The purpose of this section is simply to provide our readers with some guidance in understanding the complexities related to insurance plans or policies, and shall not be construed as replacement for your actual insurance benefit
description. Paying your insurance premium does not guarantee insurance benefits! There are three, very important caveats we’d like to share with you:
- Know what your insurance benefits are. It is not an excuse if you were not aware something was not covered by your insurance plan, or if you were verbally misinformed by a representative at your insurance company.
- Benefit verification by any insurance company, whether by phone or otherwise, is not a guarantee of payment (some insurance companies have recorded disclaimers to this effect, while others require the live representatives to verbally state the disclaimer).
- You are ultimately held financially responsible to the Provider of Service should your insurance fail to pay any insurance claim.
We strongly encourage our patients to refer to their insurance policy booklet or manual and/or contact their insurance company directly for any questions.
The cost of having a vasectomy is normally covered by most insurance plans. However, the benefits provided by insurance plans vary widely. Therefore, only a brief summary will be contained in this section. In general, group plans provide better benefits over individual plans, and benefits may differ from plan-to-plan even when offered by the same insurance company.
An office consultation is scheduled on a day, at least, 48 hours prior to vasectomy. As of January 1, 2009, our current charge for a New Patient Office Consultation is $250. Depending on your group plan, you may be responsible for a Specialist Office Copay only. Some plans have different copay amounts when the rendering physician is a specialist. Other plans may have a calendar year deductible and/or a percentage (co-insurance) of the allowed amount, or a combination of an office copay and coinsurance. Sometimes, the insurance plan will not cover (or provide any benefits for) the office consultation. For instance, some individual insurance plans may only provide catastrophic coverage. Please contact your insurance company directly to verify your benefit for this type of service, and refer to your insurance benefit manual or plan description.
The actual vasectomy is normally an office procedure performed on a different day. As of January 1, 2009, our current (retail/non-insurance covered) charge for vasectomy is $950. In some instances, this may be covered under the Specialist Copay, or deductible and coinsurance, or a combination of both. At times, the vasectomy is not covered by the plan. Please refer to your benefit handbook, and verify your coverage for vasectomy directly with the insurance company.
Although Dr. Buch no longer participates with any insurance plans, our staff is ready to assist you with completing forms that you can submit for out-of-network benefits. We realize the desire and need for you to maximize the return on your money spent for health insurance. Unfortunately, it has become impossible for us to provide you with the high level of quality care that you deserve, while complying with the heavy burden that health insurance companies now impose on their providers. We hope you understand, and we will do everything possible to provide you with exceptional service preserving the traditional character of the doctor-patient relationship.