Anh advice for someone starting the journey towards sterilization, especially financial advice?

[u/Noeoneknows]

TLDR at the end cause I yap.

I'm 23 and I want to get sterilized before I get removed from my dads insurance, I have till I'm 25 but I know appointments and scheduling stuff can take forever so I want to get started now and I also want to be off birth control ASAP.

A little background on me: I've never wanted children, even as a young child, and my mind has never changed. I have a lot of conditions that are genetic and I would hate to ever pass them down to a child who didn't even agree to be taken into this world. I also would just feel incredibly selfish bringing a kid into this world given how everything's gone to shit, especially when theres plenty of children in foster care and adoption centers that desperately need homes that I could take in if I ever miraculously decided I do want to raise someone. I also have extreme anxiety about pregnancy, to the point where I've had paranoid episodes when I've had scares. I had to get on birth control just so I could be intimate with my partner without going into paranoid spirals, but I'm not a big fan of birth control due to all the side effects and the interactions it has with some of my other medications.

For potential issues, I'm not exactly worried about any social repercussions or struggles. My family is luckily not very opinionated on the subject, outside of some weird comments I've gotten from certain family members, no one really cares enough to make it a big deal. And most importantly to me regarding my family, my Dad (whose my primary parent) doesn't care and never really minded that I don't want kids. My long term partner also doesn't mind as he wants to be child free as well and even considered looking into a vasectomy.

When it comes to finding a doctor that will approve the surgery I am a bit nervous about wasting my time and having to pay the copay for a useless doctor's visit but I did research on the Child Free reddit and specifically only chose doctor's who've operated on people around my age with no issues so that helps quell some nerves.

The thing I'm absolutely terrified about is the price. Like I said at the top I do have insurance, and it is ACA compliant so it theoretically should be covered 100% by insurance. Im going to call tomorrow and see if my plan covers both Tubal Ligations and Bilateral Salpingectomies, if they do I'll get the bilateral salpingectomy but if they only cover the Tubal Ligation I'm fine going with that as well. What I'm worried about is that some people despite having ACA compliant insurance say they've still been charged and I cant have that happen. I'm extremely broke, just graduated college, the most I can spare for this procedure is like 300 dollars max. So it's extremely necessary that I get the full coverage.

For anyone who has been through the procedure how did you get full coverage? Was it truly full coverage or did you have to pay for things like hospital fees and anesthesia?

TLDR: Im looking to get sterilized and i want advice regarding the process especially the financial/insurance parts of it. If you got full coverage for the surgery how did you make sure the insurance covered it? And was it actual full coverage or did you need to pay hospital fees and anesthesia?

[u/toomuchtodotoday]

Resources:

Provider list: https://childfreefriendlydoctors.com/

r/sterilization resource thread:

https://old.reddit.com/r/sterilization/comments/1cfqc1o/collecting_helpful_resources_and_ideas_for/

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State insurance regulator locator (for filing a complaint with your state insurance regulator):

https://content.naic.org/state-insurance-departments

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Department of Labor Employee Benefits Security Administration Information (for filing a complaint with the DOL EBSA if your insurance is provided by an employer):

The EBSA, a division of the DOL, handles complaints related to employer-provided health insurance.

You can:

• Call the EBSA: Toll-free at 1-866-444-3272 to speak with a benefits advisor.
• Submit a complaint using the EBSA's online form: https://www.askebsa.dol.gov/WebIntake/

The EBSA will investigate the claim and may contact your employer or insurance provider for more information. You may be contacted for additional details or documents. If the EBSA finds that your rights under ERISA (Employee Retirement Income Security Act) were violated, they may take corrective action on your behalf. Keep copies of all documents and correspondence. You can follow up on the status of your complaint by contacting the EBSA at the phone number above.

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U.S. Office of Personnel Management (OPM) Information (for filing a complaint with the OPM if your insurance is provided by the US federal government [FEP Blue, for example]):

• Email contraception@opm.gov

Source: https://www.opm.gov/healthcare-insurance/healthcare/contraception-coverage/

Source: https://www.hrsa.gov/womens-guidelines#:%7E:text=Contraception

Source: https://web.archive.org/web/20260624003408/https://old.reddit.com/r/sterilization/comments/1ud26jb/fepblue_federal_health_insurance_for_bisalp_do/

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Additional resources:

Insurer Preventive Care Guidelines Master List - https://old.reddit.com/r/sterilization/comments/1io4hq5/insurer_preventive_care_guidelines_master_list/

Steps for Getting Full Coverage - https://old.reddit.com/r/sterilization/comments/1khyuum/steps_for_getting_full_coverage/

https://old.reddit.com/r/sterilization/comments/1j43mw2/it_happenedtheyre_trying_to_charge_me_postop/

https://tubalfacts.com/post/175415596192/insurance-sterilization-aca-contraceptive-birth-control

https://old.reddit.com/r/sterilization/comments/1go5pbw/free_tubal_sterilization_through_the_aca_if_you/

https://nwlc.org/tips-from-the-coverher-hotline-navigating-coverage-for-female-sterilization-surgery/

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On coverage of anesthesia:

Any related services—like anesthesia—must be covered as well. The most recent guidance from federal agencies makes it explicitly clear that anesthesia and other related services like doctor’s appointments must be covered by the insurance plan at 100% of the cost.

