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Provider Manual

Sterilization: Tubaligation or Vasectomy Coverage

Last Updated on January 24, 2019

Security Health Plan covers sterilization procedures. Prior authorization is not necessary, but providers must follow the mandated “Sterilization Consent” form requirements established by Medicaid fee-for-service. Key points of the consent form are listed below along with Security Health Plan’s provider requirements.

Consent form requirements

  • The Wisconsin Medicaid Sterilization Informed Consent form must be completed at least 30 days prior to the procedure, excluding the consent and surgery dates. The consent form is available from the State.
  • The individual must be at least 21 years old at the time consent is obtained.
  • The individual must not be declared mentally incompetent.
  • The consent form will remain valid for a maximum of 180 days.
  • The consent form must be completed in full and submitted to Security Health Plan.

The “Sterilization Consent” form will be matched with the patient’s date of procedure to ensure the 30-day waiting period has occurred.

  • Completed consent forms must be:
    • Faxed to Security Health Plan’s Claims Department at 1-715-221-9500, or
    • Mailed to: Security Health Plan Attn: Claims Department P.O. Box 8000 Marshfield, WI 54449-8000
  • Claims submitted without consent forms will be denied. 

Provider requirements

  • The procedure must be performed by a Security Health Plan BadgerCare Plus affiliated provider.
  • No second opinions are necessary.

For more information, call Security Health Plan’s Claims Department at 1-800-791-3044.