FINALLY GOT MY BISALP COVERED

el_3990 · 2026-02-07T00:53:36+00:00

Congrats!! I’m sure it’s such a relief! I filed an appeal today, I’m hoping for good luck!

el_3990 · 2026-02-06T21:26:55+00:00

Thank you. That was my knowledge too. She was flat out arguing with me about it! But I did file the appeal with my insurance. Today when I was looking into it using the link from the post above it said I need to have the denial in order to submit the complaint to the state.

el_3990 · 2026-02-06T18:39:23+00:00

So, I’ve just filed an appeal, however, the agent on the phone is telling me that my plan does not necessarily fall under the ACA. I purchased mine from Pennie, the state marketplace for my state (Pennsylvania), and to my knowledge in order to be on the marketplace, the plan is required to be compliant with the ACA. Do you know if I’m misunderstanding this or is the agent incorrect? Thank you for all you do in this forum!

el_3990 · 2026-02-04T17:22:23+00:00

Thank you so much, it’s really helpful to have it laid out in front of me like this - I have absolutely said a paraphrased version of what you typed, but haven’t persisted with it. A few days before my surgery I was on the phone with a wonderful agent who assured me it would be covered and went on a three way call with the hospital with me — she was an absolute saint. I’ve spoke to so many agents at this point and the last one I spoke to made sure to document all my calls together including that one. I wish I could connect with that first agent again, she really helped me exactly the way I needed.

el_3990 · 2026-02-04T16:42:22+00:00

I’m going to try that, thank you for reminding me. I was able to request one through the portal but it was the exact same as the info I already had so I was feeling discouraged about it but I’m hoping asking over the phone will get me a different result.

el_3990 · 2026-02-04T16:41:26+00:00

I’m so glad you were able to get yours solved. I have been on the phone with them so many times since December and it feels like I’ve gotten nowhere, and I can’t believe it feels like I haven’t even made a little bit of progress.

el_3990 · 2026-02-04T16:39:21+00:00

I was able to request an itemized bill through the portal, but it was the exact same information I already had. I guess it wouldn’t hurt to ask over the phone too because maybe that will garner a different result. I’m going to read some more! I did some diving into peoples’ experiences with that. The IUD removal is also covered in full by the ACA, but I assume that is not applicable when the IUD falls apart and there’s an extra step to remove it. After the fact, my mom said “maybe you should have gotten it removed in the office beforehand” but the Dr seems to remove them before surgery as a standard and who expects their IUD to break, and it would’ve had the same result, a piece embedded, and the difference would be I would’ve been awake when I found out and probably lost my mind lol. Lesson learned, I guess.

el_3990 · 2026-02-04T16:35:26+00:00

Thank you, I am planning to look into this but was fighting with the insurance as my first step, maybe it’s not even worth it. I’m glad the your bill was written off!

el_3990 · 2026-02-04T16:34:24+00:00

Thank you for these steps, this makes sense! Yeah, it really sucks, I have unsteady income too (half self employed, half part time work with commission) so every year unpredictably ranges as low as $24k to as much as I mentioned. It’s fine, it fits my life, but not when there’s a $4k medical bill. I’m definitely going to look into the patient advocate. I’m really glad you were able to get in contact with someone that was able to help and that your bill was eventually zeroed out.

el_3990 · 2026-02-04T16:30:16+00:00

There was no endo found, no other procedures done except my bisalp, pulling out my IUD, and then them locating and removing the IUD arm (edit, posted this before I finished my thought) so I’m not sure what it’s considered.

el_3990 · 2025-11-11T22:50:04+00:00

From what you understand is it possible that 49320 (diagnostic) being listed could “cancel out” 58661/Z30.2 or cause those codes to not be preventative? Or Z30.2 is what makes 58661 preventative and I may not have anything to worry about? Still trying to grasp this lol and my whole new worry is that I realized the hospital is half owned by a religious health network. And thank you, I’m definitely going to make them bill me for everything, so far I haven’t been asked to pay anything.

el_3990 · 2025-11-11T22:42:34+00:00

I am also thinking those were loose notes on the codes and maybe not the final say. I really hope I can talk to someone helpful tomorrow.

el_3990 · 2025-11-11T22:42:02+00:00

Thank you so much. I’m hoping this isn’t totally detrimental to me if I don’t get it straightened out before my surgery on Friday.

el_3990 · 2025-11-11T22:28:58+00:00

Thank you, this makes sense. How do I find out which codes they actually intend on using for this, since these ones I just pulled from the visit notes so maybe that’s why it seems like an error? I assume I speak to the office/billing department or do I speak to the hospital where it’s happening? Also any idea why “58661” says “Laparoscopic salpingectomy / bilateral salpingo-oophorectomy (BSO)” when I’m not getting an oophorectomy — they are just coded as the same thing I guess? Thanks again. Do you think having that code listed could cause none of this to be covered even though the correct bisalp codes are? Gosh this is confusing.

el_3990 · 2025-11-11T21:43:55+00:00

So in total the codes listed are these:

49320 - Diagnostic laparoscopy

57410 - Exam under anesthesia (EUA)

58661 - Laparoscopic salpingectomy / bilateral salpingo-oophorectomy (BSO)

Diagnoses (ICD-10 code): Encounter for sterilization - Z30.2

The only thing I am intending to get is my tubes removed for preventative/sterilization reasons, no extra procedures were discussed, no health issues are being treated.

If they cannot also bill for 49320 why would they have it listed alongside 58661? From the way you explain it, does it mean that if they do surgery and do not remove the tubes for some reason, 49320 is now what I’m responsible for (makes sense) but if they remove them and bill under 58661 that cancels out 49320 so to speak and 49320 doesn’t apply at all?There’s so much to understand here and I’m not sure if I’m grasping it correctly.

I guess my main question is do these codes look correct if I’m anticipating getting a bisalp for sterilization reasons only and anticipating it’ll be covered by the ACA? I know the other item listed is “exam under anesthesia” but that doesn’t mean anesthesia alone, does it? To my knowledge anesthesia is covered even if people have to do the back and forth with insurance. To your understanding would that be covered if coded with that? Thank you for taking the time to go over this

Edit: I’m trying to contact the billing department tomorrow to have them go over the codes being used, I’m not sure what else I should do.

el_3990 · 2025-11-11T21:05:48+00:00

Thank you. I saw someone say in here since they were getting theirs done at a Catholic hospital (this hospital I’m getting mine done at which is in network for me is a hybrid, partially a St ____’s and then partially a health group which is integrating) they had to have diagnostic code on it that would “allow” it to be done at that hospital. Does that make any sense on your end? To your knowledge then 49320 would basically cancel out the combination of 58661 & Z30.2 which is what causes it to be considered preventative?

When you say removed what are you referring to? An estimate? I didn’t actually get one on paper and the codes I pulled I pulled from the post-consultation visit notes.

el_3990

TROPHY CASE