Insurance Info

Insurance 101 for SimpleVas® Patients

Personal Lines Insurance Definition

You may have called your insurance and they said they “cover” your vasectomy -which means that you will owe NOTHING for your service, correct? NOT NECESSARILY!! The fact that your insurance plan covers your vasectomy DOES NOT NECESSARILY mean you are responsible for ANY PAYMENT. In many cases, you will still have to pay a DEDUCTIBLE, a CO-INSURANCE, or a CO-PAYMENT.

In order for you to better understand the terms of your insurance plan, you should make sure you understand some of the common terms associated with insurance.

* Remember to VERIFY with your insurance company if you are covered for this service

ACCEPTED INSURANCES

Aetna, Coventry, Cigna, Midlands, Wellmark BCBS

* We are NOT ACCEPTING Medicaid at this moment

1. Call the insurance phone number in the back of your insurance card (it is YOUR responsibility, not ours). Consider that we will charge insurances their allowed scheduled fee. If you have a high deductible and have not met it yet, it might be more affordable to pay the price offered for those without insurance.

2. Let them know you want to have a vasectomy (CPT code for the procedure is 55250)

3. Make sure to tell them this is an “office procedure” and NOT an “outpatient procedure”

We request a deposit fee to secure your appointment date, as we value your time and ours. No-shows / last minute cancellations limit the access to interested patients.

* Deposit is fully refundable until 7 calendar days prior to the appointed vasectomy date. Deposit will NOT be refunded thereafter for either cancellation or postponement (special circumstances will be considered to keep the deposit for a future date)

** Deposit will be reimbursed at the time of service for those using insurance, unless coverage is insufficient

*** Deposit will be applied to cost of vasectomy for those opting out of using insurance

What is a DEDUCTIBLE?Uncategorized Archives - ISU American Business Insurance

This is the TOTAL AMOUNT you MUST PAY out-of-pocket BEFORE your insurance starts to pay. For example, if your deductible is $1,000, then your insurance won’t pay anything until you have paid $1,000 for services subject to the deductible (remember that the deductible may not apply to every service you pay for). Furthermore, even after you have met your deductible YOU MAY STILL OWE a co-pay or a co-insurance for your procedure.

What is a CO-PAY?

This is a FIXED AMOUNT that you must pay for a COVERED SERVICE, as defined by your health plan. Co-pays usually VARY for different plans and types of services. Typically, you must pay this amount at the time of service. Again, co-pay amounts are fixed -which means you ALWAYS pay the same amount, regardless of the visit. With SimpleVas®, if you responsible for a co-pay, you will be charged for a PCP (primary care physician) visit co-pay.

What is a CO-INSURANCE?What is Coinsurance? What you don't know CAN hurt you | CoverLink Insurance | Ohio Independent Insurance Agency

This type of OUT-OF-POCKET payment is calculated as a PERCENT of the total allowed amount for a particular service. In other words, IT’S YOUR SHARE of the total cost. For example:

– Your insurance plan’s allowed amount for an office visit is $100

– You have already met your deductible

– You are responsible for a 20% co-insurance

In the situation above, you would pay $20 out of the allowed $100 at the point of service. The insurance company then would pay the rest of the allowed amount for that visit. Remember that the co-insurance amount MAY VARY from visit to visit, depending on the service you receive.

Insurance payments vary depending on the company

So, HOW MUCH will I owe for my SimpleVas® visit?PayPal Payment Request Usage Guide - Visualmodo Blog

If you have NOT MET YOUR deductible, then your $100 DEPOSIT  will be APPLIED towards your deductible.

You will then owe any applicable co-insurance or deductible BALANCES after our billing office (PractiSynergy) receives the Explanation of Benefits (EOB) from your insurance company, and we will send you a bill for the balance. If we find that you may have overpaid, we will refund you via check as soon as possible. As for COPAYS -these amounts rarely vary, so if your co-pay for your visit is $20, then you will owe $20 at the time of your visit.

Examples of EOBs for your SimpleVas® Vasectomy

Here are a few examples of Explanation of benefits (EOBs) for the service you receive. An EOB is a document your insurance sends to explain the various costs -including the amount you, as the patient, are RESPONSIBLE for- associated to your care. See below these examples for definitions of the terms associated.

EXAMPLE INSURANCE A: Patient HAS NOT yet met his annual deductible. Therefore, the patient IS RESPONSIBLE for 100% of the allowed amount.

Date of SERVICE

CPT code

Units

BILLED amount

ADJUSTMENT amount

Patient RESPONSIBILITY

(Deductible, patient pays)

Insurance A PAID

05/01/20

55250 1 $1,200 $850 $850 $0

TOTAL

1 $1,200 $850 $850 $0

EXAMPLE INSURANCE B: Patient OWES a 20% CO-INSURANCE for the service provided.

