How to Get Natural Cycles Covered by Insurance

To get Natural Cycles covered by insurance, verify that your plan is subject to the Affordable Care Act’s contraceptive mandate, get a prescription from your provider, and submit the claim using HCPCS code A9293. The ACA requires most private health plans to cover FDA-approved and FDA-cleared contraceptives with no copay, coinsurance, or deductible when you use an in-network provider.1HealthCare.gov. Birth Control Benefits and Reproductive Health Care Options in the Health Insurance Marketplace Natural Cycles received FDA De Novo clearance in 2018 as a software application for contraception,2Food and Drug Administration. Device Classification Under Section 513(f)(2)(De Novo) – DEN170052 and the FDA Birth Control Guide lists “software application for contraception” as its own product category.3Natural Cycles. Is Natural Cycles Covered by Insurance Because the ACA requires coverage of at least one option in each FDA-recognized category, and the HRSA Women’s Preventive Services Guidelines add a catch-all for “any additional contraceptives approved, granted, or cleared by the FDA,”4HRSA. Women’s Preventive Services Guidelines there is a strong legal basis for coverage. The practical challenge is that many insurers haven’t updated their systems to recognize a digital contraceptive, so the process often requires specific documentation and, sometimes, an appeal.

Confirm Coverage Before You Subscribe

Call your insurer’s member services line before paying for a subscription. Ask specifically whether your plan covers “FDA-cleared software applications for contraception” or “fertility awareness-based digital contraceptives.” The representative may not know Natural Cycles by name, so framing the question around the FDA category is more productive than the brand.

If they say it’s not covered, ask them to look up HCPCS code A9293, the billing code for FDA-cleared fertility cycle tracking software. Having a code in hand shifts the conversation from “we don’t recognize this” to something the representative can actually search. Also ask whether the service falls under your plan’s preventive care benefits with no cost-sharing.

Get any confirmation in writing. Ask for an email or letter that includes the representative’s name, the date, and a reference number. That documentation becomes the backbone of an appeal if a claim is later denied.

Some major insurers already recognize the category. Aetna, for example, considers FDA-cleared mobile apps for contraception based on fertility awareness to be medically necessary under federal preventive care mandates when prescribed by a treating provider.5Aetna. Prescription Digital Therapeutics – Medical Clinical Policy Bulletins

Get a Prescription Even Though You Don’t Need One to Buy

Natural Cycles does not require a prescription for purchase. But a prescription substantially improves your odds of reimbursement, and some insurers require one. Aetna’s policy, again, ties coverage to a prescription from a treating provider.5Aetna. Prescription Digital Therapeutics – Medical Clinical Policy Bulletins

Ask your provider for a prescription or a medical necessity letter that identifies Natural Cycles by name as an FDA-cleared contraceptive software application. The letter should explain why this method is clinically appropriate for you, particularly if you have reasons to avoid hormonal contraception. Framing the prescription around your specific medical situation gives the insurer less room to label the product elective or experimental.

Use HCPCS Code A9293 on the Claim

The single most common reason Natural Cycles claims get denied is that the insurer’s system has no clear category for a digital contraceptive. The right codes solve that.

  • HCPCS code A9293 covers “fertility cycle (contraception and conception) tracking software application, FDA cleared, per month, includes accessories (e.g., thermometer).” It’s the code built for products like Natural Cycles.
  • Your provider should pair A9293 with a contraceptive management diagnosis code such as Z30.09 (encounter for counseling on general contraception) or Z30.9 (encounter for contraceptive management, unspecified).

If you’re filing the claim yourself rather than routing it through a provider’s office, include both codes on the form. Call the insurer first and ask which claim category the submission should use, whether prescription benefits, preventive care, or medical device. That call keeps the claim from being routed to the wrong department and rejected on a technicality.

Submit the Claim With the Right Documentation

Because Natural Cycles is purchased from the company rather than dispensed by a pharmacy, you’ll typically pay upfront and file for reimbursement. Gather these before you submit:

  • An itemized receipt. Natural Cycles emails one automatically and also makes it available in the “Manage your account” section of their website under Billing, then Receipts.6Natural Cycles. I Have an FSA or HSA Account – Am I Eligible for Reimbursement
  • Your prescription or medical necessity letter.
  • A completed claim form from your insurer’s website or member services line, with HCPCS A9293 and the diagnosis code included.
  • Any written coverage confirmation you already obtained.

