Vasectomy Consult and Procedure: $590
Vasectomy Reversal Consult: $100
Vasectomy Reversal: $5900
If you have health insurance, and if that insurance plan is one with which we have a contractual agreement, your fees may be lower. See below under “Private Health Insurance”.
Visa and Mastercard
Visa and MasterCard are accepted at the Tampa/Lutz office. Cash is accepted at all locations. If you want to use a Visa or MasterCard at locations other than the Tampa/Lutz office, you may pre-pay with Visa or MasterCard by calling the Tampa/Lutz office at least one day in advance with your credit card information. For vasectomy services, we accept CareCredit (click here for our office policy) for the balance payment ($490) after the $100 deposit has been paid by cash, check, or Visa/MasterCard. We do NOT accept CareCredit for reversal consultations or reversal procedures.
Private Health Insurance
Health insurance often covers vasectomy. This is complex, so read carefully. Health insurance COMPANIES sell a variety of health insurance PLANS. Within the same company, some plans may cover vasectomy and others may not. And even if a plan “covers” vasectomy, it will not “pay” for a vasectomy if the plan-holder has not met his 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 February 2020 (always subject to change): Aetna $448.82; AvMed $450.00; BCBS $484.83; Cigna $461.59; United $493.27. We are still working on our contracts in Colorado, but until finalized, men in Colorado with coverage under the companies above will be offered the rates above. Those men without insurance are offered the $590 rate (still FAR less than an unintended pregnancy!), payable by cash, check, or credit card called into the Tampa office at least one business day before the procedure.
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). Since insurance companies can sometimes make mistakes, 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 [we are VA providers; see below], 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 to get a bill that you did not expect.) 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 and Curington 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 Av-Med plans except the “Engaged” plan common in the Miami area, and (3) with nearly all Cigna plans except “Local Plus” and “BayCare”.
Again, get the name of the person with whom you speak. We bill insurance companies $700, as opposed to $590 for direct pay patients. If you are told that you have coverage under your plan, we will verify that* and bill your insurance company directly. If we are told that your deductible has not been met, you will be asked to pay the plan’s “allowable” at the time of the procedure. 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 that vasectomy is a covered procedure and that the patient either has no deductible or his deductible has been met. The patient then receives a surprise bill from us for the insurance company’s allowable amount. If unpaid, the bill goes to collections, so do not proceed with the vasectomy if you don’t want to take this financial risk. As of August 2019, Drs. Stein and Curington 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 HMO (not BayCare or LocalPlus), AvMed, United HealthCare, and Aetna. Patients with Blue Cross HMOs and Blue Select are offered the Blue Cross rate of $484.83; and patients with Cigna-BayCare and LocalPlus are offered the Cigna rate of $460.45. We are NOT providers with Humana/TriCare because their allowable rates are SO much lower than those of other companies. We are told that Humana/TriCare does cover vasectomy through their contracted providers, sometimes with no deductible. For pateints with Humana, we offer the United rate of $493.27.
* We will not verify coverage for those with BCBS of South Carolina (held by many Publix employees) and BCBS of Illinois because the verification processes for BCBS-SC (800-334-2583) and BCBS-IL requires that our caller listen to a seemingly endless recording of unrelated codes. Those with BCBS-SC and BCBS-IL will be asked to pay the allowable up front and will be reimbursed if and when we are paid by BCBS-SC or BCBS-IL.
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 $100, so you helped me accomplish what I knew had to be done.”
Title X (Title Ten)
If your income is low and you have no health insurance that covers vasectomy, Federal Title X (Ten) grant money is available in Florida and nationwide to help fund family planning services, including vasectomy. Most of these federal Title X funds are allocated through county health departments. Please see our Guide to Florida Health Department Vasectomy Programs. If you live in a county whose health department has no vasectomy program or no federal funds available for vasectomy, you may apply for financial aid through the health department of a neighboring county.
The VA (Veteran’s Administration)
The VA covers vasectomy through our office, even if you are not service-connected. Go to your local VA clinic with your military discharge form DD-214 to get a referral authorization. Simply ask that you be referred to our office. When we receive the referral authorization, we will call you to arrange a date and time that works well for you.
We have learned that, when it comes to procuring vasectomy services, Medicaid can be more of a hindrance than a benefit. Some county health departments will deny Title 10 funding for patients who are on straight Medicaid or enrolled in Medicaid HMO’s. Medicaid has a reputation of paying so slowly that few doctors wish to participate. Certain county health departments participate, but they may require referral authorizations from the Medicaid primary care physicians, and getting a referral authorization may be discouragingly slow. Dr. Stein was but is no longer a Medicaid provider of vasectomy services because the reimbursement is low ($143) and the paperwork unbearable. (Three claims were recently denied because we used abbreviations: Dr. Stein’s middle initial “G.” and “M.D.”, rather than “George” and “Medical Doctor”.) However, some county health departments will offer Title 10 financial assistance (see below) to men with Medicaid if there are no local providers of vasectomy services under the Mediciad program.
Medicaid tries to shift all Medicaid patients to Medicaid HMO’s, sometimes without the Medicaid recipient even being aware of the shift. Drs. Stein and Curington are not contracted providers with any Medicaid HMOs, as some Medicaid HMO administrators have done exceptionally well financially, and we do not want that financial success to be at our expense or the expense of proper care for patients.