Bi-Salp & Florida Blue

Good morning -

I am looking for some support when it comes to insurance and coverage for my bi-salp (which is scheduled for tomorrow AM!!). I have been a quiet lurker on the sub and it has been immensetly helpful, but now it seems I am in need of my own support. If you need any additional information here - please let me know! As some background, I have Florida Blue Options Standard PPO through the state insurance group. Some of the identifying information has been removed for privacy purposes.

I sent the following message to Florida Blue last week for confirmation as I was being told I would need to pay $250 to meet my deductible and then another $2250 in co-insurance for my procedure for a total of $2500. I also paid a $25 co-pay for my consultation, but that is neither here nor there. If I have to eat that, I will.

Email: I hope this message finds you well. I am writing to request clarification regarding my current health insurance plan.

Plan Compliance: Could you please confirm whether my current Florida Blue BlueOptions plan is ACA-compliant and includes the required Essential Health Benefits, specifically preventive services?

Procedure Coverage: I have an upcoming procedure scheduled at HOSPITAL, for a tubal ligation with bilateral salpingectomy. Based on my understanding of the Affordable Care Act, sterilization procedures for women are considered a preventive service and should be covered at no cost to the patient (i.e., no copay, deductible, or coinsurance), provided the plan is ACA-compliant.

Can you please confirm:

- Whether this specific procedure is covered under the preventive services provision of my plan,
- If any out-of-pocket costs (e.g., copay, coinsurance, or deductible) would apply in my case, and
- Whether the facility and providers at HOSPITAL are considered in-network for my plan.

Procedure Code (if needed): If it is helpful to confirm coverage, I am happy to obtain and provide the procedure and diagnosis codes from my provider. I appreciate your help in clarifying these details so I can make informed decisions about my care and coverage. Please let me know if you require any additional information from my end.

At the time - I did not have the procedure codes that were being billed, but Florida Blue responded with the following message:

Dear PATIENT, Thank you for contacting us. The answer to your question is below: Per your plan benefits under the Women's Preventive Services a tubal ligation is a covered benefit payable at 100% of the Florida Blue allowance. Remember, you can access your personal health information, plus helpful tools and service - 24 hours a day on your member website.  We're always adding new features and service to help you stay well and save money. Sincerely,
Your Customer Service Team
Florida Blue

I just got off the phone with the hospital who stated the codes being billed are 58661 and Z30.2, but insurance is saying that this is not covered under preventative care and I am still on the hook for the initial estimate. She said they will still do the procedure as long as I pay a 25% deposit. I don't want to risk having to reschedule, but do you have any advice as to where I should go today prior to my surgery tomorrow or what I should be asking? AFAIK these are the codes that others have referend in their posts, too. :(