Does Insurance Cover A Vasectomy Reversal?

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.

How much does a reversal of a vasectomy cost?

The average vasectomy reversal cost at ICVR is $8700, with success rates as high as 99.5 percent. Other doctors’ vas reversals can cost a lot less, while others can cost a lot more. The trick is to inquire as to why and what they forego in order to be so much less expensive.

The goal of this website, published by Sheldon Marks, MD, is to describe how much a vasectomy reversal will cost in 2022 and what each patient will get for that money, which varies greatly from doctor to doctor. It’s crucial to remember that the end goal is a baby, not a vasectomy reversal. Cutting corners or performing rapid reversals may work for some, but there are likely to be other issues and risks, such as decreased success rates.

Cost, as taught to me by my father many years ago, is the amount of money spent on a product or service, whereas value is what each person gets for their money. Too often, people just consider their out-of-pocket expenses and do not consider what they receive or do not receive in return. They make the error of assuming that the cheapest doctor is also the best, and that all doctors provide the same outcomes, success, and care.

One of the most frequently asked inquiries is, “How much does a vasectomy reversal cost?” The cost of reversing a vasectomy can range from $800 to more than $70,000. Most major urologic doctors estimate that the treatment will cost between $8000 and $15,000, with a few as high as $70,000, all for the same procedure with similar outcomes. Several experts who care for vas reversal failures believe that many discount doctors have lower reversal success and higher rates of complications because of their quickie, high volume approach, no or minimal follow-up care, the use of older and simpler techniques (that allow the doctor to go fast), or not having critical support and OR staff, according to a recent fertility society meeting. Many doctors, we’ve heard, send out unexpected invoices weeks or months after the reverse vasectomy surgery.

For a routine, first-time vasectomy reversal for fertility, we offer a fixed, all-inclusive price package of $8700 with no hidden charges or unexpected fees. More difficult vasectomy reversals, redo vasectomy reversals, or vasectomy reversals for the treatment of post-vasectomy pain syndrome cost more (PVPS).

Because the doctors of ICVR are regarded as leading authorities by so many top tier doctors, and because we wrote the textbook (1) published articles, and taught the classes and courses to other doctors, every patient can expect the highest chances for vas reversal success, with vas-to-vas connections having a success rate of up to 99.5 percent (2). Many other doctors, sadly, believe they are doing a fine job with a vas reversal success rate of 70, 80, or 90 percent.

This cost remains the same for patients at ICVR, regardless of whether the vas reversal takes longer than the usual 2 to 3 hours or whether we need to conduct the more intricate and difficult vas-to-epididymal bypass (vasoepididymostomy, VE) on one or both sides.

Are Vasovasostomy covered by insurance?

Medical insurance may pay the costs of reversing a vasectomy in some situations. However, in the vast majority of situations, insurance does not cover the surgery. (1)…

The author discusses vasovasostomy, a surgery that reattaches the vas deferens tubes after a vasectomy. What to expect following surgery and how well it went (2)…

Insurance may cover the costs of a vas reversal in some situations, but it does not in the vast majority of cases. We recommend that you contact your insurance provider (3)…

How successful is a reverse vasectomy?

If you had your vasectomy less than 10 years ago, your chances of being able to generate sperm in your ejaculate again after a vasectomy reversal are 95 percent or higher. The success percentage is lower if your vasectomy was performed more than 15 years ago. Pregnancy rates vary greatly, ranging from 30 to more than 70% in most cases.

Does Medicare cover vasectomy reversals?

A vasectomy is typically regarded as a cosmetic procedure. That is, it is a procedure that you choose to have rather than one that is required to treat a medical issue.

Medicare, on the other hand, only pays for procedures that are deemed medically necessary. Elective operations, such as vasectomies and vasectomy reversals, are never covered.

Unless the technique is being utilized to treat an underlying medical problem, this rule applies to all sterilization procedures. Endometriosis can be treated by hysterectomies, for example.

A vasectomy, on the other hand, is always done as a means of birth control and is not covered.

Other surgical operations may be covered under Part A and Part B, together known as original Medicare, but vasectomies are not.

