Hey everyone, I’m hoping for some help with an insurance question. My OBGYN just approved me for a tubal, but my insurance only covers it if it’s ‘medically necessary,’ so I’d have to pay for it myself otherwise. I don’t love my current insurance and am thinking about switching, but the main reason I got insurance was to cover this procedure. Anyone know of companies or plans that cover elective tubal ligation or bilateral salpingectomy? I’m in Texas, and without insurance, it would cost thousands. Any advice would be appreciated!
Also, I should mention that I have short-term insurance, so the ACA rules don’t seem to apply here.
You could try having your doctor submit a pre-authorization request. If they deny it, maybe you could appeal it through your insurance. Not sure if short-term plans allow appeals, but it might be worth a try.
As someone licensed in insurance, that denial doesn’t sound lawful under the ACA. Try submitting a pre-authorization with your insurance. If they deny it, contact your state’s Insurance Commissioner and file a complaint.
You’re correct that short-term insurance only covers emergencies or sudden illnesses and isn’t a full plan. If you’re looking for broader coverage, check healthcare.gov. It can be a bit confusing, so if you need help, you can find someone locally at https://localhelp.healthcare.gov. You might find a better plan that’s also cheaper than short-term.