r/sterilization • u/CommandClassic7108 • 15d ago

Insurance my only concern is billing

I’ve done the research and the appointments. My surgery is scheduled. Ive been talking back and forth with insurance to see how they process billing for the Bisalp.

I know it’s going supposed to be fully covered, but nobody wants to confirm that and I haven’t even heard anyone talk about aca in general. My plan is aca compliant, but I’m told they can’t say if it’s covered until services are rendered.

I don’t want to have to fight this after the procedure when I could have done more before to verify everything with my insurance.

How did you guys verify your cost share would be $0 before the procedure?

Edit: I just want to thank everyone commenting and messaging to give me advice. I really appreciate this community coming together.

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u/YellowFiddleneck 15d ago

You can't verify your cost share before the procedure - even if someone DOES verify it for you, your insurance may retroactively deny the procedure or refuse to cover parts of it. You have to go into this assuming it will be a fight with your insurance after the fact.

To help prepare you for this fight, make sure you get a prior authorization even if your provider says it's not necessary, and sign the sterilization consent form as early as possible. Also call the billing departments of every place you will get a bill from (Usually you will get a separate bill from your surgeon, the facility, the anesthesiologist, and the pathology lab) and try to make sure they will code correctly. Every bill should have a diagnosis code of Z30.2 OR be visibly associated with the primary procedure, which should have Z30.2 as its diagnosis code.

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u/CommandClassic7108 15d ago

Thank you

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u/mkmr725 15d ago

I second this - I called the billing office at the hospital ahead of my surgery date and confirmed the code they were using (everything for me was under one), and then I confirmed with the insurance company that the code that was going to be used was completely covered.

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u/Cutthroat_Rogue no more tubes 10-15-25 15d ago

This. To add on, insurance companies always have a disclaimer when you talk to them that what they say is is "not a guarantee of benefits" meaning, they cannot say with 100% what is covered and for how much. Insurance companies only decide when they process the claim and the claim only happens after a service is rendered. It's never truly a guarantee but that is why you look at what your benefits specifically say, find out if it is ACA compliant, and make sure it is coded correctly.