Medicare Advantage

Only if you have a Medicare Advantage (Part C) plan may you get a vasectomy covered by Medicare.

Medicare Advantage plans must cover everything that traditional Medicare does, and many also include extra coverage for things that Medicare does not cover.

Vasectomies may be covered under your Medicare Advantage plan, depending on your plan.

Does insurance cover a 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.

How can I have a baby if my husband had a vasectomy?

Vasectomy is becoming one of the most popular sterilization procedures in the United States. If you change your mind about having children after your vasectomy, there are two treatments that can let you have a kid with your partner. A vasectomy reversal or sperm aspiration prior to in vitro conception are the two alternatives (IVF). Your doctor can advise you on which technique is best for you and your partner depending on the following factors:

What are the first steps I should take?

The first step is to consult a urologist. A urologist is a physician who focuses on the medical treatment of a man’s reproductive organs. Your urologist will review your medical history and do a physical check to ensure that you don’t have any other health problems that could influence your fertility. Your partner should also see a doctor to ensure she is not suffering from infertility.

What happens in a vasectomy reversal procedure?

Vasectomy reversal techniques are divided into two categories. The procedure employed is determined by whether part of the male reproductive system was blocked during your vasectomy.

  • The two ends of the vas deferens are connected by a vasovasostomy (vas-o-vay-ZOS-tuh-me). The vas deferens is a tube that transfers sperm from the testes out of the body. On both the right and left sides of the scrotum, you have two vasa deferentia. During your vasectomy, each of your vasa deferentia was cut to prevent sperm from mingling with semen.
  • The epididymis is connected to the vas deferens by a vasoepididymostomy (vas-o-ep-ih-did-ih-MOStuh-me). The epididymis is a coiled portion of the sperm ducts that matures sperm. When a vasovasostomy is not possible due to obstructions produced by the vasectomy, this operation is used.

During the operation, your doctor will choose which procedure is best for you. Both methods of vasectomy reversal offer the potential to allow you and your partner to have a child naturally through sexual activity.

How is sperm aspirated prior to an IVF cycle?

Your doctor aspirates (gently suctions) sperm from your testicles during this surgery. This technique is commonly done in the office under local anesthesia (with numbing medication). It’s also possible to do it under general anesthesia (when you are put to sleep). A tiny needle is used to extract sperm from each vas deferens near the testicle, or possibly from each testicle itself. After this treatment, most men experience some little discomfort.

The sperm is then used in a laboratory to fertilize your partner’s eggs through IVF. The sperm can be aspirated on the day of the IVF operation or retrieved ahead of time and preserved for a later IVF procedure. The use of sperm for artificial insemination is not suggested due to the tiny quantity of sperm.

When combined with IVF, this approach is quite effective, especially if your spouse is under 35 years old. This approach also has a number of other advantages. It’s possible that it’ll take your partner less time to become pregnant, and you won’t need to use birth control following a successful pregnancy. For the male partner, it is also a less invasive procedure. There are a few drawbacks as well. It is more costly. Your partner may have more than one child at the same time if more than one embryo is transferred. It’s also a more invasive process for the female spouse, and you might have to repeat it if you want more children.

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.

Does Medicaid cover 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.

Can I have a baby after vasectomy?

When couples wait at least three months after a vasectomy to have intercourse without birth control, the chances of falling pregnant are nearly nonexistent.

A doctor will test the semen after a vasectomy to see if there are any sperm present. The individual who gets the vasectomy and their partner should utilize a backup contraceptive technique until a doctor gives them the go-ahead to limit the possibility of pregnancy.

There’s a chance that some sperm will remain in the semen if people have sex without contraception too soon after a vasectomy. If that’s the case, this sperm might fertilize an egg and result in a pregnancy.

Can a vasectomy reverse itself after 20 years?

Vasectomies can be reversed for up to 20 years after the initial procedure. However, the longer you wait to reverse a vasectomy, the less likely you are to be able to conceive a kid.

A vasectomy reversal will not boost your chances of getting your spouse pregnant if he or she has had a tubal ligation. In vitro fertilization and sperm aspiration are two options you should discuss with your doctor.