary.


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## Frankly Speaking (May 24, 2002)

Quote:


Originally Posted by *MamaVolpe* 
The company itself may not offer circ to all policys but some states mandate the coverage.

The only state that mandates coverage for routine circumcision is New Mexico. That law was only recently passed. I think it was 2002 or 2003. This came at a time when other states were passing laws defunding Medicaid circumcision so this was an unusual action.

.


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## layla983 (Oct 8, 2007)

Fun fact our mine insurance (it's state employee insurance, DH is a teacher). I called to find out what was & what wasn't covered. My stuff, minus any pain meds for labor, was covered at 100%. DS was only covered at 80% after he filled the $100 deductable. I thought that was weird since I was covered at 100%, I just assumed DS would be because it read in the policy book like it would be. When I mentioned that I thought that was odd, the lady on the phone blurted out, "But the good news is that we cover 100% of circ, done in the hospital or at the peds office later!"

My response?

"Um, no, that's the worse news considering I have no interest is cutting parts of my baby off any at point without just reason. But I tell you what, how about you apply that $600 fee you'd pay for a surgery that isn't medically needed for my newborn to the actual NEEDED cost of his hospital stay? I think THAT would be the good news."

She changed the subject quickly.

So they won't pay the $350 for DS's actually needed charges, but they WOULD HAVE paid an extra $600 for surgery. Makes perfect sense, doesn't it?


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## Raelynn (Apr 7, 2007)

Quote:


Originally Posted by *layla983* 
"Um, no, that's the worse news considering I have no interest is cutting parts of my baby off any at point without just reason. But I tell you what, how about you apply that $600 fee you'd pay for a surgery that isn't medically needed for my newborn to the actual NEEDED cost of his hospital stay? I think THAT would be the good news."

Great response! It sure makes no sense what is and isn't covered.


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## bluetoes (May 12, 2007)

When we renewed I wasn't given the option and was too wimpy to ask. Wish I hadn't been.


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## trmpetplaya (May 30, 2005)

Quote:


Originally Posted by *delphiniumpansy* 
I normally don't post here because I have girls but I do recall from when I was preg the first time that our insurance does not pay for circumcision. Blue Cross of WA does not consider it medically necessary.

Premera in WA also doesn't cover it - I know because my ex-co-worker had a boy







Medicaid doesn't cover it in WA either







I should have asked KPS when I called them about how they cover homebirth, but I didn't think to.


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## thixle (Sep 26, 2007)

Found out today that TennCare covers it, only if it is done within 30 days








It's actually in the manual-thingy that you choose doctors/care providers from.







:


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## MarnieMax (Dec 24, 2004)

Quote:


Originally Posted by *Eben'sMama* 
In California, most private ins companies don't cover it (BC/BS, Pacificare, etc.), I believe. I also know for a fact that Medi-Cal (state health coverage) does NOT pay for circ, as it is considered medically unnecessary.

We had Pacificare when my sons were born and they covered it at the time (10-15 years ago). Perhaps things have changed. DH has a new job and we are now under Blue Cross. Circumcision is specifically listed as covered under 'infant care', etc. I was very disappointed.


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## KBecks (Jan 3, 2007)

it's elective cosmetic surgery and it should not be covered. Insurance companies would save!


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## Keeping up (Apr 7, 2004)

Interesting stuff (well, odd choice of words).

Canada's circ rate is significantly lower than the US - and I would suggest no insurance coverage as the primary reason, which I guess is a good thing. [FWIW, I think Canadians have a different perspective on the 'look' of anything, in general - so a bit different than americans.]

I wonder what would happen if the US rules were changed (i.e. no coverage, no legal requirement etc.) I wonder how long it would take for US circ rates to decline to Cdn levels.

I have super-duper insurance through my employer that covers the periphery items (i.e. 100 drug coverage, massage, PT, private room, blah blah blah). I wouldn't at all be surprised that circ is covered by my employer.

I didn't know circ wasn't covered by OHIP (again, universal health care coverage) with #1 son - it wouldn't have made a difference. My husband made the decision not to circ his boys long before he was born - and I never went a step further to determine any costs.


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## Frankly Speaking (May 24, 2002)

Quote:


Originally Posted by *AnnD* 
Canada's circ rate is significantly lower than the US - and I would suggest no insurance coverage as the primary reason

That is a small contributing factor. At one time, the Canadian circumcision rate was about where it is now in The US but by the early part of this century, it had fallen to about 17% nationwide and most of that 17% was concentrated in the western provinces. An event in 2002 made a major contribution to the current rate that is about 6%. Prior to this time, Dr. Dennis Kendall had been issuing warning memos to the College of Physicians and Surgeons of Saskatchewan that they were at financial risk in performing circumcisions and those memos spread among the other provinces. However, before August 2002, they were not given much attention. That all changed in August 2002 when Ryleigh McWillis was circumcised in Vancouver and died a couple of days later. Dr. Kendall's warnings became very real. Instead of parents rejecting circumcision, the doctors in Canada started refusing to perform circumcisions at all. Soon after that, the governments of the various provinces in Canada stopped paying for circumcisions.

It was this combination of factors, the very public death, the doctors refusal, the education of parents and the end of coverage for the procedure that mostly brought it to an end.

Likewise, it will be a combination of factors that will bring circumcision to an end in The US. At some point, there will probably be an action that acts as a catalyst like Ryleigh McWillis' death or a court case that will consolidate the work on other fronts to bring it to an end.

.

Likewise

, which I guess is a good thing. [FWIW, I think Canadians have a different perspective on the 'look' of anything, in general - so a bit different than americans.]

I wonder what would happen if the US rules were changed (i.e. no coverage, no legal requirement etc.) I wonder how long it would take for US circ rates to decline to Cdn levels.

I have super-duper insurance through my employer that covers the periphery items (i.e. 100 drug coverage, massage, PT, private room, blah blah blah). I wouldn't at all be surprised that circ is covered by my employer.

I didn't know circ wasn't covered by OHIP (again, universal health care coverage) with #1 son - it wouldn't have made a difference. My husband made the decision not to circ his boys long before he was born - and I never went a step further to determine any costs.[/QUOTE]


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## the_lissa (Oct 30, 2004)

I actually think it is a huge reason because we are so used to not paying for things that when we do have to pay for something, we really think about it.

I know many, many people who were on the fence or decided on circumcision, but didn't because ohip didn't cover it. Some because they didn't want to spend the money and some who figured that it wasn't necessary if it wasn't covered.


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## DahliaRW (Apr 16, 2005)

Quote:


Originally Posted by *trmpetplaya* 
Premera in WA also doesn't cover it - I know because my ex-co-worker had a boy







Medicaid doesn't cover it in WA either







I should have asked KPS when I called them about how they cover homebirth, but I didn't think to.

I have premera in WA and it is covered, 100%. So it depends on the employer I think. But they did fully cover my homebirth.


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## sunnymw (Feb 28, 2007)

United Healthcare (the gray card, not the blue) in GA covers it 100%. They do not fully cover prenatal care, labor, delivery, or anything else. They do cover vaxes 100%


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## TattooedMommy (Aug 11, 2006)

I live in CA and have Health Net through my husband's employer. I just got our new coverage booklet for the year and saw that Circ is 100% covered as an out patient procedure. I'm guessing that my DH's employer chooses to have it covered.


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## catters (Nov 20, 2007)

our insurance didn't cover circ. We weren't going to circ anyway (and, did not) it would have cost us around $300 to circ our son.


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