Tubal ligation reversal is a surgical procedure sought out by those who have had their fallopian tubes cut or barred; the objective is to restore the patient’s fertility. Though, insurance coverage for this procedure may appear limited. Here’s what you should know:
Will Insurance Cover Tubal Ligation Reversal?
Reversing this form of birth control can be expensive, often at the cost of thousands of dollars coming out of your pocket. Because tubal reversal surgery is categorized as an elective procedure (a non-urgent medical procedure that can be scheduled in advance) financial coverage for this procedure may be sparse.
Though some may cover partial costs, many insurance companies won’t cover this elective treatment since tubal reversal itself isn’t seen as medically necessary. Here we will go through a few tips to help you assess your options.
Will Medicaid Help Cover Tubal Ligation Reversal Costs?
Unfortunately, in most cases, Medicaid, a government-funded program, will not cover tubal reversal. Like most insurance companies, Medicaid typically provides coverage for medically necessary procedures.
Categorically, tubal reversal is placed outside the scope of standard coverage, since it’s done to restore fertility as opposed to addressing a medical condition.
It’s important to note that Medicaid does provide coverage for other reproductive health services such as:
- Tubal Ligation (sterilization) for permanent birth control.
- Pregnancy-related care, including prenatal and postnatal services.
- Fertility diagnosis and treatment (varies by state and specified in Medicaid program).
However, Medicaid’s reproductive health benefits are state-specific, so it’s imperative you check your state’s Medicaid program for precise details.
How Can I Get Coverage for Tubal Ligation Reversal?
The best way to check if your insurance policy covers tubal reversal surgery is by reviewing your policy or contacting your provider. Here are a few ways to explore your coverage:
- Review Your Insurance Policy:
Though not all insurance companies offer coverage, it’s important to not rule out your own. Assessing your policy will narrow the process when determining if you are covered under reproductive and fertility treatments. Though not always the case, some plans may offer coverage for procedures that restore fertility.
- Contact Your Insurance Provider:
You can contact your insurance provider and inquire about coverage for CPT codes pertinent to tubal ligation reversal and whether authorization is required.
- Request a Pre-Authorization:
Pre-Authorization, also known as pre-approval, is a process required by various health insurance companies to determine if a medical procedure will be covered or not. Requesting pre-authorization clarifies any uncertainty prior to performing the procedure.
In summary, it’s a beneficial way to ensure the insurance company will pay and approve the service in advance, reducing unnecessary or costly procedures.
Though tedious, taking these steps can help alleviate some of that uncertainty that comes with seeking medical coverage.
Does Insurance Cover Medically Necessary Tubal Ligation Reversal?
On occasion, procedures like tubal ligation can cause post-operative complications – problems that can unexpectedly happen after a surgery. If you are someone experiencing abnormal symptoms, or problems as a result of tubal ligation, you may be able to contend that the tubal reversal is medically necessary. When seeking insurance coverage for tubal ligation reversal, proving medical necessity is crucial:
- How To Work With Your Doctor to Prove Medical Necessity:
Reversal surgery is typically classified as elective, however there are cases where it meets the qualifications of medical necessity as a result of your original tubal ligation.
- Chronic Pelvic Pain
- Menstrual Irregularities
- Post-Tubal Ligation Syndrome symptoms (i.e., mood swings, hormonal imbalance)
- Other medical concerns possibly related to the procedure
It’s important to go through your symptoms and medical history with your doctor. Be honest and thorough about any symptoms you’ve experienced since your initial procedure.
- What to Include in a Letter of Medical Necessity:
You can request your doctor to write a comprehensive letter of medical necessity to submit to your insurance provider. The letter should include the following:
- An extensive report of your symptoms and diagnosis.
- How the tubal ligation may be negatively affecting your condition.
- A professional recommendation for a reversal as the best course of action.
- Any test results or medical records supporting your diagnosis.
- Be Thorough and Follow Up:
It’s important to stay involved throughout this process. Regularly follow up with your doctor’s office and insurance company to ensure all pertinent documentation has been submitted and is under review.
Determining medical necessity for tubal ligation reversal requires a strong cooperation between you and your doctor. By openly talking about your symptoms, undergoing evaluations, and obtaining a well-documented letter of medical necessity, you can create a compelling case for insurance approval.
Review Financing Options with Select Fertility Clinics
If you’re finding no luck in receiving coverage from your insurance, you can look to fertility clinics and see if they offer financial assistance or offer coverage plans; interested patients may be eligible for financing options.
Here at Reproductive Fertility Center, our team can gladly go over the options available to you during your initial consultation. For more information, contact us today!
