Will Health Insurance Pay For Tubal Reversal Surgery? –

Nearly all individuals contemplating tubal reversal surgery will inquire, “Will my health insurance cover the cost of tubal reversal surgery?”.

will-health-insurance-pay-for-tubal-reversal-surgeryUnderstandably, tubal reversal and vasectomy reversal are not cheap. Both are surgeries and it is natural to wonder if health insurance will pay for all…or at least some…of the cost of reversal surgery.

Most health insurance companies may consider covering a part of the cost of elective surgery reversal, although not all companies will pay for it and it is not guaranteed.

If your health insurance does not cover the entire cost of surgery reversal, we can provide you with some financial assistance to help you out.

What if health insurance will not cover tubal reversal surgery?

If you discover that your health insurance company will not cover tubal ligation reversal, do not be surprised, as most health insurance companies do not consider it as an elective surgery for a non-threatening medical condition.

health-insurance-will-not-cover-tubal-reversal-even-if-you-have-PTLS-symptomsGetting breast implants, face lifts, tummy tucks or liposuction are cosmetic procedures that a person does to make themselves look or feel better. These are elective surgeries and health insurance plans do not cover procedures they deem as not medically necessary.

They are basically saying that we are not going to pay for it, and we do not necessarily need to have the surgery, but we want to or feel the need to because most health insurance plans unfortunately do not cover cosmetic surgeries like tubal ligation reversal.

If you report symptoms after your tubal ligation, health insurance plans may refuse to recognize that you may be having them. Insurance companies are aware of this tactic and refuse to recognize symptoms as a result of your tubal ligation. The main reason they do not cover the side effects from the initial procedure is because they do not provide care when patients discover that the surgery is not covered.

If your health insurance does not cover the cost of reversal, you should contemplate financing your surgery to reverse it.

Preverification: Will health insurance pay for your reversal surgery?

When you signed the contract with your company health insurance, they provided detailed information about what medical expenses will be covered. In return, you agree to pay them every month, and your health insurance is essentially a contract between you and the insurance company.

This is why most health insurance companies are hesitant to cover plastic and cosmetic surgery procedures, as they are not medically necessary.

Unfortunately, most health insurance companies consider infertility treatment or infertility surgery to be non-life-threatening conditions that do not require medical necessary treatments/procedures.

The best way to determine if your health insurance company will cover your reversal surgery is to call your health insurance company and ask if they will cover your surgery.

Preverification: Use these medical codes

Below are the CPT and ICD-10 codes for our tubal surgery procedures. They will ask you for both the surgical CPT code and the diagnosis ICD-10 code to determine if the procedure is covered.

Reversal of tubal ligation.

The codes provided below are tubal reversal codes for patients seeking to reverse their tubal ligations.

  • The ICD-10 code for bilateral tubal occlusion is N97.1.
  • The CPT code for tubal ligation reversal is 58750.
  • Screening laparoscopy.

    The optional screening laparoscopy procedure will only be performed during their tubal reversal surgery for patients who are coded accordingly. Both the tubal reversal codes displayed above and the codes displayed below will require the attention of your health insurance representative.

  • The ICD-10 code for bilateral tubal occlusion is N97.1.
  • The CPT code for 49320 laparoscopy screening.
  • Vasectomy Reversal.

    The codes provided below are for patients seeking to reverse their vasectomy.

  • The ICD-10 code for bilateral blockage of the vas deferens N50.8 and the reversal of vasectomy sterilization Z31.0.
  • The CPT code for surgical reversal of vasectomy is 55400.
  • Excellent! If you have reached out to your health insurance company, then they have agreed to cover the expenses for either all or a portion of your surgery.

    Numerous health insurance providers generally do not include the expenses of tubal reversal or vasectomy reversal treatments, therefore it is recommended to not have overly optimistic anticipations.

    Preverification: Will you need a letter proving medical necessity?

    Sometimes, your health insurance company will agree to cover the cost of tubal reversal surgery only when a doctor presents a letter of medical necessity.

    Sometimes, when patients request it, a medical necessity letter provided by your local doctor is required for a reversal surgery, which is the diagnosis for why you need it and the symptoms for which you are experiencing. This is requested for patients who have Post Tubal Ligation Syndrome or abnormal symptoms as the reason for the reversal.

    Your health insurance company requires pre-authorization or pre-certification for patient responsibility. Since our surgical fees are all-inclusive, we do not provide a breakdown of costs to insurance companies. Unfortunately, we are unable to accept insurance claims or payments from health insurance carriers for reversal surgery.

    If you require a medical letter of necessity, Dr. Monteith or Choice Personal A will not be able to provide a letter before or after a surgery reversal. Additionally, if you need to provide a medical letter of necessity, your health insurance will not cover it.

    Your primary care physician or the doctor assessing you for symptoms following tubal ligation will need to furnish the letter that documents your symptoms and clarifies the medical requirement for your surgery.

    Getting Reimbursement Reversal Surgery: Submit Member Claim Form

    Congratulations if you were notified that you would receive coverage for a reversal procedure, it means you must possess an outstanding health insurance scheme.

    Health-insurance-typically-does-not-pay-for-tubal-reversal-surgeryIf you are having reversal surgery at A Personal Choice you will have to pay for the full cost of reversal surgery at the time of scheduling. We are unable to bill your health insurance company before or after surgery.

    Once your surgery is finished, you will then have to submit the billing documents to your health insurance provider for reimbursement.

    You will need to submit this information to your health insurance company using a claim form. Additionally, you will also be provided with a receipt for the procedure code, diagnosis code, and surgery code. Depending on the findings at the time of the surgery, we will provide you with more comprehensive and specific codes.

    You should be capable of downloading the Member Claim Form from the website of your health insurance provider.

    Health Insurance and tubal reversal: Advice on obtaining reimbursement

    If you need to submit a claim form after completing surgery, your health insurance carrier will cover all or part of the cost of the surgery.

    Please include the documents that we have given you and ensure that they send the reimbursement payment directly to you.

    Throughout the rest of the year, this implies that you might have to incur reduced expenses for alternative medical care because they could allocate the sum you paid for your reversal surgery to your annual deductible, regardless of whether they provide coverage for the cost of the reversal surgery. It is crucial to submit a Member Claim Form.

    Financing tubal reversal surgery

    If your medical insurance does not encompass the expenses of a reversal, you might consider investigating the possibility of financing tubal reversal surgery.

    Many people will finance their medical treatment as it can provide them with the opportunity to have surgery right away and pay for it at a later date.

    Additional details: Funding options for tubal reversal surgery.

    These two companies, Medical Credit United and CareCredit, are giants in the field of healthcare financing. They currently work with Personal Choice A, a leader in the healthcare financing industry, to provide many patients with the means to make their dreams of reversal surgery a reality.

    Have Questions? We’re Happy To Help!

    By utilizing the buttons below, you can find answers to our frequently asked questions. Our main goal is to transform your surgery into more of a life’s experience rather than a mere process, by offering a distinctive surgical experience with individualized attention and one-on-one care.


    Ask The Doctor

    If you have specific medical questions and you are a patient at our reversal center, you should contact (919) 977-5050 directly. If your doctor is unavailable, you can reach out to another doctor. Before submitting your questions, please make sure to read them carefully. Dr. Monteith will answer your questions about reversal surgery promptly and directly.