Trying to ascertain whether or not your insurance provider covers tubal reversal surgery can be frustrating. There have been numerous reports of policy holders getting a different answer from their insurance company on a call-by-call basis. The best way to get a definitive answer is to provide your carrier with the diagnosis and procedure codes provided by your surgeon. The diagnosis code, also known as the ICD-9 code is 628.2. The CPT or current procedural terminology code is 58750. Both of these codes are used internationally for insurance reimbursement purposes and to facilitate uniform communication between medical professionals related to diagnoses and treatments. Depending on the type of policy that your employer has selected, the procedure may or may not be covered.
Although at face value tubal reversal surgery seems entirely elective, complications may arise from the initial sterilization procedure that adversely affect the health of the patient. Some of these symptoms including fatigue, heavy periods and increased irritability have all been grouped together to be identified as post tubal ligation syndrome. Although yet to be officially recognized in the medical profession, numerous patients have come forward reporting these symptoms and others, which are thought to be caused by the disruption in estrogen levels. The consensus is that if your doctor declares the reversal to be medically necessary, as indicated by your symptoms, then you have a much better chance of getting approved for coverage.
Your provider might only offer partial coverage for the procedure, which can vary from a small percentage to 70% or more. Regardless, you will still have to pay for the procedure up front and then obtain a full or partial reimbursement from your provider by filing a claim. Many tubal reversal offices refuse to process claims themselves due to the hassle involved.
You can always supplement the unpaid portion of the bill through other means, such as employer-sponsored flexible spending plans. You will have to talk to your human resources department for further details, but essentially this is a set amount of money which you elected to have set aside for medical expenses. If you are currently unemployed, you can always have your spouse inquire about this at their own place of business. You don’t have to contend with interest charges if you use this money but again it is only available for medical reimbursement after the medical expenses have been incurred. Depending on the type of spending plan you have, this money may not be carried over into the next year so you might as well take advantage of it.
Be mindful of any wait times associated with processing your health insurance claim or tapping into medical plans. Depending on your insurance provider, it may take 30 days or more before you hear back from them. Furthermore, many tubal reversal centers will often ask that you pre-pay for the procedure a few weeks in advance. Plan for these delays so you can properly maintain cash flow until you get word back. In the meantime, your credit card bill will be fast approaching. Don’t think you will be able to dodge the interest payment by paying off the balance before the end of the month. Instead, try to pay off your tubal reversal bill in cash or divide it between cash and a credit card so the interest becomes more manageable until you are reimbursed.