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How To Get Insurance To Pay For Tubal Reversal

What If I Had The Essure Procedure

Costs of Tubal Reversal Surgery

Dr. Ghomi believes that the Essure procedure cannot be reversed. Despite many online claims, there are no studies showing success after Essure reversal. Essure reversal to achieve pregnancy should be considered highly experimental. Essure coils are designed to cause tremendous tubal damage where the tubes meet the uterus. As a result, we do not offer tubal reversal after the Essure procedure.

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You may apply for a medical loan from United Medical Credit or CareCredit. Medical loans are unsecured financial loans that you can use to cover your health care costs.

Securing financial assistance is an option to consider if your tubal reversal operation isnt covered by your insurance company. It gives you access to the amount you need if you dont have enough cash to cover the full amount of your operation upfront.

Most Common Reason For Tubal Reversal

The most common reason for having tubal reversal is guilt and regret. Many women feel guilty at some point after having their tubes tied.

They had their tubes tied while they were young, in abusive relationships, or had children that were close in age.

The stress of having to care for kids in difficult circumstances is just too much especially when you do not have much support. As these mothers become older, they often find things change. They are older and wiser. They may be in a new relationship and their new partner is usually more caring and understanding.

With the passage of time, those young children who were close in age at the time of tubal ligation are now older teenagers. Having a 16 year-old and a 15 year-old is not the same as having a 3 year-old and a 2 year-old. Not even comparable!

When the kids get older then empty nest feelings start to creep in. Some women want another child. These feelings quickly turn into regret.

Regret usually leads people to think of ways they can right a past wrong. Approximately 90% of our patients seek reversal to have more children. They simply regret getting their tubes tied.

So without a doubt tubal reversal because of regret . is the most common reason women seek reversal of tubal ligation.

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Health Insurance Companies Are In Business To Make Profit

Health insurance companies are not going to let you sign up and then immediately start getting costly, non-essential surgeries or treatments.

Long ago health care companies realized health care is expensive and the costs increase every year. They only way they can make a profit is to charge you more every month and/or pay out less money than they take in.

Long ago these companies decided they would not pay for unnecessary surgeries.we call these elective surgeries. Which means, you elected or chose to have this surgery for personal reasonsnot medical reasons.

Cosmetic surgery and infertility procedures are often considered elective surgery. They are not medically necessary. They are not required to save your life.

Unfortunately, many healthy insurance companies will not pay for infertility treatments because they dont see infertility treatments as necessary to save your life.

Some companies will only cover infertility treatments but only if you meet certain conditions basically if the infertility is not due to any fault of yours. Some may only pay for IVF once you pay for tubal reversal surgery and have proof the tubal reversal did not work.

Many health insurance companies determined if YOUmade a VOLUNTARY decision to limit YOUR reproduction then why should THEY pay money to correct YOUR poor decision?

So if you understand the above you can more easily understand why health insurance companies are very suspicious of people who try to claim medical necessity.

Does Blue Cross Blue Shield Cover Tube Reversal

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The Blue Cross Blue Shield Association is a union of 37 companies that are independently owned and serve as insurance companies. Every company in the affiliation takes its own business decisions and administers the respective states with different regulatory conditions. The Blue Cross Blue Shield Association is a national federation that provides help to the less-fortunate citizens with their medical procedures and bills that follow.

This group of health insurance companies that cover tubal reversal also has a set of rules that one needs to follow to avail the benefits of the insurance that covers tubal reversal offered by this union. These rules are pretty much the same as mentioned above for the health insurance that covers tubal ligation reversal. Just like Medicaid, if your medical procedures fall under the category of medically necessary only then will the organization provide you with the benefits of insurance that cover tubal ligation reversal. If these bills and procedures do not fall under the said title then you might not get the said insurance.

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Medicaid And Tubal Ligation

Getting Medicaid to cover some procedures can be challenging. You have to meet the strict federal requirements before you can get your tubes tied. So, you would need to be at least 21 years old, mentally competent, have provided informed consent under §§441.257 and 441.258 and have waited for at least 30 days since you provided that consent.

However, in exceptional cases, such as when you undergo premature delivery, you can get your tubes tied so long as three days have elapsed since you gave your informed consent.

Federal guidelines on how funding can be used for sterilization exist to safeguard people from possible coercion, as has happened in the past against members of minority groups.

Tubal Reversal Under $3000 Near You: Insurance Or Hsa

Getting tubal reversal under $3,000 near you is possible without finding a local surgeon willing to perform the procedure at this meager price.

The secret is finding ways to get a third party with deep pockets to pick up most of your costs.

Getting your health insurance to cover tubal reversal is one strategy with low success odds, as most women will not meet the strict criteria.

