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:
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:
Again, get the name of the person with whom you speak. It’s important that you have the name of the company representative, so that he or she can be held accountable. Sometimes the insurance company denies payment after the insurance company rep (a person or website) indicated to you that vasectomy is a covered procedure and that you either have no deductible or your deductible has been met. We collect payment from EVERYBODY, the rates allowed by your insurance company or $690 if you don’t have insurance. For example, if you have Aetna, we will collect the Aetna allowable ($505.09 less your prepaid deposit of $150) at the time of service. If we are then paid by Aetna, you will be reimbursed.
As of January 1, 2025, Drs. Stein, Galante, and/or Samplaski are contracted providers under many plans offered by, among others, the following companies:
We are NOT providers with Humana/TriCare or AvMed because their allowable rates are SO much lower than those of other companies. We are told that Humana/TriCare and AvMed do cover vasectomy through their contracted providers, sometimes with no deductible.
Why a deposit policy? 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.”