Dr. Sheldon Marks, a microsurgeon and author, explains how and why insurance rarely pays for a vas reversal in this article.
In the end, most insurance companies will not pay a vasectomy reversal for most men. Insurance companies consider it a cosmetic operation rather than a “medically required” procedure. They refuse to pay for the cost of repairing a mistake that men now regret. Furthermore, an insurance insider told me that a successful vasectomy reversal will increase insurance company costs because they will now be responsible for the birth and costs of additional children with no additional income to cover these costs.
Because there are so many different insurance plans and so many variances within each plan, each patient will need to call their insurance provider to see if their plan covers a “outpatient microsurgical vasovasostomy” (code # 55400-50). It’s recommended not to use the phrases “vasectomy reversal” in your conversation.
Even if the insurance company person claims, “Yes, an outpatient vas reversal is covered,” as they frequently do, realize that this is typically not the case, and they will refuse to pay afterwards. It’s one of those fine print clauses that no one ever reads in their health insurance policy. When they answer “sure, it’s covered,” what they really mean is that outpatient surgery, even with a non-contracted physician, is usually a “covered expense” under the terms of the insurance contract. The difficulty is that despite decades of executing tens of thousands of vasectomy reversals, the insurance company virtually invariably refuses to pay once the surgery is completed. Here’s how they do it: the authorization department that says it’s “covered” isn’t the same one that needs to approve the payment and issue the check afterwards. The payment division then adds that the insurance company is not legally obligated to pay even if “pre-approved.” The patient is now accountable for paying the unexpected bill.
Even if the insurance company or agency “approves” the vas reversal and gives the doctor a check, it may only be a few hundred dollars for a several thousand-dollar treatment, in my experience. The reason for this is that the insurance company gets to pick what is “fair and customary” for a vasectomy reversal in 2021, even if it is thousands of dollars less than the genuine costs. Even if the clinician is not trained, skilled, or experienced in urologic microsurgery, some insurance plans try to steer patients to a “in plan” contracted urologist to do the vas reversal.
No insurance company, corporation, government/military body, or veterans agency has a contract with ICVR. We just cannot afford to engage many more full-time staff to submit and re-file hundreds of claims over and over again, enduring months of problems and disputes with insurance companies in the United States and around the world. Instead, we’ve discovered that it’s easier for the patient to pay for the vas reversal up front and then request for reimbursement from the insurance provider. To aid in this procedure, we supply a copy of the operative note.
We also provide payment options for most couples because we understand that a well-performed microsurgical reversal vasectomy is not inexpensive.
Sheldon H. F. Marks, MD reviewed, revised, and updated this page on January 1, 2022.
Does insurance pay for vasectomy?
After your yearly deductible has been met, most health insurance providers will cover most or all of the cost of your vasectomy. A vasectomy may be covered by Medicaid or other state programs in your area if you qualify.
Why are vasectomies not covered by insurance?
Vasectomies are not considered a preventive care under the Affordable Care Act, therefore insurance companies are not required to cover them.
Is no scalpel vasectomy covered by insurance?
In the United States, a vasectomy is one of the most prevalent surgical treatments. This simple procedure prevents sperm from exiting the body through the penis, making it a type of birth control. In the United States, about 500,000 vasectomies are performed each year. In most cases, they are covered by insurance.
The no-scalpel vasectomy has been the favored method of vasectomy since the 1980s. This procedure is just as successful as a vasectomy. The no-scalpel technique is a popular choice because it is less invasive and requires less recuperation time.
What is cheaper vasectomy reversal or IVF?
When couples visit a fertility center or receive a referral from the wife’s OB/Gyn, they may be advised to try In Vitro Fertilization (IVF) first rather than vasectomy reversal. This can be perplexing for many patients.
Not only is vasectomy reversal less expensive than IVF, but it also saves the couple time and energy if the female spouse has no infertility difficulties.
It’s also the most natural and enjoyable way to have a child.
According to studies, having a child via IVF is often two to three times more expensive than vasectomy reversal.
According to one study published in the Journal of Urology Clinics of North America in August 2009, vasectomy reversal is “the gold standard,” and it is the physician’s responsibility to present patients with all options, including cost, in order to help them make an informed decision when advising them on infertility treatments in this era of cost containment.
How much is sperm aspiration and IVF?
The cost of sperm retrieval is determined by various factors, including the physician’s surgery fees, sperm freezing expenses, facility fees, and anesthetic fees.
The costs are often substantially more if it is done in a hospital or surgicenter than if it is done in a doctor’s office. The overall cost of a sperm aspiration with freezing will typically range from $3000 to $12,000, depending on the factors indicated above.
How expensive is a vasectomy?
The cost of a vasectomy, including follow-up appointments, can range from $0 to $1,000.
The cost of a vasectomy varies depending on where you get it, what type you receive, and whether you have health insurance that will cover some or all of the expense. Some health insurance plans, Medicaid, and other government programs may cover vasectomies for free (or at a reasonable cost).
Even if a vasectomy is more expensive up front than other options, it usually saves you money in the long run because it lasts forever. Female sterilization is around 6 times more expensive than vasectomies.
Does a vasectomy make you last longer in bed?
The good news is that having a vasectomy will have no effect on your sexual life. It has no effect on the generation of the male hormone testosterone, hence it has no effect on sex drive. It also has no effect on your capacity to ejaculate or get an erection.
How painful is a vasectomy?
The treatment itself should be painless, although the anesthetic injection may cause a small pinch before the area becomes numb. When the vas deferens tubes are touched during vasectomy, some men describe a pulling or tugging sensation, but this usually only lasts a few moments.
Will you gain weight after a vasectomy?
“Will I gain weight after a vasectomy?” is one of the most often asked questions concerning vasectomy. You will not gain weight after a vasectomy. Your weight may be affected if your lifestyle changes after the vasectomy and has a negative impact on your weight. A vasectomy has no effect on a man’s masculinity or productivity. A vasectomy has no effect on the hormones released by the testes. In reality, even after a vasectomy, your body continues to generate sperm. The only difference is that because it has nowhere to go, the sperm gets absorbed by your body. Testosterone, which controls muscle mass and strength, will continue to be produced.