Fortunately, other avenues make getting your tubes untied more affordable. You might find grants to defray costs and whittle them down further by using pre-tax money to pay for the procedure.

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How Is A Tubal Reversal Performed

There are three methods by which a tubal reversal can be performed. These include the old-fashioned open method, standard laparoscopy, and Robotic Assisted Microsurgical techniques. In the past, patients who underwent the open method had a 3-4 incision in their lower abdomen to reach the uterus and tubes. Microscopes were then used to open the tubes and sew them back together. This method allowed precise surgery to be performed, but by using an open incision, patients had a much longer recovery, usually requiring a week or more from work. The open incision also inherently causes scar tissue, which we just hoped did not affect the tubes. Through laparoscopy, patient recovery is much faster, and less scarring inside occurs. The drawback of this procedure is that due to limitations in the instruments, even the best surgeons cannot perform as precise of a tube repair as they could previously do under a microscope by hand. This could possibly sacrifice the success of the surgery. With the use of the da Vinci Robotic surgical system, the best of both worlds are combined, allowing a true microsurgical repair to be done, with a quick recovery and low chance of forming internal scar tissue. Typically one small incision in the belly button , and three other small incisions are made. This procedure is by far the best for the patient, providing several advantages to ensure that you have the best possible outcome

Related Questions For Tubal Reversal

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How much trouble would it be to get my tubes unclamped?2 answersDoes insurance cover clamp removal?1 answerIs it possible to get pregnant without getting my tubes untied?1 answerI had my tubes clamped, is there any possibility they can loosen?2 answersCan I get my Tubes Untied once I’ve had Tubal Ligation?1 answerThe posibility of tubes coming untied on their own?1 answerCan your tubes grow back?1 answerWhat’s the likelihood that Hulka clips would come off after more than six years of having a tubal ligation?1 answerI had my tubes tied 13 yrs ago through my belly button. I’m 42 and still have regular periods. Could I have a tubal reversal?1 answerMy right and left fallopian tubes were completely transected, what does this mean? Can I have still have a tubal reversal?1 answerMy fallopian tubes have been cut and burned. Can I get a tubal reversal?1 answerWhat is the average success rate of reversal of a bilateral partial salpingectomy?1 answerMy tubes are clamped instead of burned, will that make Tuabl Reversal more successful?2 answers

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Fast Facts About Tubal Reversal Costs

  • Tubal ligation reversals are rarely covered by insurance which leaves nearly the entire cost of the procedure to be paid out of pocket.
  • Even when IVF is covered by insurance, policies nearly always have exclusions for those with voluntary sterilization surgeries like tubal ligations or vasectomies.
  • The cost of tubal ligation reversals ranges widely. The average cost is somewhere around $8500.
  • Tubal ligation reversal costs can sometimes be split into anesthesia, surgical, and hospital fees, so its important to find out what is included at your tubal ligation reversal surgical center.
  • A tubal ligation reversal doesnt guarantee a live birth. Pregnancies following tubal ligation reversals have higher odds of ectopic pregnancies and odds of conception are also constrained other factors like age, ovarian reserve, sperm quality, and more.

Preverification: Will You Need A Letter Proving Medical Necessity

Sometimes your health insurance company will say they will pay for tubal reversal surgery but only if a doctor provides a letter of medical necessity.

A letter of medical necessity is a letter provided by your local doctor describing what your symptoms are, what your diagnosis is, and why a reversal surgery is medically required. This is sometimes requested when patients report the reason for the reversal is for abnormal symptoms or Post Tubal Ligation Syndrome.

Any pre-certification or pre-authorization required by your health insurance company is the responsibility of the patient. Since our surgical fees are all-inclusive, we do not provide a cost breakdown to health insurance companies. We are unable to accept payments from health insurance carriers or file insurance claims for reversal surgery.

If your health insurance requires a letter of medical necessity then A Personal Choice or Dr. Monteith will not be able to provide such a letter either before or after reversal surgery.

Your primary care doctoror the doctor evaluating you for symptoms after tubal ligation. will have to provide the letter documenting your symptoms and explaining the medical necessity of your surgery.

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Who Should Consider Tubal Ligation Reversal

Many women feel pressured by a partner or loved one to get their tubes tied for financial or lifestyle reasons. The conversation of a tubal reversal usually happens when a woman is with a new partner who does not have any children of his own.

Sometimes, a couple might experience the loss of a child after a tubal ligation and may want to explore the possibility of having another baby.

Whatever the case, the decision to undergo a tubal reversal is a personal one and should be discussed with a reproductive surgical specialist.

Is Robotic Surgery Safe

Free Tubal Ligation Reversal Surgery Give Away!

