Vasectomy Procedure Reimbursement: Two simple steps!

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Here are the steps required by your health insurance company for vasectomy procedure reimbursement.

Step 1. Have your vasectomy completed by our office. Step 2. Pay for vasectomy on the day of service and we will provide you with a receipt and medical billing report. Step 3. Obtain a “Member Claim Form” from the website of your health insurance company. Step 4. Complete the Member Claim form with the information we provide you. Step 5. Submit Member Claim form to your health insurance company for reimbursement. You will need to include the billing receipt we provide you. This billing receipt has the appropriate codes and medical information required to support your completed Member Claim Form. Most health insurance companies require the form be sent by mail. Some may allow electronic transmission, email, fax, or up-load to an on-line portal.

Below are sample completed Member Claim forms with the correct billing codes demonstrating how the form should be completed to obtain vasectomy procedure reimbursement from your health insurance company. The form will be completed differently depending on if you have 1 or 2 office visits.

If the following information is too much…we can walk you through it at the time of your visit with us.

VASECTOMY: Single Visit (Most patients will use this form)

Most men will choose to have a vasectomy under local anesthesia completed in a single visit. If you have your vasectomy done under local anesthesia during a single office visit then complete your Member Claim form like this sample form:

Sample Completed Member Claim Form: Single Visit Vasectomy

You will also need to provide your health insurance company the receipt provided by our office. Your form will need to have the same dates and codes as our receipt.

SEDATION VASECTOMY: Single Visit

If you have Sedation Vasectomy performed during a single visit then complete your Member Claim form like this sample form:

Sample Completed Member Claim Form: Single Visit Sedation Vasectomy

You will also need to provide your health insurance company the receipt provided by our office. Your form will need to have the same dates and codes as our receipt.

Please be advised your health insurance may be reluctant to reimburse you for anesthesia procedures done outside of hospital setting. They may also object to paying the facility fee.

Although we have a fully functioning operating room in our office, health insurance companies typically only reimburse for procedures done in a hospital or ambulatory care surgical center setting.

Without getting too complicated, your health insurance company’s reluctance to reimburse is more of a political/licensing issue… not a patient safety issue.

We recommend you submit a Member Claim Form even if they tell you that you don’t have coverage or you may not be fully reimbursed… because any amount paid to our office should contribute towards your yearly deductible and they need a record of that payment.

***You want to get credit for your payment. Don’t let your health insurance company off the hook! Remember the average health care CEO salary in 2018 was $18 million dollars!***

CONSULTATION: Visit Only

If you choose to have a consultation visit before your procedure (either with local anesthesia or Sedation Vasectomy) then complete your Member Claim form like this sample form:

Sample Completed Member Claim Form: Consultation Visit Only

VASECTOMY PROCEDURE: After Consultation Visit

If you had a consultation first and then returned on a separate date for a procedure under local anesthesia then complete your form as this sample form has been completed:

Sample Completed Member Claim Form For Vasectomy Under Local Sedation

Technically, you should be able to submit the codes for the two visits on one Member Claim form…you would need to indicate the consult and the procedure were done on separate dates when you complete the form.

You would also need to include the two separate receipts provided by our office. The receipts need to have dates and codes that exactly match your completed Member Claim form.

SEDATION VASECTOMY: After A Consultation Visit

If you had a consultation first and then returned on a separate date for a Sedation Vasectomy procedure then complete your Member Claim form as this sample form has been completed:

Sample Completed Member Claim Form For Sedation Vasectomy Procedure After Consultation Completed

Technically, you should be able to submit the codes for the two visits on one form…you would need to indicate the consult and procedure were done on separate dates when you complete the form.

You would also need to include the two separate receipts provided by our office. The receipts need to have dates and codes that match your Member Claim form.

Please be advised your health insurance may be reluctant to reimburse you for anesthesia procedures done outside of hospital setting. They may also object to paying the facility fee.

Although we have a fully functioning operating room in our office, health insurance companies typically only reimburse for procedures done in a hospital or ambulatory care surgical center setting.

Without getting too complicated, your health insurance company’s reluctance to reimburse is more of a political/licensing issue… not a patient safety issue.

You will need to get the real Member Claim Form from the website of your health insurance company. The form can only be submitted with the receipts we provide you and after your procedure has been completed.

If you have any questions then contact your health insurance company and they will be able to assist you. Member Claim forms are commonly submitted by health insurance members.

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