Will Insurance Pay for Vasectomy Reversal

Will insurance pay for vasectomy reversal? That's a good question. In my case, I think this is what happened. The insurance company told me "no", but because of my pain, they would have to look at from medical necessity. Apparently, the insurance company should have told me they don't pay for reversals regardless of the reason. But because I was given a letter of eligibility and every representative told me they'd pay, the insurance company eventually decided to honor what they told me. Even though, what they told me was incorrect.

So does insurance pay for vasectomy reversal? Not if it's for infertility. Now if it's for post vasectomy pain, you might have a case. However, if the reps say there is a medical necessity clause in your health plan, get something from the insurance carrier in writing, stating they'll pay for it.

Okay, the last 24 hours have been decent without the rapaflo. My left side has the usual post-E.J. ache, my right side feels pretty good. I'm still have little sensations on my right side that radiate into my abdomen. I've had those for as long as I can remember. I think I'm not noticing them as much though.

It's kind of like my back pain. When I first had it, it hurt real bad, every day. Now, 10 years later, I have to really do something before I notice it. Hopefully, my nerve pain will turn into that. Well, that's it. I just wanted to talk a little bit more about the question of will insurance pay for vasectomy reversal.

Vasectomy Reversal Insurance Coverage

Before I tell everyone what happened with my insurance coverage for my vasectomy reversal, let me tell everyone how I'm feeling first. Last night was a decent night. I can't say I have any complaints about pain. I had various sensations yesterday, but no nerve pain and nothing so serious that it bothered me. I did notice that the sensations I did have on my right side, just below my abdomen, were constant. As a side note, I had 2 E.J.s yesterday. That makes 3 in 24 hours. That probably sets a personal record for me in the last 6 years. I'll be curious to see if that has any impact on my sensations or pain.

Also, I'm not taking the rapaflo anymore. I didn't wake up to pee last night, which is good. Hopefully, I'll feel okay without it, because I really didn't like the way it made me feel, in general. But, if I have to take it, then so be it. I'll keep you posted how I feel without it.

I'm trying to adopt the philosophy that the continuous pains I have are like when you work out too hard and have that lactic acid build up. So, if I can just trick myself into thinking that, then I think it helps me deal with it better. Now that I'm pretty much recovered from my weekend of sod, I'm going to try to get back on the treadmill. Nothing too strenuous, just get back in the habit of going to the gym and getting on the treadmill.

Okay, now about the insurance. Before I had my vasectomy reversal, I called the insurance to see if they'd cover the procedure based on medical necessity. After checking with them a total of 4 times before my reversal, I was given the clear impression that it would be covered based on medical necessity. One month after my reversal, they denied the claim. Many phone calls later I found out that the pre-reversal letter of eligibility and all the info the representatives told me was given to me in error. They told me there was nothing that could be done and I would have to appeal our employer to see if they'd cover the procedure.

I was somewhat confused, but mostly furious that they would tell me it was eligible beforehand, and then say it isn't eligible afterward. Well, for whatever reason, the insurance company called me yesterday and said they had changed their mind. They would, in fact, cover my reversal as if it were any other surgery allowed by the plan! All I can say is, "Thank you God!". We've been praying for this ever since we first discovered the claims were denied.

Interestingly, this change of mind came after our first appeal with the insurance company - after they told us there was nothing more they could do. But we really feel the Lord's hand was upon this situation. Before I had made my decision to have the reversal, I actually prayed that God would help us through the decision making process and guide us as we pursued a restorative solution to my vasectomy side effects. This is the first, maybe second, time we've really ever just turned something like this over to God, asking Him to help us. Usually, we just make decisions and hope for the best. Not surprisingly, that hasn't worked out very well for us.

