Let’s get personal.
It’s not like we haven’t had a lot of personal conversation already over the past decade, but let’s talk about something new.
Health is inherently political. Health is also a business, and in the US, it feels a lot less like healthcare and more like “sick care”. This is something that is talked about a lot among medical professionals and allied health professionals. Prevention is cheaper than treatment, and with so many different ideologies and values, our health infrastructure can’t and won’t make everyone happy.
I think I wanted kids when I was a kid. I say think because I used to say I wanted as many as a stack of pancakes. I actually remember saying this and as a teen my family would bring it up too. However, I didn’t really understand that I could also say I don’t want them.
I have friends who have always wanted to be parents, and I have loved watching them take on that role and become different people than who I met. There’s one friend mom that comes to mind when I think about a mom I would want to be if I wanted kids. She is everything that my mom wasn’t and couldn’t be. She’s also everything my dad wasn’t and couldn’t be. She is also the person who admits when they can’t do or don’t know something, but still ties to figure it out.
So this post, isn’t about bashing people want or have kids.
This post is take you through a different health journey with me.
I don’t want kids and that’s ok.
I met with my OBGYN today to get the process started because I didn’t really know what it would entail. Prior to her, I had spoken with other providers, some were supportive, but never would let the conversation go passed that. I had one provider who told me she was unable to do the procedure because I had skin removal and my anatomy was different. This is 100% false, nothing was relocated, I just had excess skin removed.
Since moving to South Carolina, I’ve talked with my provider two other times, primarily to get information, and today I said, ok, what’s next?
I spoke with the surgical coordinator and she’s going to verify my health insurance benefits and check to see if I need pre-authorization before scheduling my surgery.
So what am I getting and let’s chat insurance coverage?
A salpingectomy involves removal of one or both fallopian tubes, this is different than tubal ligation which cuts, ties or blocks the fallopian tube. Benefits to having the salpinectomy:
- it’s a permanent solution to prevent pregnancy
- reduces or eliminates the risk for ovarian, uterine and Fallopian cancers
Aside from pregnancy prevention, it can also help those who experience ectopic pregnancy (pregnancy outside of the uterus).
I pay out-of-pocket for my health insurance through the state of South Carolina’s marketplace, meaning, my health insurance doesn’t come from my employer, nor do they give me money to pay for my insurance.
Below is a screen shot of my insurance bill.
I have a lower level plan and because of my income bracket I get a tax credit of $187 toward the bill of $390.40 (per month). This means I pay $203.40 every month for just myself. There are some who pay more and some who pay less, for more or less benefits. This is one of challenges of our healthcare system. When I do my taxes, I have to submit forms regarding this credit and I can also submit documentation that I pay out-of-pocket (post tax) for my coverage.
I also have a high deductible. My deductible is $7,200 and my out-of-pocket maximum is $9,100.
Some things to know:
- The Affordable Care Act (ACA), also called Obamacare expanded reproductive health coverage with access to preventative care like immediate access to birth control. Around 63 million women had access to birth control without a copay in the US. It also provided access to screenings for cervical cancer and yearly wellness visits without out-of-pocket expenses.
- Sterilization for men and women is usually covered by insurance, but coverage varies heavily.
- A vasectomy is less invasive and cheaper than tubal ligation or salpingectomy.
- Some sterilization surgeries are covered as prevention like birth control, but this is dependent on your insurance carrier and policy with the carrier.
Here’s what I know about my insurance and provider:
- Preventative services are covered before my deductible is met with my health insurance.
- For some services, they may be covered before my deductible is met, but I may need to share costs with my insurance carrier.
- Reading through preventative care benefits for women on Healthcare.gov, sterilization is listed for coverage without a copay, coinsurance even if I haven’t met my deductible yet.
- There’s a $1,500 deposit require by my OBGYN’s office and then there are costs associated with the surgical facility/hospital, but I won’t know what these fees are until we learn what my plan will and won’t cover.
- My plan may require pre-authorization, which means we can’t finalize my surgery date until the insurance approves it. My doctor’s office said this can be on average 2 weeks, hopefully not longer, but it depends.
- I have a 50% coinsurance for outpatient for surgery and anesthesia. Coinsurance is the percent you pay after you’ve reached your deductible, but before you reach your out-of-pocket maximum. This is good to know, but also depending on cost, may not impact me.
So, now I get to wait a little bit and try to not check MyChart compulsively.
