Health insurance will cover a hysterectomy if medically necessary. Most insurers require pre-authorization by a doctor, and the procedure must be performed in an in-network facility. However, it’s important to note that some inpatient services and elective hysterectomies may not be covered.
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Understanding Hysterectomies
A hysterectomy involves full or partial surgical removal of the uterus and may extend to other reproductive organs such as the cervix, fallopian tubes, ovaries, and pelvic lymph nodes. While the surgery can be minimally invasive, the procedure is permanent and gets rid of the patient’s ability to have a baby. Because of this, insurers often require a second opinion before authorizing coverage.
Types of Hysterectomies
There are several different types of hysterectomies based on how the uterus is accessed for removal and what method of surgery is used.
Abdominal Hysterectomy
As the most common method, this procedure accesses and removes the uterus through a small incision in the lower abdomen.
Vaginal Hysterectomy
In this method, the uterus is accessed through the vagina. This method is the least invasive, and patients often have little to no recovery downtime.
Laparoscopic Hysterectomy
Laparoscopic technology allows the surgeon to insert a camera through a small incision in the abdomen to view the uterus and other organs for surgical removal.
Degrees of Removal
Your insurance coverage may differ based on the degree of uterine removal, such as a full instead of a partial hysterectomy.
Radical
A radical hysterectomy not only removes the uterus but the cervix, pelvic lymph nodes, part of the vagina, and surrounding tissue.
Partial
A partial hysterectomy removes the upper uterus and leaves the cervix intact.
Total
A total hysterectomy removes the entire uterus along with the cervix.
Total with Bilateral Salpingo-Oophorectomy
This type of hysterectomy not only removes the entire uterus and cervix but also the fallopian tubes and the ovaries.
How Does Health Insurance Cover a Hysterectomy?
Health insurance covers hysterectomies done to treat medical conditions such as cancer, endometriosis, uterine fibroids, or pelvic inflammatory disease (PID). Your doctor must confirm the surgery is medically necessary, and your surgeon and facility must be in-network.
Insurance companies may impose some limitations based on whether you undergo an inpatient or outpatient procedure and may only cover hysterectomies under certain conditions. Your network, available surgeons, or hysterectomy type may also limit your coverage.
How Much Does a Hysterectomy Cost?
Several factors affect the cost of a hysterectomy, including the method and degree of your surgery. Your specific health insurance coverage, where you live, and network size also impact costs.
Patients without health insurance may pay between $9,500 and $23,000 out of pocket for a hysterectomy, while those with insurance may pay 50%-100% of their costs, depending on their benefits and whether they have met their deductible.
How Medicaid and Medicare Cover Hysterectomies
Medicaid and Medicare will cover a medically necessary hysterectomy for beneficiaries who have met their annual Part A and B deductibles. After that, Medicare pays 80% of the cost of care. If you are dual-eligible, Medicaid may cover your hysterectomy under certain circumstances, especially if there’s a medically necessary reason.
Alternatives to Hysterectomies
If your doctor recommends a hysterectomy, it’s often a last resort, and there may not be a viable alternative. However, seeking a second opinion is important to help you explore possible alternatives. Alternatives like targeted surgeries, medications, or physical therapy may exist for minor cases of uterine fibroids, endometriosis, or uterine prolapse.
Alternative Financing for Hysterectomies
If you do not have insurance or your plan does not cover a hysterectomy, there may be some alternative financing options to help lower your out-of-pocket expenses. Consider visiting a surgical clinic or outpatient center, as these facilities often charge less than a hospital. Additionally, payment plans or individual discounts may be available through your healthcare provider.
Putting it all Together
Doctors sometimes recommend hysterectomies as a last resort to treat serious conditions like endometriosis, uterine fibroids, or cervical or ovarian cancer. Health insurance covers hysterectomies as long as they are considered medically necessary and the facility is in-network.
Your out-of-pocket costs depend on your policy terms, copay, and deductible requirements. While there may not be alternatives to a hysterectomy, it’s important to consider a second opinion to explore treatment options.