There are many active duty members that look forward to getting a tubal reversal with the help of their TriCare insurance policy. This is possible if you are covered under a TriCare Prime plan and are willing to be patient. This procedure is performed at a limited number of installations and the precursory tests that need to be conducted can take time. Finally, physician availability can fluctuate as attention is directed to incoming combat injuries. Nevertheless, having your tubal reversal surgery performed at a military hospital for free can reap you significant savings worth the hassle.
The first order of business is setting up an appointment with your primary care physician in order to obtain a referral to OB/GYN. Tell them about your interest in getting a tubal reversal and they should gladly oblige. Be sure to bring any documentation related to your initial sterilization treatment to the specialist you are referred to. They will likely recommend a slew of tests to ensure that reversal treatment is the best way to go.
A hysterosalpingogram (HSG) may be conducted to confirm an obstruction in the fallopian tubes. A dye injected into the vagina is illuminated by an X-ray and is observed traveling into the uterus and fallopian tubes. A clomid challenge test (CCT) will also be performed to evaluate your ovarian reserves in addition to a regular blood test. Finally, your spouse will be subject to a sperm analysis to eliminate yet another potential cause. These tests can be conducted at your nearest installation and sent elsewhere if need be (depending on who ordered them).
Keep in mind that demand for tubal reversals continues to skyrocket and that you may have to wait more than a year for these tests alone (unless some other medical necessity requires them). Certain installations also have restrictions that could make you ineligible – ask about them. Existing children and weight requirements are two examples.
If everything checks out, your name will be added to the wait list and it’s a waiting game from here. After six months and no word back, you may grow impatient and begin to wonder whether you can have the procedure performed at a non-participating provider and still be re-imbursed. The answer is yes, although the amount you get back can vary.
You will need to file a claim with TriCare using Claim Form DD2642 and submit an itemized receipt with billing codes for each service rendered. Some facilities do not provide a itemized bill which can make receiving maximum reimbursement difficult. Nevertheless, we have heard accounts of patients receiving anywhere from $200 to $700 back. Note that you may forfeit your right to reimbursement if you don’t go through your primary care provider for a referral to a non-participating specialist. The ten or so minutes spent compiling your receipt, filing out the claim and faxing it over to TriCare justifies the potential compensation.
Don’t create a dead end for yourself by not exploring other funding options available to you while awaiting word back. Setup a pre-payment account with your specialist of choice and begin making monthly contributions of $200. By the end of the year, you’ll have collected $2400 for your surgery, which will make you feel far less disappointed if this route doesn’t pan out.