Insurance for health, home and cars is essential to make sure you are protected; however, having your health insurance cover all of your medical needs is often a struggle. When diving into the world of what is seen as cosmetic or elective surgeries, it becomes even more of a struggle to have the procedures covered. Tubal reversals are usually seen as an elective procedure, and will result in most insurance companies denying coverage.
Many women choose to have a tubal ligation, which severs the fallopian tube and prohibits an egg from entering the uterus, fertilizing and implanting. As time passes, however, some women decide they would like to have a baby and wish to reverse the ligation and restore function to the fallopian tube. The success rate of the process varies widely by the surgeon and type of ligation that was originally performed.
Insurance companies often view the tubal reversal as elective. Health insurance is designed to fix health issues, and someone choosing to have a tubal reversal is seen as not a health issue, but rather a desire. It is viewed very similarly to cosmetic surgery. It is very difficult to find any insurance company that will cover any elective procedure, including tubal reversal.
Call your insurance company or prospective insurance companies. Any billing to an insurance company must include procedure codes and diagnosis codes, and use these two specific codes when inquiring about coverage for tubal reversals: ICD 628.2 and CPT 58750. These codes rarely change, but you can call your doctor to verify that these are the codes he will use in billing. If the insurance provider states they will not cover the procedure, ask if any portion of the surgery can be covered, such as anesthesia.
In some cases, a tubal ligation can result in medical issues. If your doctor feels that your tubal ligation should be completed for your health, he can write a letter to the insurance companies and make the case for medical necessity. When a procedure is requested out of medical necessity, the chances for insurance approval rise.