Date of SERVICE

CPT code

Units

BILLED amount

ADJUSTMENT amount

Patient RESPONSIBILITY

(Co-insurance, patient pays)

Insurance B PAID

05/01/20

55250 1 $1,200 $850 $170 $680

TOTAL

1 $1,200 $850 $170 $680

EXAMPLE INSURANCE C: Patient OWES a $20 CO-PAY for his visit.

Date of SERVICE

CPT code

Units

BILLED amount

ADJUSTMENT amount

Patient RESPONSIBILITY

(Co-pay, patient pays)

Insurance C PAID

05/01/20

55250 1 $1,200 $850 $20 $830

TOTAL

1 $1,200 $850 $20 $830

 

Useful DEFINITIONSDefinition of NLP - The Association for Neuro Linguistic Programming

Date of service: The DATE of your vasectomy visit

CPT code: The code that indicates the SERVICE PROVIDED during your visit (55250 refers to bilateral vasectomy)

Billed amount: This is the AMOUNT WE BILLED the insurance company for your vasectomy, based on our fee schedule.

Adjusted amount: This amount IS NOT A PAYMENT, but rather a write-off or “reduction”. It is based on the contract in place between your surgeon (SimpleVas®) and your insurance company. Neither you nor the insurance company pays this amount. The provider essentially writes it off.

Allowed amount: The contracted amount agreed to between the surgeon (SimpleVas®) and your insurance company

Patient responsibility: This is the amount that YOU, the patient, ARE RESPONSIBLE for paying. If a secondary insurance is on file, we may forward this amount to that insurance for payment. Once we get the secondary EOB back, you will receive a bill for any outstanding balances in the Patient Responsibility column.

Insurance paid: This is the amount the INSURANCE COMPANY PAID us for the services you received on the date of your vasectomy.

 

Very important for you to REMEMBER!!HMO, PPO, POS - Which Health Insurance Plan is For You?

Most insurance companies offer SEVERAL DIFFERENT PLANS or subsidiaries. Thus, two patients with BlueCross/BlueShield, for instance, may have COMPLETELY DIFFERENT BENEFITS, and therefore, completely different financial responsibilities. Some plans have no co-pays or deductibles; other may have a $10,000 deductible. Furthermore, some providers may not accept all plans from a particular insurance. This is why it is important that you INVESTIGATE the details of YOUR SPECIFIC PLAN.

 

If your insurance offers an online PATIENT PORTAL, sign up for it! These resources typically enable you to:

  • Check your BENEFITS
  • Track your DEDUCTIBLE
  • See which PROVIDERS in your area accept your particular plan
  • Track your CLAIMS
  • COMPARE your claims to your receipts from the doctor’s office (if they don’t match up, then you can follow up on any discrepancies).

Learn about your INSURANCE PLAN

So What's the Difference Between a Premium, Deductible, Copay, Coinsurance, and Max Out-of-Pocket

What is my PREMIUM?What does Premium Means in Finance? | Fincash.com

This is the MONTHLY AMOUNT YOU PAY for coverage. The lower it is, the higher your deductible will typically be. Plans with low premiums and high deductibles often are called “catastrophic” plans. Conversely, higher premium plans often feature lower deductibles, co-pays, and co-insurances.

What is my DEDUCTIBLE, and what does it apply to?Deductible - Maryland Health Connection

This is the TOTAL AMOUNT that you must pay EACH YEAR before your insurance begins to pay. For example, if your deductible is $5,000, then you must pay $5,000 towards deductible-applicable services BEFORE your insurance will pay anything. Once you reach your deductible, your co-pay or co-insurance may apply.

 

 

What is my CO-PAY?Copay Insurance: A Beneficial Clause in Your Health Insurance Policy?

High co-pays are a common drawback to low-premium plans. Remember, the co-pay may apply even after you met your deductible. The co-pay for your SimpleVas® vasectomy will be applied at the level of a PCP (Primary Care Physician).

 

 

What is my CO-INSURANCE?Co-what? Copays, coinsurance, & other common health insurance terms | HealthPartners Blog

Co-insurance is another version of COST-SHARING. So you’ll likely have to pay either a co-insurance or a co-pay.  However co-pays are fixed amounts -and thus, are more predictable- co-insurances are percentages. Therefore, your financial responsibility varies based on how much your surgeon charges for the services provided.

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Some insurance plans (ie. PPOs, HMOs, and EPOs) are limited to a certain network of surgeons. So make sure you have a good selection of covered professionals and facilities in your area. If you travel frequently, or live in a rural area, you may want to choose a plan that has no network restrictions.

 

 

 

Do I need a REFERRAL for a SimpleVas® Vasectomy?The True Cost of Poorly Managed Physician Referrals

No, you don’t need a referral to come to have your SimpleVas® Vasectomy done.

 

 

Is there a SELF-PAY OPTION?TAB01320 Medical Labels for Self Pay, 7/8 x 1-1/2, Fluo

The self-pay rate for your SimpleVas® Vasectomy is ONLY $600.

Because an uninsured patient with a high deductible may have to pay the MAXIMUM ALLOWED COST by the insurance company, you may want to consider paying cash for your procedure.

 

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