What Doctors Don't Tell You About Tubal Ligation and Post Tubal Ligation Syndrome by, Susan Bucher © 2006 Buy a copy for yourself or for someone you know   click here for more information

insurance companies and doctors

by charlene

NOTE: This is just a rough draft of ideas. Anyone Else have any Ideas???? Anybody know any lawyers that could help us with this? Anybody know any politicians or insiders in insurance companies? How do we go about writing something up for consideration to the insurance companies and REALLY make an impact? How do we get this legally implimented?

For DOCs and INS Cos

Insurance companies MUST cover tubal reversals if they cover tubal ligations. The reason for this being: tubal ligations can cause chronic pain and gynecological problems. Some of those gyn probs may lead to a hysterectomy (a hyster being more damaging to a woman’s body than a reversal.) A woman’s quality of life may be diminished due to a TL and she is entitled to APPROPRIATE and lasting treatment. Also, a TL is the ONLY form of birth control that cannot be voluntarily reversed by the woman (stop taking hormones) and/or the reversal procedure is not covered by insurance (removing an IUD or other insert.) A woman may experience severe regret or a sense of loss over the permanent loss of her fertility, she may lose a child and wish to have another, and the reversal procedure is cost prohibitive for most families. If an insurance company will pay to have a woman’s fertility permanently revoked, they should also pay to have it restored if the loss of fertility is the result of surgery that the insurance company covered. The insurance company may choose to not cover post-partum TL due to the higher regret rate and due to the fact that it makes it more difficult to distinguish PTLS from post-partum depression or other post-partum issues.

Doc MUST provide a list of possible side effects from the tubal ligation, and the patient must sign a copy of that list and be counseled on those risks. She must be advised that if she is getting the TL to avoid taking bcps then this may not be the best birth control for her. She must be advised that she may be prescribed and asked to take birth control pills as a result of symptoms from the TL. Ins Cos can require that this form be provided to and signed by the patient prior to covering a TL.

Docs must learn the effects of PTLS if they perform TLs and they must either offer their patients appropriate treatment for those symptoms or refer the patient to a specialist in the area that treats PTLS.

There is a monetary incentive to Docs who do TLs. We must find SOME way to balance that incentive, because SOME Docs are just WAY to eager to sign a patient up for a TL procedure rather than suggest a less damaging form of birth control such as an IUD.

Insurance Cos may pay a lower percent of the cost of a TL – say, up to 80% regardless of the policy (to save themselves some money for TRs as well as to make it a little more thought provoking than “it’s covered, why not?”) Programs for low-income families may be exempted from this, since it is unlikely that a woman on Medicaid can come up with 20% of any surgical costs, but there should be a required 6 month post-partum wait and an additional counseling session and TR should STILL be covered if she experiences PTLS symptoms since a reversal is the most appropriate treatment. Once Medicaid ends, a woman who had her TL through that program is often left “high and dry” as far as getting ANY treatment for her symptoms (most often, not even the “band-aid” anti-depressants or birth control pills are available to her.) Maybe there could be a provision added that states that she will receive treatment for side-effects or complications from surgeries that were performed while she was on Medicaid? (Medicaid for pregnant women typically ends shortly after the birth of the child or end of the pregnancy.) Just because a woman has a limited income does not mean that she should be left to deal with side-effects of TL with no help. It also does not mean that she should be left clueless about the possible side-effects just because the state and some docs do not want these women having more children.



Posted on Nov 17, 2004, 10:05 AM

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