Here are the best information about Does health insurance cover vasectomy public topics compiled and compiled by our team
Visa and Mastercard
Visa and MasterCard are accepted at the Tampa/Lutz office. Cash is accepted at all locations. If you want to use a Visa or MasterCard at locations other than the Tampa/Lutz office, you may pre-pay with Visa or MasterCard by calling the Tampa/Lutz office at least one day in advance with your credit card information. For vasectomy services, we accept CareCredit (click here for our office policy) for the balance payment ($490) after the $100 deposit has been paid by cash, check, or Visa/MasterCard. We do NOT accept CareCredit for reversal consultations or reversal procedures.
Private Health Insurance
Health insurance often covers vasectomy. The basic idea is that we collect the payment from you, and often the insurance company pays us so we can reimburse you. You will be required to pay the full cost of your vasectomy before your vasectomy. You can do this on the day of your vasectomy or before. We will collect the payment from you, and if your insurance company pays us, we will reimburse you. In many cases, though, the insurance companies do not pay. This is complex, so read carefully the following details.
Health insurance COMPANIES sell a variety of health insurance PLANS. Within the same company, some plans may cover vasectomy and others may not. And even if a plan “covers” vasectomy, it will not “pay” for a vasectomy if the plan-holder has not met his deductible. However, even when the deductible has not been met, the patient owes no more than the “allowable” for vasectomy under our contract with his insurance company. Here are some examples of Florida “allowables” as of February 2020 (always subject to change): Aetna $448.82; BCBS $484.83; Cigna $461.59; United $493.27. We are still working on our contracts in Colorado, but until finalized, men in Colorado with coverage under the companies above will be offered the rates above. Those men without insurance are offered the $590 rate (still FAR less than an unintended pregnancy!), payable by cash, check, or credit card called into the Tampa office at least one business day before the procedure.
If you have private health insurance, call your insurance company (the phone number should be on the back of your card). Since insurance companies can sometimes make mistakes, obtain and save the name of the representative. Here are the important questions:
- Is vasectomy covered under my plan? If they need it, the procedure code is 55250; the diagnosis code is Z30.2; and our tax ID number is 59-2549110. Be sure that you make it clear that this is an “OFFICE procedure”, NOT an “office VISIT”, and NOT an “OUTPATIENT procedure” (to insurance companies, “outpatient” means done in an outpatient operating room facility).
- If vasectomy is NOT covered under your plan, (1) you may seek assistance under Title 10 if your income is low (see below), (2) the VA may pay for it if you are a Veteran [we are VA providers; see below], or (3) you may cover the cost yourself, which saves time and offers the most flexibility.
- If vasectomy IS covered by your insurance plan, ask the following questions:1) Do I have a deductible and how much of that have I already met this year? You may be told by the insurance company rep that “it is a covered procedure with just a copay”. You MUST ASK about a deductible; otherwise, you may be very disappointed to find that your insurance company isn’t paying. If I don’t have a deductible or if I have already met it …2) Does my plan require that I use only “network” doctors contracted with the plan? If so …3) Are Drs. Stein and Curington contracted providers under my plan? If not …4) Is there any “out-of-network coverage” for procedures by doctors who are not in the plan’s network? As examples, we are “in network” with nearly all Blue Cross plans except Blue Select and the BC HMO, and with nearly all Cigna plans except “Local Plus” and “BayCare”.
Because we have had so many problems over the years with insurance companies, we collect payment from everybody before performing the procedure. We will collect from you either $590 or the “allowable” amount from your insurance company. If we are later paid by the insurance company for your procedure, we will reimburse you. If you are told that you have coverage under your plan, we will verify that* and bill your insurance company directly. Sometimes the insurance company denies payment even after the insurance company rep indicated that vasectomy is a covered procedure and that the patient either has no deductible or his deductible has been met. If we are not paid by the insurance company, we will not reimburse you. We can not reimburse money that we are not paid. Do not proceed with the vasectomy if you don’t want to take this financial risk.
As of April 2021, Drs. Stein and Curington are contracted providers under many plans offered by, among others, the following companies: Blue Cross PPOs & Blue Options (not HMOs and Blue Select), Cigna PPO and HMO (not BayCare or LocalPlus), AvMed, United HealthCare, and Aetna. Patients with Blue Cross HMOs and Blue Select are offered the Blue Cross rate of $484.83; and patients with Cigna-BayCare and LocalPlus are offered the Cigna rate of $460.45. We are NOT providers with Humana/TriCare because their allowable rates are SO much lower than those of other companies. We are told that Humana/TriCare does cover vasectomy through their contracted providers, sometimes with no deductible. For pateints with Humana, we offer the United rate of $493.27.
* We will not verify coverage for those with BCBS of South Carolina (held by many Publix employees) and BCBS of Illinois.
Yes, we accept cash too. Many people find that with the very low cost of the vasectomy, and the very high hassle-factor of insurance, they would just prefer to pay cash.
Why a deposit policy? Without a deposit policy, a number of patients will cancel or postpone within a few days of their appointments, often after we have denied those appointment times to other patients. With a deposit policy, there is no need to overbook to compensate for no-shows. Also, patients with insurance often have copayments, and it is easier for us to refund the deposit less copay than it is to bill patients for their copayments. We also get more compliments than complaints about the policy: “I walked out of appointments twice with prior doctors, Doc, and I regretted it both times. But I wasn’t about to walk away from $100, so you helped me accomplish what I knew had to be done.”
Title X (Title Ten)
If your income is low and you have no health insurance that covers vasectomy, Federal Title X (Ten) grant money is available in Florida and nationwide to help fund family planning services, including vasectomy. Most of these federal Title X funds are allocated through county health departments. Please see our Guide to Florida Health Department Vasectomy Programs. If you live in a county whose health department has no vasectomy program or no federal funds available for vasectomy, you may apply for financial aid through the health department of a neighboring county..
We do not accept Medicaid..