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.
Dr. Jeffrey Buch is a urologist, and is, therefore, considered a specialist. Before making an appointment, please verify with your insurance plan whether you will need a prior authorization from your Primary Care Physician (PCP), if applicable (i.e., HMO plan, rather than PPO plan).
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.
At present, the following insurance plans are accepted: Aetna EPO/PPO/POS, BlueCross BlueShield PPO, Cigna PPO, Private Health Care Systems (PHCS) Network, and United HealthCare. Please note that we do not accept all insurance plan types, and we may not be considered in-network in some. For example, we are a non-designated Aetna Aexcel POS II provider. As such, your out-of-pocket expense is higher. Other insurance plan types we do not accept include, but are not limited to, Aetna HMO, BlueChoice Solutions, Cigna POS and HMO. Again, due to numerous insurance plan variations, we strongly urge that you verify with the insurance company whether Dr. Jeffrey Buch is “in-network” and determine your benefits prior to making an appointment. Please contact our office should you have further questions.
Dr. Buch is one of the leading vasectomy reversal specialists in the United States. Contact us for a vasectomy reversal in Denton, Lewisville, North Texas, Houston, Austin, & San Antonio areas.