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Tricare insurance vs. Essure? 
27th-Feb-2009 02:49 am
Well, this is aggravating.

This past Wednesday, I was supposed to have Essure done. But last week the clinic told me that Tricare insurance (my husband is active duty in the Army) won't cover it. After some phone calls and tracking-down, I discovered that Tricare covers the procedure but not the implants. But since that combination costs the clinics money, they won't cover it...and I'll end up having to pay over $2000 for it. Granted, that's considerably less money and pain than an unwanted child, but I was hoping it wouldn't cost such a huge chunk out of our finances. The clinic decided to refer me to another one in the hopes they'd work with the insurance. I have the (redundant) consultation there early next week. I had chosen the original clinic because it was the only local one with female doctors qualified to do Essure, but I guess the men in the field aren't in it for anything suspicious. :-p

I could get a tubal, but the thing I like about Essure is the non-surgical part...though Tricare DOES list surgical sterilization as covered. I'll perhaps get a tubal if Essure doesn't work out for me one way or another.

Then again, I could just stay indefinitely on Loestrin, but even the teeny percentage of failures on the pill make me too nervous for comfort. A major backup would help ease my mind. And with menopause coming up in the next 10-15 years, I want something non-hormonal in place for when all that weirdness comes into question. I just wish I'd been able to do something permanent back when I was in college or soon thereafter...no insurance or money back then even up to recently. I also wish hysterectomies weren't so major, since girly innards have been problematic in my family, and there's a good chance I'll need one anyway (and getting rid of VERY nasty monthly ick in effective and nonhormonal ways would also be nice).

Have any of you had to deal with Tricare? Do any of you have suggestions?
23rd-Mar-2009 05:04 pm (UTC)
My husband is Active Military too...and I have Tricare. I, actually, just had an IUD placed (not working out so far) because my doctor scared me out of getting permanently sterilized. He told me about something called post-tubal ligation syndrome so I researched it and decided against anything permanent. I originally went to see this gyno because he was the only one in my area to offer the Essure procedure. Before I went to see him I contacted Tricare directly and they told me EVERYTHING would be covered. I am not sure if they lied to me or to you. But just as you said...the handbook states that sterilization is covered. It's a lot cheaper for them to pay for a one time, permanent procedure than for kids. Have you tried another OB/GYN or clinic? The gyno that placed my IUD is over an hour away from where I live. I forgot to mention that I have Tricare Prime Remote. So, maybe your insurance is a little different from mine. Either way...I hope you are able to resolve your problem. Good Luck!`
23rd-Mar-2009 08:24 pm (UTC)
Hey there! I talked to Tricare too, and we're in the south region (since our home state is Tennessee) which is also Humana, and mine is standard (I've heard that it can be tough to have an off-base doctor with Prime). So things may vary from regional coverage providers. I think there are some steps being rolled through on both sides to get Essure totally covered. Hopefully it will be soon.

I've been absolutely sure for several years now that I want to be sterilized, and maybe even a life-threatening side-effect might not have dissuaded me from seeking it. I want it PERMANENT and more effective than any pill could do (yes, teeny tiny percentages still make me nervous).

My clinic did refer me to a sister site of theirs, which ended up being closer to me but no female gynecologists. So my new (male, eek a little) gynecologist said I should get an ultrasound done in preparation for Essure/ablation, and probably to see if there was some underlying cause to my NOT-fun monthly issues. They found a fibroid tumor (prime suspect for those), and the most effective way to remove it is a hysterectomy. Woohoo!! I was avoiding the surgery option (tubal) since it would be less traumatic, but a bigger surgery that would do what I want (sterile and no more periods AT ALL) as well as remove the problematic tumor - that wins. And it's almost certain to be covered by Tricare as the docs will write it up as a necessary procedure. I'm probably one of the only people they've heard of who's looking forward to a hysterectomy (May 27) with such glee!

Hopefully your issues will resolve too!
25th-May-2009 03:08 am (UTC) - tricare vs essure
I just had the essure procedure done three days ago and i'm also in the south region and it's totally covered. I saw a regular doctor since i'm not near a military facility. You should call them back i think u got some wrong information. My doctors office got a fax from tricare directly before even performing it on me.
25th-May-2009 08:59 am (UTC) - Re: tricare vs essure
Good deal, I'm glad yours worked out. Hopefully this has been resolved then! There were talks from various sources saying that it was getting looked into, back when I was having the runaround.

On one weird positive note, I'm a little glad this happened because the series of events led to the discovery of a fibroid tumor, and I'm getting a partial hysterectomy instead.
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