Does caresource cover essure

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Essure reversal This series of codes are for patients who want Essure reversed and want to become pregnant. Sometimes your health insurance company will pay for surgery but only if a doctor provides a letter of medical necessity. A letter of medical necessity is a letter provided by the doctor supervising your care. This letter describes your symptoms, your diagnosis is, and why Essure removal or Essure reversal surgery is medically required. Any pre-certification or pre-authorization required by your health insurance company is the responsibility of the patient.

Since our surgical fees are all-inclusive, we do not provide a cost breakdown to health insurance companies. We are unable to file insurance claims for reversal surgery. If your health insurance requires a letter of medical necessity then A Personal Choice or Dr. Monteith will not be able to provide a letter or medical necessity either before or after reversal surgery.

Your primary care doctor…or the doctor evaluating you for possible Essure related symptoms…. Your health insurance company should send your reimbursement for surgery directly to you after you have completed and submitted your Member Claim Form. Every health insurance company has a Member Claim Form. After your surgery is completed, you will then need to submit the billing paperwork we provide you to your health insurance company for reimbursement.

We will provide you with more specific and comprehensive codes depending on the findings at the time of surgery. You will also be provided a receipt for surgery and diagnosis and procedure code sheet. This means you may have to pay less for other health care expenses for the remainder of the year. Your health insurance company may inform you your procedure will be covered. Please be aware this information is not always correct. Ultimately the insurance company reserves the right to make the final determination after services are rendered.

Essure reversal is done to become pregnant again and is considered an elective non-life threatening fertility procedure. Essure removal is done for symptoms. Health insurance companies recognize there are immediate complications from Essure in some patients and are more willing to cover Essure removal. If you have a tubouterine implantation to reverse Essure then health insurance companies will recognize this as a procedure to treat infertility and they will ultimately deny coverage.

Many health insurance companies will reimburse for Essure removal…. Often the health insurance company is expecting you to have either a hysterectomy or complete fallopian tube removal in a hospital.

Health insurance companies will often request an itemized list of services. We cannot provide a itemized list of services or a breakdown of charges. Health insurance companies will only recognize and provide reimbursement if the itemized list of services comes from a hospital.

This is unethical and potentially illegal. We will not change codes once they have been provided on your original documentation.

Only a doctor who has evaluated and treated you over time can provide such documentation. Your primary care provider or the doctor who inserted your Essure devices must provide you with documentation required to support the medical necessity of your Essure removal. You should not have your surgery at A Personal Choice.

Instead you will need to find a doctor who can remove your Essure devices in a hospital setting with hospital billing. If you have Essure removal in a hospital you should make sure the doctor has experience with Essure removal. Doctors with limited experience are more likely to perform a hysterectomy to remove Essure or leave Essure fragments due to improper removal techniques.

If you want Essure reversal there are very, very few doctors who are actually reversing Essure for patients in a hospital setting. We are seeing a steady increase in patients who have not become pregnant after Essure removal by their local doctors.

The purpose of Essure reversal is to restore the natural function of the fallopian tube and allow for natural conception and pregnancy.

Health insurance companies consider Essure reversal and IVF as fertility treatments. They consider these procedures elective, non-urgent, or not life saving procedures. Fertility is not considered urgent or worthy of spending the companies money.

Health insurance companies will never pay for Essure reversal. A large number of women have reported abnormal side-effects after having the Essure devices inserted. Many of these women are having Essure devices removed, their fallopian tubes removed, or hysterectomy. Essure device perforating the uterus. Does Essure cause problems? In the very beginning, both doctors and health insurance companies refused to acknowledge patients were having problems from Essure.

The procedure to remove Essure was often not offered by doctors and declined by health insurance companies. Over time as more patients have reported Essure complications, more doctors are willing to treat Essure problems and more health insurance companies have become willing to pay for treatment of Essure complications. More information: Cost of Essure removal with Dr Monteith.

Currently most health insurance companies will pay for Essure removal is you have a complete hysterectomy removal of the uterus or complete removal of the fallopian tubes along with the Essure devices. Health insurance companies will only pay for Essure removal if the hysterectomy or fallopian tube removal is done in a hospital setting.

If you want to become pregnant, health insurance companies will not pay for Essure reversal or in-vitro fertilization IVF. If you want Essure removed and want your insurance to pay for the entire procedure…then you will need to have your Essure devices removed in a hospital setting. You will either need to have a hysterectomy or removal of the fallopian tubes total bilateral salpingectomy. Monteith is a participating member in Blue Cross Blue Shield, Cigna, and Aetna and some of his Essure reversal and Essure removal patients are seeing partial reimbursement for Essure related surgery at A Personal Choice.

If you are a member of one of the above health insurance plans then you may be able to get reimbursement for Essure removal surgery with Dr. Patients are required to pay in full before surgery. After surgery, A Personal Choice can submit your procedure to either Blue Cross, Cigna or Aetna to see if they will provide any reimbursements.

Monteith specializes in helping couples have more beautiful children with reversal surgery and helping women treat abnormal symptoms after their tubes have been tied! If you would like more information about reversal, including the cost and success rates , then enter your email address below and you will be emailed more information about reversal. By joining the group you can communicate with other women who have had successfully reversed their tubal ligation and restored their natural fertility.

We provide a unique surgical experience with personalized attention and one-on-one care. Please use the buttons below for answers to our frequently asked questions. View Our Videos. If you are considering reversal surgery and have questions about the procedure, fill in the form below and we'll get back to you as soon as we can! If you would like to speak with a nurse for a Free Consultation then feel free to call us at Please view our most frequently asked questions before sending your questions.

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