Submit everything together. Incomplete claims are the easiest ones for insurers to sit on. Your insurer must notify you of acceptance or denial within 30 business days of receiving the claim.7HealthPartners. Understanding Medical Claims – What They Are and How They Work If nothing arrives by then, call and reference your submission date.

Plans That Don’t Have to Cover It

Not every health plan is subject to the contraceptive mandate. If yours falls into one of these categories, you’ll likely need to pay out of pocket or use a tax-advantaged account:

Your Summary of Benefits and Coverage will tell you whether the plan is grandfathered. If you suspect your employer has claimed a religious exemption, ask HR directly.

Pay With an HSA or FSA if Coverage Isn’t Available

If your plan won’t cover Natural Cycles, you can still pay with pre-tax dollars through a Health Savings Account or Flexible Spending Arrangement. Natural Cycles confirms that subscriptions are FSA and HSA eligible.6Natural Cycles. I Have an FSA or HSA Account – Am I Eligible for Reimbursement You can’t currently use an FSA or HSA debit card at Natural Cycles directly, so pay with a personal card and submit the itemized receipt for reimbursement.

The IRS defines qualifying medical expenses as costs for “diagnosis, cure, mitigation, treatment, or prevention of disease” and specifically includes birth control pills and the cost of “equipment, supplies, and diagnostic devices” used for medical purposes.9Internal Revenue Service. Publication 502 – Medical and Dental Expenses An FDA-cleared contraceptive fits within these categories. Your FSA administrator may require a written statement from a third party such as your doctor confirming the expense.10Internal Revenue Service. Publication 969 – Health Savings Accounts and Other Tax-Favored Health Plans Having your prescription on file speeds that step.

This route is worth using even while you’re still fighting for full insurance coverage. FSA or HSA funds now, direct insurance billing later if the appeal succeeds.

Appealing a Denial

Denials are common with digital contraceptives, largely because formularies and coverage categories haven’t caught up. A denial isn’t the end of the process. Your insurer must tell you in writing why the claim was denied and how to dispute the decision.11HealthCare.gov. How to Appeal an Insurance Company Decision Read that letter closely. The three most common reasons are misclassification (the insurer didn’t recognize the product as a contraceptive), lack of prior authorization, and a determination that it isn’t medically necessary. Each takes a different response.

Internal Appeal

You have 180 days from the date you receive a denial to file an internal appeal.12HealthCare.gov. Internal Appeals Address the specific reason in the letter. If the insurer says the product isn’t a covered contraceptive, cite the FDA De Novo classification DEN170052, the FDA Birth Control Guide listing for software applications for contraception, and the ACA’s requirement that plans cover all FDA-cleared contraceptive methods.4HRSA. Women’s Preventive Services Guidelines Attach your prescription, the FDA clearance documentation, and any prior written coverage confirmation.

If the denial cites medical necessity, include a letter from your provider explaining why Natural Cycles is the appropriate contraceptive choice for you. Some insurers offer peer-to-peer reviews where your provider talks directly with the insurer’s medical reviewer, which is often the fastest way to resolve a necessity dispute.

External Review

If the internal appeal fails, you can request an external review by an independent third party. Federal rules give you four months from the date of the final internal denial to file.13eCFR. 45 CFR 147.136 – Internal Claims and Appeals and External Review Processes The reviewer isn’t employed by the insurer, and the decision is binding. If the reviewer sides with you, the insurer must pay. Your denial letter will specify which external review process applies to your plan.

Regulatory Complaint

If you believe the insurer is violating the ACA’s contraceptive coverage mandate, file a complaint with your state’s department of insurance. Most departments have online portals and consumer assistance staff who investigate compliance with coverage mandates. This is particularly effective when the denial is based on the insurer not recognizing digital contraceptives as a category at all. For employer-sponsored plans, the Department of Labor’s Employee Benefits Security Administration handles complaints about ERISA-governed plans. A complaint doesn’t replace the appeal, but it creates a regulatory record that puts pressure on the insurer.