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What is the cost of Essure and tubal ligation?

Tubal sterilization cost refers to either the cost of tubal sterilization or Essure.

Tubal Sterilization: Tuba Ligation Cost verses Essure Cost

Essure cost verses tubal ligation cost has some important factors to consider for those deciding between the tubal sterilization methods because these procedures are billed differently from one another, sometimes by a considerable amount. Different factors go into the costs of an Essure procedure and a tubal ligation cost, and the details will be reviewed here for your education. Most patients are really only concerned with what their particular out of pocket expense will be, since both are covered by standard medical insurance. This article provides insight into all the costs related to tubal ligation and Essure. cost of tubal sterilization Dr Snyder's office (and likely your doctor) can help sort through your particular situation to get an out of pocket cost estimate.

The tubal sterilization cost can be as little as a $20 co-payment. For those without insurance coverage, an Essure procedure in the doctor's office can cost up to $4000. For a tubal ligation procedure, the cost can be as much as $10,000 to $15,000 without any contribution from insurance. The cost to you, for either procedure, therefore depends on your particular medical insurance coverage and how much of your deductible has been met.

Comparing Essure Cost to Tubal Ligation Cost

Only the Essure procedure can be performed in a doctor's office which saves on cost. Tubal ligation must be performed in an operating room, which will add to the cost. Some doctors choose to perform Essure in an operating room, which generally is just as costly as doing a tubal. So the first thing that must be considered is where the procedure will be performed.

Insurance Coverage Calculation Comparisons

Most insurance policies require that a patient pay for a portion of the entire cost of either type of tubal sterilization out of pocket. The term "co-pay" or copayment usually refers to a set amount the patient is required to pay for an office visit, and many times Essure can be done in the doctor's office. For other insurance plans, the out of pocket expense is related to deductibles and co-insurance and limited by an out-of-pocket maximum for each plan year. When a deductible applies, it is the amount paid by the patient before insurance covers anything, whereas co-insurance is a percentage of the amount over the deductible that the patient pays (in addition to the deductible) up to a predefined maximum, after which insurance pays 100% of the remainder. So if a patient is responsible for $1000 deductible plus 20% coinsurance up to a maximum out of pocket expense of $2500 per year, and an Essure was billed at $4000, the patient would need to pay $1000 (deductible) plus $600 (20% of $3000 remainder as coinsurance) for an out-of-pocket total of $1600 if there has been no prior claim activity that policy year. If her deductible was paid toward an earlier claim (deductible met), then only $600 would be owed. If the entire out-of-pocket maximum for the plan year has already been reached, then there is no out-of-pocket cost for the patient for the Essure procedure done in the office.

Operating rooms and anesthesia add significantly to the cost of tubal ligation and Essure. If the doctors' and hospital bill total $10,000 for a tubal ligation for the same patient and plan as above, then $1000 deductible is applied, as well as $1500 coinsurance (20% of $9000 is $1800, but limited by out-of-pocket max to $1500), so the total is $2500. This, of course, varies depending on how much deductible Essure micro insert and coinsurance is expected with your plan, as well as by how much has been paid previously for other health care claims the same policy year.

As if that is not confusing enough, each doctor and hospital has a contract with each insurance company for a contracted price for procedures, including Essure and tubal ligation, which usually results in a discount from the billed charges to start all the calculations. This discount is different for each insurance company. Furthermore, although doctors generally have a set price they charge for services such as tubal sterilization procedures, hospitals, surgery centers and even anesthesiologists charge different amounts for different patients depending on use of devices, medicines, operating room times and medical complications. The only way to really know what the charge from them will be is to wait until the procedure is over and look at the bill!

The new Affordable Care Act (Obamacare) has proposed that birth control be covered without any out of pocket expense. Whether and when this will apply to permanent birth control such as Essure, tubal ligation and vasectomy, remains to be seen.

Conclusion

In summary, the cost of Essure is generally less than the cost of tubal ligation since it is usually completed in the office and not at a hospital. The cost of tubal sterilization, like all surgical procedures, is not straight forward. Health insurance usually covers the procedure, but deductibles and coinsurance often apply. With respect to tubal ligation, costs such as anesthesia and the use of an operating room significantly add to the charges. Where as, verses the cost of Essure procedure which is usually done in the doctor's office, is covered with just an office co-payment. Simply contact your doctor's office to receive an out-of-pocket cost estimate. Knowing the cost of Essure verses the cost of tubal ligation is an integral part of deciding which procedure to is right for you.


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