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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:
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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).
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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.
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