Will My Health Insurance Help
Pay for My Vasectomy?
While our out-of-pocket fee is $690, health insurance often "covers" vasectomy. "Covers" means that the insurance company will pay for it if you don't have an umet deductible, or will apply your payment for vasectomy to your deductible for that year. We collect payment from EVERYBODY, the rates allowed by your insurance company or $690 if you don't have insurance or if your insurance cannot be verified. Health insurance COMPANIES sell a variety of health insurance PLANS. Within the same company, some plans may cover and others may not. And even if a plan "covers" vasectomy, it will not "pay" for a vasectomy if the plan-holder has an unmet 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 January 1, 2025 (always subject to change) for the consultation (review of registration, discussion of issues, and limited exam) and vasectomy procedure:
Aetna $505.09; BCBS $581.90; Cigna $510.09; United $574.04.
Please check with your plan whether vasectomy is a covered procedure, whether you have met your deductible, and whether we are providers under your plan. Men in Colorado with coverage under the companies above will be asked to pay the regular fee of $690 (still FAR less than an unintended pregnancy!), payable by cash, check, or Visa/MasterCard. We will file a claim, and Colorado patients will be reimbursed whatever we are paid by their insurance companies.
So ... If you have private health insurance (as opposed to Medicare or Medicaid), call your insurance company (the phone number should be on the back of your card). Obtain and save the name of the representative. Here are the important questions:
As of January 1, 2025, Drs. Stein, Galante, and/or Samplaski are contracted providers under many plans offered by, among others, the following companies:
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 $150, so you helped me accomplish what I knew had to be done."
While our out-of-pocket fee is $690, health insurance often "covers" vasectomy. "Covers" means that the insurance company will pay for it if you don't have an umet deductible, or will apply your payment for vasectomy to your deductible for that year. We collect payment from EVERYBODY, the rates allowed by your insurance company or $690 if you don't have insurance or if your insurance cannot be verified. Health insurance COMPANIES sell a variety of health insurance PLANS. Within the same company, some plans may cover and others may not. And even if a plan "covers" vasectomy, it will not "pay" for a vasectomy if the plan-holder has an unmet 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 January 1, 2025 (always subject to change) for the consultation (review of registration, discussion of issues, and limited exam) and vasectomy procedure:
Aetna $505.09; BCBS $581.90; Cigna $510.09; United $574.04.
Please check with your plan whether vasectomy is a covered procedure, whether you have met your deductible, and whether we are providers under your plan. Men in Colorado with coverage under the companies above will be asked to pay the regular fee of $690 (still FAR less than an unintended pregnancy!), payable by cash, check, or Visa/MasterCard. We will file a claim, and Colorado patients will be reimbursed whatever we are paid by their insurance companies.
So ... If you have private health insurance (as opposed to Medicare or Medicaid), call your insurance company (the phone number should be on the back of your card). 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, or (3) you may cover the cost yourself, which saves time and offers the most flexibility. If vasectomy IS covered ...
- ... 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 if you don't get reimbursed.) If I don't have a deductible or if I have already met it ...
- ... Does my plan require that I use only "network" doctors contracted with the plan? If so ...
- ... Are Drs. Stein, Galante, and Samplaski contracted providers under my plan? If not ...
- ... 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" (1) with nearly all Blue Cross plans except "Blue Select" and the BC HMO, (2) with nearly all United and Aetna plans, and (3) with nearly all Cigna plans except "Local Plus" and "BayCare".
As of January 1, 2025, Drs. Stein, Galante, and/or Samplaski 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 Open Access (not BayCare or LocalPlus),
- United HealthCare (not HMOs), and
- Aetna.
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 $150, so you helped me accomplish what I knew had to be done."