Tubal Reversal Under $3,000 or $4,000 | Getting Insurance to Pay

The cheapest tubal ligation reversal goes to patients getting their health insurance (or Medicaid) to pay for some or all of the surgical steps. 

However, you have to show that you have a valid medical reason before insurance will cover any part of the procedure, which is difficult to prove.

Fortunately, other avenues make getting your tubes untied more affordable.

Follow along as we illustrate three money-saving options that solve to tubal reversal for less than $5,000, $4,000, and $3,000 out-of-pocket net of other related considerations – factors many people can easily overlook.

With an average cost of $8,500, the reductions could make a huge impact.

Making Tubal Reversal More Affordable

Three pathways can make your tubal ligation reversal surgery more affordable – even when insurance will not cover any of the costs, which is most common (see below in the next section).

Under $5,000

In the first pathway, free tubal reversal grants could nudge your costs under $5,000, but not much further. Grants are money provided by another person or organization that you do not have to repay.

The federal government does not provide grants to individuals for personal use, so the opportunities are scarce. Instead, you may have to look for charitable organizations that rely on the generosity of donors. They often have limited resources and can offer assistance to just a handful of couples each year.

Under $4,000

In the second pathway, a Flexible Spending Account (FSA) can drive your net tubal reversal costs under $4,000 while offering an extra benefit you probably never considered.

FSA-enabled tubal reversal payment plans save you money at the same time. Your employer must reimburse any qualifying expenses immediately, meaning you could have up to 52 weeks to repay an interest-free loan while reducing the amount of income subject to taxes.

The FSA contribution limit for 2022 is $5,700 for a married couple. Suppose a fictional duo has a $100,000 adjusted gross income and work in California. The use of pre-tax money to pay for the surgery yields these savings.

RateSavings
Federal22.00%$1,254
FICA7.65%$436
State9.30%$530
   
Total38.95%$2,220

In this example, a couple can use an FSA to get surgery under $4,000 ($3,500 to be exact) while paying the surgeon up to $5,700 in pre-tax dollars – if you can find a low-cost doctor willing to charge this price.

Of course, the savings vary based on the income tax rates in the state where you work [1] and if they recognize pre-tax payroll deductions.

No TaxHighest Rates
WyomingCalifornia: 13.3%
WashingtonHawaii: 11%
TexasNew Jersey: 10.75%
South DakotaOregon: 9.9%
NevadaMinnesota: 9.85
FloridaNew York: 8.82%
AlaskaWisconsin: 7.65

Under $3,000

In the third pathway, a Health Savings Account (HSA) could drive your tubal reversal costs under $3,000, provided you know the secret to unlock the extra savings. An HSA is a tax-favored account connected to a High-Deductible Health Insurance Plan (HDHP).

The hidden feature of an HSA is that as long as you establish an account before incurring a qualifying expense, you can pay yourself back later using tax-favored dollars, provided you continue with an HDHP.

In other words, the annual contribution limits do not restrict your savings.

  • Self-only: $3,650
  • Family: $7,300

In this illustration, our example couple can use an HSA to drive surgery costs under $3,000 while paying the surgeon up to $7,702 in pre-tax dollars – if you can find a low-cost doctor find one willing to charge this price.

So, how much will it cost to get your tubes untied using an HSA? Follow the math ($3,000/38.95% = $7,702), swapping your possibly higher procedure price and marginal tax rates.

How to Get Insurance to Cover Tubal Reversal

How do you get medical insurance to pay for tubal ligation reversal surgery and drive your costs well below $4,000 or $3,000? Unfortunately, all plans exclude previous voluntary sterilization from coverage unless you have a qualifying medical reason.

Fortunately, women have two ways to demonstrate a valid medical reason and get coverage. Focus on these two viable affordability options while avoiding blind alleys that lead you nowhere.

Medical Reasons

Having a qualifying medical reason for tubal reversal surgery is the only way to get health insurance to pay claims. However, your options for coverage are much better for the intended outcome than the procedure.

Outcome

You are more likely to get insurance to pay for the intended tubal reversal outcome. Your future pregnancy and childbirth are qualifying medical reasons with no exclusions for previous voluntary sterilization.

Supplemental health insurance covers infertility outcomes. However, you must purchase the coverage before you conceive to avoid exclusion for preexisting pregnancy.

  • Short-term disability replaces a portion of income during maternity leave
  • Hospital indemnity insurance pays a cash benefit for normal labor and delivery

Procedure

You are less likely to get insurance to pay for the tubal reversal surgery because the qualifying criteria are strict. You must establish a valid medical reason for the procedure: prevent, diagnose, or treat an injury, disease, or symptoms.

