Can you get your tubes untied with Medicaid? How do you get your private insurance plan to pay for tubal ligation reversal surgery?
Surprisingly, the answer to both of these questions is the same – it will be tough because insurance rarely covers the reversal of voluntary sterilizations.
Here is the bottom line. Both Medicaid and private insurance plans might pay when there is a covered medical reason for each possible step: upfront testing, the procedure itself, and any post-operative issues.
However, these situations do not apply to women who changed their minds about having another baby.
Therefore, you may need to find another way to make the surgery more affordable by looking ahead to the intended outcome and using financing to get started.
Getting Tubes Untied With Medicaid
Can you get your tubes untied with Medicaid? Yes, as a Medicaid recipient, you can undergo tubal ligation reversal surgery – but will probably have to pay for the procedure yourself unless you have a medically necessary reason.
Therefore, getting your tubes untied with Medicaid may mean finding alternatives.
Covered Medical Reasons
Medicaid and other private insurance plans may pay for three types of covered medical reasons relating to your pending tubal reversal procedure. Each phase or category must be medically necessary.
Women can get tubal reversal under $3,000 (depending on deductible and coinsurance) if you can establish that the procedure is medically necessary: prevents, diagnoses, or treats an injury, disease, or symptoms.
You may be able to get your Medicaid or private insurance plan to cover specific tubal reversal pre-surgery testing steps. Ask your clinic to code the test for a medically necessary reason.
- Pre-operative bloodwork to spot infections (STD, HIV, or Hepatitis)
- Ultrasound and exam to visualize the health of reproductive organs
It is unlikely that your Medicaid or private insurance plan will cover the tubal reversal surgery itself as it corrects earlier voluntary sterilization. The purpose is rarely a covered medical reason – unless the procedure corrects an underlying disease or symptom.
- Post Tubal Ligation Syndrome (PTLS) is the rapid decline of estrogen/progesterone hormone levels caused by damaged blood supplies to the ovaries
- Dysmenorrhea is pain and cramping during your menstrual cycle
Also, related services rendered while under the knife might be covered. For example, the removal of uterine fibroids and polyps could be medically necessary and needed to restore fertility.
It is more likely that your Medical or private insurance policy will cover any complications arising from your tubal reversal operation. The surgery is very safe. However, things can go wrong, and these complications are often a covered medical reason.
- Damage to nearby organs
- Reactions to anesthesia
Medicaid Trade Names
Getting your tubes untied with Medicaid introduces two layers of possible mix-ups – as if insurance were not confusing enough already. Many states use trade names for their Medicaid programs. This chart of state Medicaid names might clear things up a little.
|Alabama||AL Integrated Care Network|
|Arizona||AZ Healthcare Cost Containment System (AHCCCS)|
|Colorado||Health First Colorado|
|Florida||My Florida Families|
|Illinois||Illinois Family Care|
|Kentucky||Kentucky Health Choices|
|New York||NYS Medicaid|
|New Jersey||NJ Family Care|
|North Carolina||Health Choice|
|Texas||Texas Medicaid & STAR|
Also, private companies such as Aetna, Cigna, and BCBS issue plans that fit under these tradename umbrellas. For example, CareSource is a nonprofit that began as a managed health care plan serving Medicaid members in Ohio. Today, it provides programs serving other populations as well.
How to Get Private Insurance To Pay for Tubal Reversal?
How do you get your private health insurance plan to pay for tubal ligation reversal surgery? Follow the same logic as for Medicaid plans (see above) – specify the medically necessary phases of the procedure (upfront testing, PTLS or Dysmenorrhea, or post-operative complications).
However, most women will strike out because they typically do not have a medically necessary condition. No private insurer will pay to reverse a voluntary sterilization procedure without a valid reason.
Even insurance mandates have specific exclusions.
IVF After Tubal Ligation
Will insurance cover IVF after tubal ligation? Yes – you can buy a policy covering the intended outcome but not the procedure itself because legal mandates exclude coverage for women with previous voluntary sterilization.
Supplemental insurance covers IVF after tubal ligation by paying a benefit for the intended outcome: mom’s pregnancy and baby delivery, provided you sign up before conception.
- Short-term disability replaces a portion of income during maternity leave
- Hospital indemnity insurance pays two possible benefits
- Mom’s confinement for labor and delivery
- Infants who begin life in Neonatal Intensive Care (NICU)
Insurance mandates exclude IVF after tubal ligation in every state with a requirement. Therefore, covering the intended outcome is your only option.
Site visitors often ask whether a specific health insurance company covers tubal reversal. With confusing topics, sometimes we ask the wrong questions.
The rare qualifying medical reason (see above), not the issuing company, determines the answer. Queries about the organization lead you nowhere.
Blue Cross Blue Shield
Blue Cross Blue Shield Association (BCBS) is a national federation of thirty-seven independently owned and operated insurance companies. Each affiliate makes its own business decisions and acts in states with different regulatory environments.
BCBS covers tubal reversal following the same rules already noted. They might pay for medically necessary procedures – otherwise, the answer is typically no.
Also, they sometimes use trade names, adding a layer of confusion.
|North Carolina||BCBS NC||No|
|Pennsylvania||Capital & Highmark||No|
Other private insurance companies may cover getting your tubes unclamped using the same logic already noted. The answer is typically no unless you have a rare medically necessary reason.
You will find no variation based on the name of the organization. Even the state-based mandates exclude infertility treatments after tubal ligation, so alternative procedures are not a good option.
- The Aetna Company operates in fifty states. Aetna is subject to an infertility mandate in some. Aetna excludes benefits when either partner has had previous voluntary sterilization.
- Cigna is a global company based in Connecticut. They operate in many different regions. The Cigna website describes the process but does not indicate that they cover the procedure – as expected.
- Kaiser Permanente is a not-for-profit healthcare company operating in California. California has an infertility mandate in the group marketplace, which does not require IVF.
- United Health Care (UHC) is an operating division of UnitedHealth Group, the largest single carrier in the USA. UHC covers infertility services when they must comply with a local coverage determination.