We've gone from what amounted to a $50K medical bill to something much more manageable. Now don't ask me why things worked out so well in this area for us when it doesn't for others. But I really think God wants me to let the world know that He's there for them too. I think He just wants people to trust Him. I'm the first to tell anybody that I'm not sure how to do that sometimes. I don't have the answers, but I do feel compelled to write on this journal every day and let people know that Jesus is a huge part of my life. I couln't get through this PVPS thing without Him. Certainly, we wouldn't have been able to get through this insurance thing without Him. Even if they decided not to pay, my wife and I feel like it all would have worked out, some way. Maybe it would have just taken longer or maybe we would have been able to negotiate a lower bill. I don't know what that would have looked like, but the hope would still be there.

I guess this was a little preachy and I apologize for that. But I wanted to share what Jesus is doing in my life. How he's helping me get through this. How there is no other explanation for the insurance changing their minds, after our appeal and after they said there was nothing more they could do for us. It's just remarkable if you think about it. That is why I wanted to share it with whomever might read this journal entry.

Vasectomy side effects blog

This blog has been a useful tool for me. It has helped me track my symptoms and vet my ideas about vasectomy side effects. Since my vasectomy reversal for epididymitis, I have discovered that recovering takes time. I've also learned that Rapaflo seems to help a little with the daily pain and helps me to have periods of normalcy throughout the day.

However, I only have 5 Rapaflo samples left and am tempted to let them run out and see what happens. Will the constant and excruciating nerve pain return? Will each day hold its own terrifying experiences of crazy and unpredictable symptoms? I'm not sure, but I probably need to find out.

Today, I feel okay. There is a little twinge developing on my right side that migrates up into my abdomen, but again, it doesn't really hurt per se'. Rather, it feels like I did too many sit ups.

I did spend a lot of time sitting at the computer yesterday trying to get my insurance appeal letter in order. I sent it to an attorney friend of mine for his review. I think we're just about ready to start our last appeal, once he returns it with his comments. Then, it's truly in the Lord's hands. Our last appeal didn't even make it to their appeal board, because it got auto-kicked out since it had the keywords, "reversal of sterilization" in it. I thought that was the whole point of doing an appeal, but I guess they don't see it that way.

Anyway, wish us luck and say a prayer for us if you would. Until tormorrow, thanks for reading.

The Scrotum Ache Kept Building and Building

I must have had a poor balance of sitting, walking, etc. yesterday, because the ache in my scrotum (on the left side) kept getting worse and worse. I didn't have any sharp pains, per se'. The ache just increased in intensity. It's like someone flicking you on the nose. After about 6 hours of it, your nose is probably going to be a little sore.

That's how my scrotum felt before I went to bed, even with the ibuprofen on board. I also went for a thirty minute walk around the neighborhood. None of that really helped though. Today though, after a good nights sleep, I feel a ton better. That's kind of what I've noticed after I take some pain medicine, whether it be tylenol or ibuprofen. Once it kicks in, it seems to help keep the pain at bay for well over a full day. I'm not sure if that is just a coincidence or perhaps there is a causal relationship, regardless, I'll take it.

I worked on my second insurance appeal today. I think it makes sense. When this is all done, I'll have to post some of the details. Who knows, maybe that would help someone who is in the same boat. They say it can take a couple of months before we know anything. That's a pretty helpless feeling. Hopefully, it won't take that long and things will turn out the way we want.

Day Before Our Long Car Drive

The day has finally arrived. We're headed to Tennessee to see if that's where we want to move. It seems nice there and we're hopeful that we'll like it, because we want the kids to be much more "outdoorsy". All you can do where I live is go to the mall or play on a city park swing set.

I'm not looking forward to the trip because I'll be sitting a lot and driving some. Those don't work well for people with post vasectomy pain syndrome. Something about being all bunched up for so long. So I'll probably take some tylenol or ibuprofen before we start on the trip.

