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. 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 with Dr. Buch is held prior to vasectomy reversal. Some insurance plans or policies may pay for this visit, while others may deny coverage if related to a non-covered procedure, e.g., Vasectomy Reversal. As of January 1, 2009, our New Patient Office Consultation charge is $250. This fee is paid during registration. If we verify benefits ahead of time, the non-covered portion of the consultation fee is collected upfront (or the Specialist Copay, if applicable). Again, in some instances, an insurance company will deny payment for the consultation even after benefits were verified prior to the visit. In this case, the patient is held liable for the entire unpaid balance.
Most insurance companies do not provide coverage for elective procedures, such as, Vasectomy Reversal (Vasovasostomy, procedure code 55400). In very rare occasions when an insurance company actually covers the reversal, it may only pay for the first attempt at vasectomy reversal, and deny coverage for a redo vasectomy reversal (nearly 50% of Dr. Buch’s cases come from failed vasectomy reversals of other surgeons). In addition, there are some tax-advantaged health savings programs that are currently available. If you participate in one of these types of programs, also known as Flexible Spending Account (FSA), or Health Spending Account (HSA), etc., the costs incurred in vasectomy reversal may qualify. Some programs may be reimbursement-only, thus requiring the participant to pay for the expenses upfront then submitting a claim for reimbursement. Other programs may also allow the participant to withdraw the available funds for pre-payment to the Provider of Service, while others may issue a credit card (Visa or MasterCard) for healthcare expenses.Please contact our office if you have any 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.