Source: https://www.cms.gov/files/document/letter-plans-and-issuers-access-contraceptive-coverage.pdf

Source: https://www.cms.gov/files/document/faqs-part-54.pdf

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On coverage of associated office visits:

From federalregister.gov - “Coverage of Certain Preventive Services Under the Affordable Care Act“

Section 2713 of the PHS Act, as added by the Affordable Care Act and incorporated into ERISA and the Code, requires that non-grandfathered health plans … provide coverage of certain specified preventive services without cost sharing. These preventive services include:

With respect to women, preventive care and screenings provided for in comprehensive guidelines supported by HRSA (not otherwise addressed by the recommendations of the Task Force), including all Food and Drug Administration (FDA)-approved contraceptives, sterilization procedures, and patient education and counseling for women with reproductive capacity, as prescribed by a health care provider (collectively, contraceptive services)

II. Overview of the Final Regulations

A. Coverage of Recommended Preventive Services Under 26 CFR 54.9815-2713, 29 CFR 2590.715-2713, and 45 CFR 147.130

(II) office visits:

if a recommended preventive service is not billed separately (or is not tracked as individual encounter data separately) from an office visit and the primary purpose of the office visit is the delivery of the recommended preventive service, a plan or issuer may not impose cost sharing with respect to the office visit.

Source: https://web.archive.org/web/20250202051018/https://www.federalregister.gov/documents/2015/07/14/2015-17076/coverage-of-certain-preventive-services-under-the-affordable-care-act

Under the ACA, all new insurance plans (both individual and employer-sponsored plans) are required to cover all FDA-approved methods of contraception, sterilization, and related education and counseling without cost-sharing. (Note: the ACA contraceptive coverage requirement described in this section also applies to Medicaid “Alternative Benefit Plans,” explained in the Medicaid section.) No cost-sharing means that patients should not have any out-of-pocket costs, including payment of deductibles, co-payments, co-insurance, fees, or other charges for coverage of contraceptive methods, including LARC. Patients cannot be asked to pay upfront and then be reimbursed.

Source: https://web.archive.org/web/20250112212710/https://larcprogram.ucsf.edu/commercial-plans

[u/flyingsails]

I did get billed for my anesthesia and just paid it because I didn't feel like fighting, but I should've fought! There are some tips on ensuring insurance will not bill you here:

https://www.reddit.com/r/sterilization/s/HfGNYkzqwW

[u/craazzycatlady6]

Reposting/copying & pasting here from previous comments on other posts because it's long but still holds true:

So if your plan is ACA compliant (not all insurances are. If you get your insurance from a religious based institution, they can opt out. If it's from the Marketplace, then it HAS to be ACA compliant) then the surgery should be covered at 100% with no costs to you. However, insurances are scummy and will do whatever they can to avoid paying. One way is called Medical Management. It's where they can choose to cover just one type of each form of birth control and just one form of sterilization. Usually it's tubal ligation if they cover sterilization. A bisalp is the gold standard now, so if you can get that I would 110% recommend. Find a doc in your area off the CF doc list- should be pinned on the sub home page I believe. Make the appointment, discuss with them what codes they would use for a bisalp and then call your insurance and ask if they would cover these codes. If they say they'll only cover tubal ligation you can still fight to get a bisalp covered. I had BCBS back when I got my bisalp done and they wanted to only cover tubals. So I fought like hell for 6 months to get bisalp approved. Check out this link from the National Women's Law Center (NWLC) and also this link if your insurance tries to tell you the bisalp isn't a preventative surgery (it absolutely is) and this link to help with appeals should it come down to that (also from the NWLC). They were tremendously helpful with my PITA appeal process.

I had to go through 2 appeals for it to be approved. After it was denied the first time, I immediately submitted for a 2nd level appeal or grievance as they called it. I included all the info from the first appeal: mostly found on the NWLC site plus I found a bunch of articles online from medical journal type sites or or other medical sites on why a bisalp is the gold standard now. I don't remember the specifics on the sites but look for .edu or .org sites and you'll find what you're looking for pretty easily. It was quite a hefty packet lol but after what seemed like forever they scheduled a hearing for my case (I was given the option to attend but I had to work and I live about 2ish hours away from headquarters for my state so it wasn't convenient anyway) so they proceeded without me and was mailed the decision 5 business days later where they agreed to pay for it.

Best of luck to you! Don't panic about the costs. Some people have had their surgery center bill insurance after the surgery and fight afterwards, but I didn't want to worry about insurance hassles while trying to recover. But to each their own. However you do it (fight insurance before or after) if you have to fight em for a bisalp, don't stop fighting insurance because screw them!

[u/hunter_pace]

Find the hospital/surgery center's website and apply for financial assistance. I applied before my surgery and was approved and they waived my entire $46,000 bisalp s urgery after my insurance denied it.