I spoke to the insurance person yesterday again! Ugh, how frustrating. The lady told me that it was their human error for sending out the predetermination letter stating the reversal would be an eligible claim per our health plan. Can you believe that, AND then she told me that the approved predetermination letter (to make sure the surgery was covered by the medical necessity clause) and verbal commitments by their authorized representatives, were non-binding. She states that it says very clearly in the health plan that reversal of sterilization is not covered. However, I told her the plan also states very clearly that if a procedure is deemed medically necessary (which is why we were told to do the predetermination), then it is clearly covered. Add to that the predetermination letter and the verbal commitments by their agents stating that the medical necessity clause of the plan had been met and as long as I followed the other rules, like making sure we used the right doctor, facility, and coding, the surgery would be covered.

So when she told me that it was their human error and that they should never had approved the predetermination, I knew it was no longer my problem. However, she then told me that because we had already gone through the first appeal, it was too late for the insurance company to do anything about it.

Sounds kind of weird huh? I thought so too. I wanted to get this recorded somewhere, so what better place than my online journal. I think something good may have come out of the call though. She will try to set up a phone call between their appeals medical director and my surgeon. I'm not sure if anything can come of that, but at least it's a start.

As far as how I feel today goes, I guess I'm doing okay. No major aches or pains.My left side is still a little achey, like it could hurt really bad at any time. I've had a little nerve pain on my right side, but nothing too terrible. Of course, I was also pretty sedintary yesterday. I think I'll try going for a walk on the treadmilll today before our trip. Nothing crazy, just kind of like a liesurely stroll.

I guess that's all for today, Lord willing. I'll return to the blog after our trip.

I Hate PVPS

Last night two things happened. First, I took a little nap (laying on my left side w/ pillow between knees). When I woke up I noticed a new twinge on the left side of my scrotum. It wasn't overly painful, just uncomfortable. The twinge came in waves. I looked down there and my left teste is markedly crescent shaped. Almost like a banana. That little puffy thing (where my epididymous should be) is now a lot harder. Still not sure if that is a spermatocele or something else. The doctor says it's just a natural change in my anatomy from the reversal. Some how, I don't think that's true. Okay, so then the twinge continued to get a little more prominent as the night wore on. Now this morning, it is still there. It feels like someone has a grip on my left nut and then lets go. And then it repeats again and again. I'm hoping it's some sort of nerve pain, rather than a bout of epididymitis coming on. I was on the computer a lot yesterday working on my websites, so maybe that's the reason I'm feeling it. But really, who knows?

Okay, the second thing that happened is I found our insurance appeal with Aetna was denied. They say the plan doesn't cover reversals for infertility. Well duh, I didn't have this for infertility. The crazy thing about it is, that everytime I speak with one of their customer service representatives, they all can't figure out why the claim was denied. They completely understand that I had it for medically necessary reasons, rather than infertility. In fact, the surgeon coded the surgery as orchitis and epididymitis, not infertilty. But, apparently, I'll have to do another appeal, this time through my wife's employer.

The hospital bill is $40,000 and the surgeon's bill is $4,500. The weird thing is the insurance paid the anesthesiologist. So, we're going to do the workplace appeal and hope for the best. There's simply no way we can pay a $46,000 medical bill. Maybe I"ll buy a lottery ticket.

But as I've said before, I'd gladly go into debt if it meant I didn't have PVPS/epididymitis anymore. My wife isn't too sure about that though :-)

Well, here's hoping the Lord will be merciful with me and take the pain away. Jesus is the only one who can help me. It seems like the older I get, the more I realize how much I need Him, everyday. If it weren't for my Lord and Savior, I doubt seriously I would be in as good a frame of mind. That doesn't mean I've got this figured out, it just means that I rely on Him to get through the day. I learned a long time ago, that when I relied on myself, bad things usually resulted. It was like, I couldn't get out of my own way. It's kind of hard to explain, but Jesus helps me with this PVPS thing and everything else, for that matter. Not sure why I'm putting this all in here, but I am supposed to journal about what I'm feeling and thinking. So I guess I'm thinking I need Jesus' help.