Will Medicaid Pay For Getting Your Tubes Untied?

Getting your tubes tied is a big decision, and not just for the physical discomfort and the contraceptive permanence. In fact, getting your tubes tied is one of the most expensive medical procedures that many women face every day, especially since women inherently have more of a risk with sex than guys do.

After the procedure, many women may decide they do want kids and might consider having their tubes untied. Unfortunately, this can be every bit as expensive as the original surgery.

Because of this expense, lots of women wonder will Medicaid pay for tubal reversal? We’ll answer this question and more below!

Why Should You Get Your Tubes Tied In The First Place?

Tying your tubes, which is known by the medical term tubal ligation, is a permanent contraceptive procedure carried out through surgery. In other words, it’s birth-control you can’t take back (at least, not without considerable effort!).

Without getting too technical, a tubal ligation procedure has your fallopian tubes pinched (blocked), tied, or cut in order to permanently stop you from becoming pregnant. They basically stop eggs from being able to be fertilized by sperm, making the odds of pregnancy essentially 0%. As a bonus, tubal ligation doesn’t change her menstrual cycle the way regular hormonal birth control does.

Tubal ligation is an invasive surgery, however, especially compared to a vasectomy. So many women think for a long time before committing to the procedure.

As a result of these benefits and its consistency in stopping pregnancy, lots of women turn to tube tying to ensure they want to become pregnant, particularly after they’ve already had several kids. In fact, tube tying is most common among women who’ve already had a kid or two and want to be able to enjoy sex without other birth control options but without the inherent risk of becoming pregnant again.

Other women may choose to tie their tubes for health reasons or if they’re sure they’ll never want children later in life.

What About Untying?

A tubal ligation reversal, otherwise known as “untying” your tubes, is a reparative surgery where your fallopian tubes are reattached or untied, theoretically allowing the body to go about its normal pregnancy processes. However, untying is not always successful, and depending on how your tubes were tied in the first place it may even be impossible.

What Medicaid Is… and Isn’t

Medicaid is, broadly speaking, a federal program that can help you with medical costs if you don’t have lots of cash to spare or have limited insurance resources. If your insurance doesn’t cover you very much or you are uninsured, you might be able to use Medicaid to cover certain medical procedures or surgeries.

Medicaid is also important because it covers things that aren’t normally covered by Medicare, which is a related but separate benefits program.

Medicaid is not a catch-all insurance program that covers all kinds of surgeries or medical needs, especially if your economic bracket means you don’t likely need the assistance. So does this help with tube untying or do you need to look elsewhere?

Does Medicaid Cover Tube Untying?

In a nutshell, Medicaid will only cover your tubal ligation reversal surgery if there’s a proven medical need. In addition, many Medicaid plans only cover certain parts of the surgery. There are three main parts to every tubal ligation reversal:

•   The initial pre-surgery testing
•   The surgery itself
•   Post operational care and complications

Medicaid does not normally cover tube untying because it is a reversal of a procedure that you theoretically undertook voluntarily (i.e. without medical need). So it’s not deemed essential by medical insurance in most cases, which is what Medicaid handles.

Medicaid covers all medically necessary costs for a tube untying surgery. To be medically necessary, the procedure or testing need to diagnose, prevent, or treat a disease, injury, or symptoms. Note that most private insurers also only cover tube untying surgery for the same reasons unless you’re on a specific plan.

Specific Situations

So what scenarios does Medicaid end up covering a tubal ligation reversal surgery?

In the pre-surgery testing phase, Medicaid may cover the tests themselves in any other preparatory costs if there’s:

•   cause to believe that the bloodwork will show signs of infection, like STDs
•   risk that the reproductive organs are in danger/may be injured during the surgery

If your clinician agrees with you, they can code the tests before the surgery as medically necessary so you can cover them with Medicaid.

During the surgical phase, the only areas in which Medicaid will cover the costs is if the procedure can correct another disease or symptom you are already experiencing. Some examples are:

•   Post Tubal Ligation Syndrome, or PTLS. This condition is characterized by the sudden decline of your progesterone and estrogen hormone levels. This occurs when your ovaries’ blood supplies are interrupted or damaged from the prior tubal ligation surgery.
•   Dysmenorrhea, which is excessive pain and cramping during menstruation. This may have been caused by a botched tubal ligation surgery or other complications.
•   The presence of uterine fibroids/polyps; these may need to be removed to help you become fertile once again.

During the postoperative phase of a tubal ligation reversal procedure, Medicaid will cover any complications that result in injury or sickness. While the surgery is typically quite safe, some complications can arise, including:

•   Damage to the ovaries and surrounding organs
•   Negative reactions to anesthesia, or experiences while not fully anesthetized
•   Infections as a result of open surgery or poor medical practice
•   Bleeding either internally or externally as a result of poor medical practice

All in all, while it’s possible that Medicaid could pay for getting your tubes untied, it’s not especially likely if you are otherwise healthy and the procedure goes as normal. Private insurance companies may be a better bet, although, since tube untying is rarely necessary for medical reasons, it’s usually not fully covered in your co-pay rates may be high.

Alternatives for Tube Tying/Untying And Other Permanent Contraception

Of course, Medicaid does cover other contraceptive plans and procedures. These may be good options if you aren’t sure about getting your tubes tied in the first place and don’t want to have to consider paying for reversal if you want kids later in life.

Pills/Condoms

Traditional contraceptive or family-planning options like birth control pills and condoms are usually covered under Medicaid or can be purchased at family-planning centers like Planned Parenthood. Most private insurance companies also cover contraceptive measures other than tube tying.

Implants

The majority of states that have strict limits on tubal ligation procedures under Medicaid have much more lax restrictions concerning other birth control measures, like implants. This is because such procedures can be easily reversed and don’t have the health risk that tubal ligation inherently does.

However, private insurers usually cover tubal ligation under the majority of circumstances and economic needs. Granted, you’ll still need to pay a co-pay fee and/or a high premium based on your plan and provider, but it’s still better than nothing.

Vasectomy

You can also opt for a vasectomy if you are in a committed relationship with a male partner. Vasectomies are both usually cheaper than tubal ligation procedures and are much less invasive for the patient. Vasectomies are also inherently less risky as a result of their location and potential health impacts.

Government Incentives

Interestingly, the Affordable Care Act includes a slight error that also acts as a bit of an incentive to get your tubes tied. Section 2713 of the ACA says that all private insurers need to cover preventative health services, including services relating to the reproductive health care for women, under their insurance plans. This sounds great on its face, but it accidentally excludes men.

In other words, you’ll end up saving money by working with an insurance provider under the ACA, but the only permanent contraceptive method explicitly covered under ACA guidelines is tube tying rather than vasectomies.

To some, this places an unfair burden on the bodies of women. Many families may decide to perform a more invasive tubal ligation surgery just to not be penalized by insurance providers or the government, especially since vasectomies can still be expensive if they aren’t covered under insurance.

However, this does mean it’s easier to get your tubes tied and have the cost for the surgery covered by your insurance that it is for the male equivalent.

Conclusion

Ultimately, Medicaid can and sometimes will pay for getting your tubes untied, but the circumstances might vary based on the state you live in and your economic circumstances. If you can’t get Medicaid to cover the procedure for whatever reason, remember you can fall back on private insurance or other forms of contraception if need be. If you have a guy you’re serious about or married to, convince him to get a vasectomy instead; it’s cheaper on his body and the wallet!

Were you about to get your tubes untied with Medicaid? Let us know in the comments and tell us your experiences!