August 7, 2016

Dealing with Insurance for my Laparoscopic Bilateral Salpingectomy

The least fun part about getting spayed has been dealing with insurance.

Let's start with the end: I lost.

Backing up a bit, before you go and get this or any surgery call your insurance company and ask what your costs will be. First, get the precise codes from your doctor. Make sure to get all codes, all of the codes that each doctor will use (I had two), the code the anesthesiologist will use, the code the hospital will use, and any other code they might need. Second, tell that code to the insurance company, have them read it back to you so you know you're on the same page, and ask what your total costs will be. DO NOT ASK IF IT'S COVERED. "Covered" in medical insurance language does not mean the insurance company will pay for it, it simply means it's an approved procedure (wtf an unapproved procedure is I have no idea). This was mistake #1 for me. Third, before you actually go in for this surgery call your insurance company again and make sure they're giving you the same answer as before. If your plan suddenly changes and they don't inform you (cause they're dicks like that) you'll be on the hook.

Another important point: the Affordable Care Act states that all birth control costs are 100% provided by insurance companies, including female sterilization. HOWEVER,
 sterility is only a side effect of a bilateral salpingectomy. Fallopian tubes were historically removed as part of a hysterectomy in order to reduce the risk of ovarian cancer, and only recently are women turning to the procedure because of how effective it is at stopping pregnancy (no tubes, no babies). Compare this to a tubal ligation, which is only done for birth control purposes. This makes sterilization an off-label use of bilateral salpingectomy. Some insurance companies have this procedure labeled as sterilization because of its quickly growing popularity (up to 33% of sterilization procedures are bilateral salpingectomy), but mine did not. In principle I felt that insurance should have covered it because my primary reasons were for sterilization. 

Further, and this is an argument I had with many people at my insurance company over many months, is that even if laparoscopic bilateral salpingectomy is used for other things, I used it for birth control, as a preventative measure, so why isn't it paid for? The only answer I got was the code didn't specify either of those things.

What I learned is that there are generally two codes a doctor can use for laparoscopic bilateral salpingectomy: one that says it's birth control, and one that doesn't. There were two codes in my paperwork: one that described it as "female surgery" (no shit) and one that described it as a "medical procedure" (imagine that). The super weird thing was when I asked the insurance rep to read the codes back to me she said it "tubal ligation." Which would be paid for. When I asked why it said tubal ligation and they still weren't paying for it she said that's where that second code comes in, the one that called it a "medical procedure." Apparently, in order for Blue Shield to pay for this surgery, it would need to have a code that indicated it was a "preventative procedure." What differentiates a medical procedure from a preventative one is something I still don't know. 
Call your insurance company and find out what their rules are. If they consider it birth control, awesome. If they don't, do your best to find out what your costs are going to be when all is said and done (hospital fees, doctor's fees, anesthesiologists fees, medical waste fees, administrative fees, any and all fees they can throw at you). Honestly, I'm an educated person and am used to talking with medical professionals and I feel insurance is needlessly and possibly intentionally complicated so people will just pay to avoid the headache.

Since this was the surgery I wanted and I wasn't going to get a less-effective surgery with a longer recovery period and more potential for risk because it would be cheaper (some things you just need to pay for), I didn't try too hard to determine all these things. Plus, I knew my company would pay my deductible so my risk of actually paying anything out of pocket was pretty small.
I had my surgery in October and finally paid up in April. When all was said and done, it cost just over $2,000 (less than my deductible, which my employer pays as part of our medical benefits package). The upside was the hospital was very understanding and worked with me to try and get Blue Shield to reconsider. They resubmitted the paperwork twice, I talked everything over with both my doctor and the billing department multiple times, and they put several holds on my fees to give me time to get it sorted out. I still can't believe it took 6 months. 

Here's my six week update, the official "back at life" time for anyone currently considering this procedure and the recovery period. And here I am one year later. Good luck to anyone considering a salpingectomy! Despite the struggles with insurance, it has been 100% worth it.


  1. I'm sorry you had to go through all that craziness. And I'm sorry that I didn't know you prior to help you out. I used to be in the insurance industry before I had my kids (left in 2008 before I had my son).

    I had these issues as well with my insurance prior to my surgery. I was told that Cigna (my carrier) would pay 100% for the tubal ligation, but a salpingectomy, I would need to prove "medical necessity" in order to have that covered, otherwise it would be out of my pocket. I actually went for the breast cancer gene testing because my sis had breast cancer last year in 2015 (yeah, I had just way too much medical stuff going on in 2016!!). But in any case, I was BRCA negative, YAY :) so it wouldn't be medically necessary for the salpingectomy (if positive, that would've given me the necessity).

    Anyway, I hope that the bills aren't too crazy for you. Usually you can ask for monthly payments and even if they're getting 20 a month or something, they'll be cool with it. I'm doing that currently for having carpal tunnel surgery 2 months ago.

    Hope all is well :)

    1. Hi Mommy Nancy! I felt like "insurance" should be a foreign language when I was going through all the mess trying to figure it all out. It doesn't really make sense, that the more effective procedure (meaning fewer women will need follow up care, which is also expensive), which is also the one that prevents cancers isn't always the one that's covered. Seems like it would be, but I don't make the rules. Lucky you having a leg up though! Knowing the right questions to ask is probably half the battle. But honestly, I would have done this anyway, since it was the procedure I wanted and I did not want anything left inside me, which is the case with a tubal.

      Fortunately my work pays for our deductible as part of our plan and the fee was under the limit, so I didn't have to pay out of pocket.

      Thanks for checking back in and for the offer of help. :) Hope all is well with you and your family!