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Click ‘Get Form’ to open MED-178 in the editor.
Begin by entering the Member’s Health First Colorado ID at the top of the form. This is essential for identification purposes.
In the 'Consent to Sterilization' section, fill in your name and the name of the health care provider or clinic where you received information about sterilization.
Provide details regarding the type of procedure you are consenting to, ensuring that you understand it is a permanent decision.
Sign and date the form in the designated areas, confirming that you have been informed about the procedure's risks and benefits.
If applicable, complete sections for interpreter assistance and additional signatures as required.
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This document is a sterilization consent form (Med-178) for Health First Colorado, Colorados Medicaid program. It outlines the patients rights, including the right to refuse sterilization without losing benefits.
Will Medicaid pay for a tubal ligation?
Does Medicaid cover tubal ligation? Medicaid covers sterilization surgery in most states. Forty states and Washington, D.C. have expanded their Medicaid programs, and female sterilization surgeries are required to be covered.
Does Medicare cover female sterilization?
Female sterilization (e.g., tubal ligation) for females is covered under Medicare only when it is necessary as part of the treatment of an illness or injury. However, under Medicaid and most private plans, the procedure is covered without cost sharing.
What are the 5 things Medicare wont cover?
Theres a good chance you can get a tubal ligation for free (or at a reduced price) if you have health insurance. Most insurance plans must cover all methods of birth control with no cost to you, including some female sterilization procedures. Learn more about health insurance and birth control.
How to get sterilized for free?
Tubal ligations are often fully covered by insurance as a form of contraception, whereas tubal removal (salpingectomy) may not be covered or go toward a patients deductible.
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STATEMENT OF PERSON OBTAINING CONSENT To the best of my knowledge and belief the individual to be sterilized is at least 21 years old and appears mentally competent. He/She knowingly and voluntarily requested to be sterilized and appears to understand the nature and consequences of the procedure.
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