Tubal Reversal and Insurance



Insurance Reimbursement of Costs for Tubal Reversal Surgery page 2

How to know if your insurance covers tubal reversal

The messages below from the Forum on Tubal Reversal Cost of the Tubal Reversal Message Board provide 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.
kevinand michelle
Member # 5320
Hi, just a little note about insurance. I have Anthem BC/BS of New Hampshire and they are covering the whole thing. The finacial person I spoke with said that I should have no out of pocket expense. My deductable is $10,000.00 so they will cover the whole thing.
nymom ofeight
Member # 4252
If Dr. Berger is outside of your coverage area you might need prior approval for them to cover it. My insurance company said they would cover it all except a $50 deductible then gave us a hard time after it was done because we went out of state to have it done. I would make sure you cover all of your bases just to make sure you are not disappointed in the end.
SherryG
Member # 664
Melany - you have to wait until after your TR to file.

I submitted the receipt with the procedure code, the breakdown letter, and a detailed surgery report with my claim. I mailed in my claim certified mail with proof of signature.

Good luck!
Melany
Member # 4918
Kym and Sherry,

I have BCBS PPO! Do you mind my asking when, before or after TR, you filed with BC/BS? Also HOW did you file? Did you just send them you bill or what? I am so excited to find out there is even a possibility that they might pay something. Thank you so much for any advice you can give!

Melany
[Big Grin]
Amy1234
Member # 5192
Seems like BC/BS is the stuff to have Smile , unfortunately thats not what I've got.
Thanks, Amy
SherryG
Member # 664
I had BC/BS PPO when I had my reversal in Nov 03. I am still waiting to get my money back from them.

Kym--just a suggestion from what I have learned over the past 3 months dealing with BC/BS. Request that the nurse review your claim. The nurse will break it down and you will get paid for the anesthesiologist, faciltiy costs and Dr. Berger's fee. If you only submit under the 58750 code they only pay the % for that code. I have an insurance broker who works for our company that was employed by BC/BS and he suggested I do this.

I would also call at least every few days to check the status of the claim also.

For my BC/BS policy, the code 58750 is only allowed $1,300.00. If you take off the 20% we pay and the $300 deductible for going out of network, that is only $800.00. Good luck to all of us in getting our insurance companies to pay. [Big Grin]
Kymincali
Member # 4470
Hi, At first I had Kaisier. They covered all my preop tests. Then before I got my TR I switched to BC/BS. They did state my policy does cover 70% of my TR. This would be an out of network expense though. I haven't gotten my 70% back yet, but they did say this would take 60 days or more to recieve something in the mail. Oh, by the way, this is a PPO policy. I feel all policies are different so talk to your carrier first before you have your TR done. Hope this helps. Kym in California
K.O.
Member # 5046
Amy,
It depends on your insurance policy and the coverage it provides. Our policy is through my husband's work and fortunately reversed sterilization for both male and female are covered. We have only a co-pay for out-patient surgery as long as we see a physician and facility within the network. Not all insurance companies pay for this procedure but luckily we have one that does Smile
Good luck to you and your TR! [Big Grin]
Kim
Amy1234
Member # 5192
Thanks Johnny. I know there are a few. I just read a post in after tr section, someone had there insurance pay everything but the deductible. Amy
savage
Member # 5134
Hi amy
It is hard to find an insurance that pays for TR. Some will pay for certain things like fertility drugs but not the TR.
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