Collaborate with your surgeon to draft a letter of medical necessity and submit the document to the issuing company for preauthorization. Some of these details might do the trick.

  • Testing
    • Pre-operative bloodwork to spot infections (STD, HIV, or Hepatitis)
    • Ultrasound and exam to visualize the health of reproductive organs
  • Surgery
    • 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
  • Recovery
    • Bleeding
    • Infection
    • Damage to nearby organs
    • Reactions to anesthesia

Untying with Medicaid

Can you get your tubes untied with Medicaid? As a Medicaid recipient, you can undergo tubal ligation reversal surgery – but will probably have to pay for the procedure yourself.

Medicaid covers tubal reversal when medically necessary, following the same parameters used by private insurance companies. Collaborate with your surgeon to document a valid medical reason (see above).

Pregnancy Medicaid pays for tubal ligation, but rarely the reversal because sterile women file fewer claims than those with natural and restored fertility. Be wary of this dead-end street.

Also, do not allow the many Medicaid brand names established in some states. The same rules apply to these organizations with alternate monikers.

StateMedicaid Name
AlabamaAL Integrated Care Network
ArizonaAZ Healthcare Cost Containment System (AHCCCS)
CaliforniaMedi-Cal
ColoradoHealth First Colorado
FloridaMy Florida Families
GeorgiaGeorgia Families
IllinoisIllinois Family Care
KentuckyKentucky Health Choices
LouisianaHealthy Louisiana
MassachusettsMass Health
MichiganMI HealthCard
New YorkNYS Medicaid
New JerseyNJ Family Care
North CarolinaHealth Choice
OklahomaSoonercare
PennsylvaniaHealth Choices
TennesseeTenncare
TexasTexas Medicaid & STAR
VirginiaVirginia Medicaid
WisconsinBadgerCare

Insurance Companies

Looking for insurance companies that cover tubal reversal surgery is a poor strategy for finding a plan that will pay for the procedure. With confusing topics, sometimes we ask the wrong questions and go down blind alleys.

The rare qualifying medical reason (see above), not the issuing company, determines whether insurance covers tubal reversal. Queries about the organization lead you nowhere.

Blue Cross Blue Shield

For instance, asking does Blue Cross Blue Shield (BCBS) cover tubal reversal will not answer whether your plan will pay for the procedure. It is another dead end.

Submitting a letter of medical necessity in collaboration with your surgeon (see above) is the best way to get your BCBS plan to pay for tubal reversal.

Blue Cross Blue Shield is a national federation of thirty-five independently owned and operated insurance companies, each setting their claims underwriting standards. Also, the many connected tradenames sow confusion.

BCBS StateTradename
FloridaFlorida Blue
GeorgiaBCBS GA
IllinoisBlue Shield Illinois
KentuckyAnthem
New JerseyHorizon
New YorkAnthem
North CarolinaBCBS NC
OklahomaBCBS OK
PennsylvaniaCapital & Highmark
UtahRegence
VirginiaAnthem
WisconsinAnthem

Other Companies

Likewise, asking whether Aetna, Cigna, Kaiser Permanente, or United Healthcare covers tubal reversal is another blind alley. Each of these companies will follow similar claims underwriting standards.

You must establish a valid medical reason (see above) before Aetna, Cigna, Kaiser Permanente, or United Healthcare honor your surgery claims.

Also, each state could choose Aetna, Cigna, BCBS, Kaiser Permanente, or United Healthcare to act as Managed Care Organizations (MCO) for Medicaid. Do not allow this confusing overlap to lead you astray. Stick with the basics.

IVF After Ligation

Will insurance cover IVF after tubal ligation? You are going down another dead-end street. For at least two reasons, no healthcare plan will pay for In Vitro Fertilization following a voluntary sterilization procedure.

  1. Health insurance rarely covers IVF because the procedure is not medically necessary (services needed to diagnose or treat an illness, injury, condition, disease, or its symptoms)
  2. All state-based IVF insurance mandates specifically exclude coverage when previous voluntary sterilization causes the underlying infertility

Therefore, remove insurance for IVF after tubal ligation from your list of alternatives that might make getting pregnant more affordable. Scroll back to the top to learn how grants, Flexible Spending Accounts, and Health Savings Accounts might reduce your spending.


Article Citations:

[1] TurboTax State Rates

More About Medicaid