Cost and Approval for TLR

COST AND APPROVAL FOR TUBAL LIGATION REVERSAL

Complete the form to get a cost estimate for your surgery, an approval, and be directed to a free discovery call.
- Tubal Ligation Reversal / Reversión de Ligadura de TrompasEssure Reversal / Reversión de EssureEssure Removal (only removing coils and tube not repaired for pregnancy) / Reversión de Essure (solo se retiran los dispositivos y las trompas no se reparan para el embarazo)Adiana Reversal / Reversión de AdianaAdiana Removal (only removing coils and tube not repaired for pregnancy) / Extirpación de Adiana (solo se retiran los dispositivos y las trompas no se reparan para el embarazo)
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- Height (feet)*
- Heigh (inches)*
- Current Weight (lb)*
  Please refresh the form if you want to make a change to your weight. This will ensure the correct cost if reflected.
- 28.2 or below
- Between 28.3 and 34.9
- Between 35 and 36.9
- Your BMI must be below 37 to be eligible for surgery. Please note that your BMI will be measured on the day of surgery.
- Surgery Cost
- RESTART
- PRE-PAY FINANCE PLAN
  - NCCRM offer a easy pre-pay plan to help you reach your family goals.
  - A $750 non-refundable deposit is required to get started and will count toward your total quote.
  - Full payment must be made at least ten days before the surgery date.
  - Payments can be made for up to 24 months, and you may pay at your own pace.
  - You may use this pre-pay option in combination with 3rd party financing.
  - Use our calculator to help you plan around your budget and timeframe.
- Height in Inches (metric)
- BMI
- 28.2 and belowBetween 28.3 and 34.9Between 35 and 36.937 or above
- Cautery / CauterizaciónCut / CorteBanded / AnilladoClipUnsure / No estoy segura/o
- 0-3 Years3-5 Years5-8 Years8-10 Years10-15 YearsMore than 15 Years
- NoYes
- NoYes, not treatedYes, treated
- NoYes
- NoYes
- NoYes
- 39 or youngerbetween 40 and 46between 47 and 4950 or older
- NoYes
- APPROVED
  
  Based on the information you provided, you are preliminarily approved for tubal ligation reversal surgery. Final approval will be confirmed once our provider has reviewed your medical records.
  
  If you’re comfortable with the estimated cost and would like to move forward please submit your medical records (no fee) OR an authorization for us to to request it on your behalf ($10 admin fee) HERE.
- MORE INFORMATION IS NEEDED
  
  Based on the answers provided, it’s not yet clear whether tubal ligation reversal is the best option for you. We’ll need a bit more information to guide you accurately.
  
  If you’d like to move forward with a medical review for approval, please forward your medical records (no fee) OR an authorization for us to to request it on your behalf ($10 admin fee) and complete a patient medical inforamtion form HERE.
- CONSIDER IVF
  
  Based on the answers provided, you do not appear to be a candidate for a successful tubal ligation reversal surgery.
  
  The good news: you may still have a strong path forward with IVF. At NCCRM, we offer one of the most affordable IVF options, and our success rates are significantly higher than the national average.
  
  If you’d like to explore IVF, please click HERE for more information regarding IVF, a cost calculator tool to determine an IVF cost estimate, and a link to schedule a free no obligation IVF discovery call.
- NOT APPROVED
  
  Based on the answers provided, you do not appear to be a candidate for tubal ligation reversal surgery.
  
  Please visit our website to explore other options.
- Name*
- Email*
- Phone Number*
  Format: (000) 000-0000.
- By checking this box, you agree to receive text messages from NCCRM about your submission, appointments, and next steps. Message & data rates may apply. You may opt out at any time.
- YesNo
- YesNo
- NoYes
- Immediately1-3 Months3-6 Months6-12 Months
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- What State do you live in?*
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COST AND APPROVAL FOR TUBAL LIGATION REVERSAL