As a specialty center for Essure reversal, our office staff are frequently asked “Does health insurance pay for Essure reversal?”
Essure was first approved in 2001. At first, not many women opted to have the Essure procedure. Very few Essure procedures were performed.
After the Bayer Health Care Corporation acquired Essure in 2013, more aggressive marketing of Essure occurred, more doctors began offering Essure, and more women opted to use Essure for permanent birth control (sterilization).
It has been estimated that over 750,000 women world-wide have had Essure. The actual numbers of women who have Essure inserted is probably way higher than the often repeated number of 750,000.
Essure sterilization is intended to be permanent. Prior research has shown a significant number of women will regret their sterilization procedure. Some women will consider in-vitro fertilization (IVF) and some will consider surgical reversal of sterilization.
These women will approach their doctors and ask does health insurance pay for Essure reversal or IVF? Unfortunately, health insurance will not pay for either of these treatments.
To better understand why health insurance will not pay for Essure reversal you should understand how health insurance companies look at tubal ligation reversal surgery.
Does health insurance pay for tubal ligation reversal?
Over 98% of health insurance companies will not pay for tubal ligation reversal.
The first tubal ligation was performed in 1880’s and since then millions of tubal ligation procedures have been performed. The first tubal reversal surgery was performed in the 1960’s. As tubal reversal surgery became a more common, health insurance companies quickly realized tubal reversal was being done for fertility reasons.
In an effort to keep costs down, health insurance companies decided tubal reversal was not medically required.
Health insurance companies have a long history of dealing with request for payment for reversal surgery and have no problem telling their members “tubal reversal is a non-covered procedure”.
Does Health insurance Pay For Essure Reversal?
Essure reversal is a procedure to remove the Essure devices and reopen the fallopian tubes. The purpose of Essure reversal is to restore the natural function of the fallopian tube and allow for natural conception and pregnancy.
More information: Tubouterine implantation for Essure reversal
Health insurance companies consider Essure reversal and IVF as fertility treatments.
These treatments are considered non-urgent and not required to improve the health or life of a person. Health insurance companies look at the Essure reversal procedure the same way they look at tubal reversal surgery, face lifts or breast augmentation procedures.
Fertility is considered non-urgent, not necessary, and not worthy of wasting health care dollars.
Does health insurance pay for Essure reversal? Our experience
In our experience, we have observed some health insurance companies will pay for Essure reversal and some will not. It really is a toss up.
Health insurance companies are seeing a large increase in submitted claims for treatment of Essure complications.
Health insurance companies will readily pay for Essure removal if you are having a complication from Essure. Unfortunately they will only pay for Essure removal if the surgery is done in a hospital and if you have a hysterectomy (complete removal of the uterus) or salpingectomy (complete removal of the Fallopian tubes).
Health insurance will pay for Essure removal but not for Essure reversal.
Will health insurance pay for Essure reversal with Dr. Monteith?
Dr. Monteith is a participating member in Blue Cross Blue Shield, Cigna, and Aetna. Some of his Essure reversal and Essure removal patients are seeing partial reimbursement for Essure related surgery at A Personal Choice.
For more information: Will health insurance pay for Essure reversal or Essure removal at A Personal Choice?
Often if your health insurance company covers Essure removal….they are more willing to cover the procedure if the procedure is done in a hospital setting.
Often your health insurance plan will is more likely to cover complete hysterectomy or fallopian tube removal. When you have Essure removal outside of a hospital or Essure reversal then reimbursement is more likely to be partial reimbursement, if you see any reimbursement at all.