Dr. Ghomi has been performing hundreds of robotic surgeries annually since 2009. Robotic surgery has become a standard of care in many surgical procedures in the United States. Complications of robotic surgery is similar to traditional laparoscopic surgery. Robotic surgery enables the surgeon to perform the delicate task of sewing the fallopian tubes together with unmatched precision and dexterity. The surgery is performed through four dime-sized incisions. Patients are discharged home after few hours of observation. Increased body weight is not an impediment to performing robotic tubal reversal.

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Advice On Getting Health Insurance To Pay For Tubal Reversal

To increase your chances of health insurance paying for tubal reversal then you should do the following.

Have a documented history of your problems. If you are having problems as a direct result of your tubal ligation then you should have had several doctors visits documenting your problems in detail. Not just one visit over 10 yearsbut several visits and evaluations. These visits, doctors opinions, and treatments should be clearly documented in your records.

You will need to explain your symptoms and tell them you are seeking coverage for tubal reversal.

  • If your tubes were clamped, tied, cut, or burned then you will need a tubotubal anastomosis procedure. The procedure code for tubotubal anastomosis is CPT 58750. You will need to ask them if the will pay for the CPT code 58750.
  • If you had the Essure or Adiana procedure then you will need to code for tubouterine implantation procedure. The procedure code for tubouterine implantation is CPT 58752. You will need to ask them if the will pay for the CPT code 58752.

Keep in mind the person you get on the phone the first timewill not be who you will speak to the second or the 30th time!

Some will be poorly trained/educated and give you inaccurate information. Always have documentation of your conversation. Ask them to email you their answer or put the communication in your file.

Keep documentation of whoever you speak to. Save all emails. You may need to provide this information as evidence to get your reimbursement.

Where Can I Get A Tubal Ligation

You can get a tubal ligation at a doctors office, hospital, or health clinic. Many Planned Parenthood health centers also do some types of sterilization procedures. If your local Planned Parenthood doesnt do tubal ligation, they may be able to refer you to other health care providers in your area who do.

Some choose to get sterilized right after giving birth or having an abortion. Talk with your doctor ahead of time if you want to combine sterilization with another procedure.

Depending on where you live, there may be age restrictions or waiting periods to get a tubal ligation. You can ask about these when you call to make an appointment.

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Can You Get Your Tubes Untied For Free

Having Medicaid or private health insurance pay for services is another option for getting your tubes untied free. Insurance rarely covers the reversal of voluntary sterilization. Therefore, this alternative will work for only a tiny fraction of low-income people who fit into one of three categories.

Does Cigna cover tubal ligation?

Tubal ligation typically is covered by most health insurance, according to Dr. Don Snyder, an Indiana gynecologist insurance companies that typically cover tubal ligation include Aetna, United Healthcare, Cigna/Sagamore and Anthem BlueCross BlueShield .

Can a tubal ligation be reversed?

In general, standard tubal ligations done in the United States can be reversed. If the operative report indicates you had a modified Pomeroy ligation, for example, the procedure can almost certainly be reversed. Your tubal ligation may be able to be reversed.

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It is identified that there are a very limited number of doctors in the United States who perform tubal reversal surgeries maintaining a consistent weekly schedule. It has been also found that the tubal reversal surgeries are more affordable than vitro fertilization. In vitro fertilization one has to spend approximately from $10,000 to $12,000 in each cycle.

In some cases a cycle can cost more than the approximated amount. If the woman is unable to get pregnant during the initial cycle of IVF, then she has to pay for the additional cycles. However, she can only be successful during the months when she has IVF. But the good thing about tubal loosening surgery is that it offers the woman to get pregnant according to her wish or requirement. However, you should remember that the tubal reversal method is permanent and thus you do not have to go through hormone injections.

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Medicaid And Tubal Reversal

If you voluntarily obtained tubal ligation, it follows that insurance companies are unlikely to pay for the reversal procedures because they consider it elective. So, its safe to assume that if Medicaid sets such strict requirements for tubal ligations, it will do the same for tubal reversals.

And generally, you will not receive coverage for the procedure because it is too expensive. But it is possible to get the reversal under some circumstances.

If you can prove a medical need for tubal reversal, you could get Medicaid to cover tubal reversal to a limited extent. And that requires that you show the reversal will treat, prevent or help diagnose other diseases or symptoms.

For example, if you end up with Post Tubal Ligation Syndrome arising from damaged blood supplies to your ovaries and your estrogen or progesterone hormone levels quickly drop and cause other issues, Medicaid may finance the tubal reversal procedure.

However, changing your mind about having another baby is not a good enough reason. If you belong to this category, you would be better off taking advantage of any IVF coverage you have if you live in a mandated state and no exclusions apply.

You may not want to rely on Medicaid to cover tubal reversal. The odds are pretty high that you will not get help unless you provide a provable medical reason. So, you are likely to be disappointed.

References

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