Tubal Reversal and Insurance

Insurance Reimbursement of Costs for Tubal Reversal Surgery

How to know if your insurance covers tubal reversal

For most couples interested in tubal ligation reversal, the issue of insurance coverage is an important concern. Whether your insurance company will reimburse you for the costs of a tubal reversal depends upon your insurance carrier and insurance policy. Some insurance companies provide coverage for tubal reversal surgery. To find out if you will be reimbursed for this procedure you will need to provide your insurance carrier with the diagnosis and procedure codes. The diagnosis code (ICD-9) for bilateral tubal occlusion is 628.2. The procedure code (CPT) for tubal anastomosis is 58750. If your insurance carrier will cover part or all of the cost of your surgery, you can file an insurance claim after your tubal reversal with instructions to send the payment directly to you.

The messages below from the Forum on Tubal Reversal Cost of the Tubal Reversal Message Board give helpful information and tips about insurance payments after tubal reversal. (As on the Message Board, the order of the messages is from newest to oldest reading down from the top of the page.)

Author Topic: How to know if your insurance covers tubal reversal.
Member # 664
The nurse is from BC/BS. Ericka from Dr. Berger's office was very helpful when I needed a breakdown letter and my total time letter with the anesthesiologist. I asked for the forms and she faxed them within hours.
Karen*Bill *4boys
Member # 5521
Was the fertility nurse from Dr. Bergers office or BC/BS? Sorry to ask so many questions but I really want to do this right and have them send me 100%. At least that is what I will try for. Thanks, Karen
Member # 664
I received my check this past Monday and it was $5,500.00. I was only expecting them to pay 80% but they paid 100%.

I didn't breakdown the receipt myself. I requested that a fertiltiy nurse review my claim before it was processsed.

I also called weekly and was never rude to the customer service people. I connected with a supervisor who listened to my story about the TR and it working (I'm now almost 11 weeks pregnant). I know she felt like she had made a difference when she told me I was getting my check. I started crying and told her God Bless you. My point is I never lost my cool even after calling for almost 3 months. Me being persistent paid off.

I put the surgery on my credit card in good faith that BC/BS would honor what they agreed to pay. Of course my husband and I knew the chance we were taking.

Maybe you could obtain a loan then pay it off when the reimbursement from the insurance company arrives.

Good luck to all!
Karen*Bill *4boys
Member # 5521
NANCYA - I live in Kentucky but my dh works in Ohio so I don't know which state it would fall under. The company my dh works for switched insurance last June and when the insurance rep was asked if tr was covered and he said no. After hearing everyone talk about BC/BS PPO which is what we have ,I decided to call BC/BS and just give them the code and not tell them what it was for and the info I got was... I pay 40% co-pay because it is out of the provider area and a 1000.00 deductible, Which doesn't sound that great because if what I have heard on the board is right, BC/BS only allowes 1300.00 for the code 58750 then that would mean you are only getting back 180.00.

BUT... SherryG was talking about getting everthing broken down so that each charge can be billed separately (Dr.Berger, facility, supplies, anesthesiologist). I hope it can be done this way. I hope this helps. Karen
Member # 4553
Karen*Bill*4 boys - What BC/BS insurance do you have? What state are you in? I also have BC/BS in Arkansas. I have not spoken with them about TR yet. Just curious. Thanks
Karen*Bill *4boys
Member # 5521
SherryG, I'm new to the board. I had tl 11 1/2 years ago and have regreted it almost as long. I have BC/BS and was wondering if you know how much you will be getting back from the insurance. I called them yesterday. What you said makes a lot of sense after talking to them. Thanks for any help you can give. Karen Smile
Member # 5436
I was so hopeful the other day that my insurance would cover at least some of this, as I have Anthem BC/BS National. But apparently our plan does not include TR Frown .
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