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)…
Can you make payments on vasectomy reversal?
CareCredit is a medical credit card that can help you pay for out-of-pocket medical expenses. The CareCredit card has a number of key features, including:
- CareCredit offers customized financing alternatives to help people spread out their medical bills rather than paying them all at once.
- Short-term financing alternatives from 6 to 24 months are available through CareCredit. If you make your minimum monthly payments and pay the entire amount owing by the end of the promotional term, you will not be charged interest on purchases of $200 or more.
- Patients utilize the CareCredit card to pay off their Chesapeake Urology bill in full and then make monthly payments to CareCredit, much like they would with a personal credit card.
How painful is a vasectomy reversal?
About 50 guys out of 100 believe the discomfort after the reversal is similar to the anguish they had following their vasectomy. Another 25 out of 100 people claim the pain is less after the vasectomy, while another 25 percent think it is more. Pain that necessitates medicine usually lasts only a few days to a week.
Does insurance cover a vasectomy?
Coverage by Medical Insurance When a vasectomy is performed as an outpatient treatment, most health insurance companies will pay the costs. After your yearly deductible has been met, most health insurance providers will cover most or all of the cost of your vasectomy.
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.
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.
How much is sperm aspiration and IVF?
The cost of sperm retrieval is determined by several factors, including the physician’s surgical fees, sperm freezing charges, facility fees, and anesthesia 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.
Can a vasectomy be reversed after 10 years?
Vasectomies can almost always be reversed. However, this does not guarantee that you will be able to conceive a kid. Vasectomy reversal can be tried even if it has been several years since the original vasectomy, but the longer it has been, the less likely the reverse will be successful.
Can a vasectomy be reversed after 15 years?
New York, New York (19 February 2004) A recent study by physician-scientists at NewYork-Presbyterian Hospital/Weill Cornell Medical Center debunks a prevalent myth about vasectomy, finding that vasectomy reversal is very effective even 15 years or more after the vas deferens, the tube that delivers sperm, is closed. The study, which was published in the Journal of Urology in January, found the greatest pregnancy rates after vasectomy of any study to date.
The study found that whether a man had a vasectomy this year or 15 years ago, the pregnancy rate following a vasectomy reversal was the same, with an average of 84 percent risk of pregnancy over two years. (In comparison, healthy men who do not had a vasectomy can expect a pregnancy rate of 90%.) Pregnancy rates following vasectomy reversal were only 50-60% in previous research, a difference that can be linked to breakthroughs in vasectomy-reversal methods. The study also discovered that the pregnancy rate plummeted to 44% at intervals of more than 15 years.
“Vasectomy is a non-permanent procedure. A reversal will result in a substantially greater pregnancy rate than sperm aspiration and in vitro fertilization (IVF) with intracytoplasmic sperm injection for males who had a vasectomy less than 15 years ago (ICSI). Even at intervals of more than 15 years, reversal results will be on par with or better than IVF with ICSI “Dr. Marc Goldstein, the study’s lead author and Surgeon-in-Chief of Male Reproductive Medicine and Microsurgery at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, states At the best centers, IVF with ICSI can result in pregnancy rates of up to 50% per attempt, albeit it may take two or three tries to get pregnant.
“Vasectomy reversal is also a more cost-effective alternative, particularly for couples who want more than one child,” Dr. Goldstein says. “IVF with ICSI is often two to three times more expensive than vasectomy reversal. In several states, including New York, a reversal is covered by health insurance, unlike IVF with ICSI.”
According to Dr. Goldstein, men desire to reverse a vasectomy for two reasons: remarriage or the loss of a child. In the United States, around half a million vasectomies are performed each year, with an estimated two percent to six percent of men seeking reversal.
Between 1984 and 2001, 213 vasectomy reversals were performed at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, according to the report. The results were divided into four groups based on the length of the obstructive interval: less than 5 years, 5-10 years, 10-15 years, and greater than 15 years. The study only looked at men who had reproductive female partners.
The study also discovered that the vas deferens’ patency (or absence of obstruction) remained high for up to 15 years, averaging 90% and remaining constant regardless of when the vasectomy was performed. Other study results contradict this conclusion, which could be explained by the recent advent of superior surgical procedures for vasectomy reversal. Dr. Goldstein pioneered one such approach, the microdot method for precision suture application, in 1998.
Another myth about vasectomy is that the existence of granulomas, which are knots that form in the vas deferens when a vasectomy is done too tight, leads to increased patency and pregnancy rates. Granulomas, which occurred in 28% of vasectomies, did not increase patency to a statistically significant level and had no effect on pregnancy, according to the current study.
The study is the first to look at pregnancy and patency after two different types of vasectomy reversals: vasovasostomy (VV) and vasoepididymostomy (VE). Patients who had bilateral VV had a significantly higher patency rate (95%) than patients who had unilateral VV and VE (83%) and bilateral VE (83%) respectively (83 percent ). Pregnancy rates, on the other hand, were steady.
Vasovasostomy (VV) is a procedure in which the vas deferens is reconnected to the vas deferens. The vas deferens is connected to the epididymis, a duct that transports sperm to the vas deferens. Vasoepididymostomy (VE) connects the vas deferens to the epididymis, a duct that transports sperm to the vas deferens. If sperm is found in the vas fluid, VV is usually done. VE is used if there are no sperm in the vas fluid. Both procedures are performed in the outpatient setting and require less than three hours.
According to Dr. Goldstein, assisted reproductive methods such as intrauterine insemination (IUI) or IVF with ICSI are the next step for men who are unable to conceive after VV or VE.
Dr. Stephen Boorjian, a urology resident at NewYork-Presbyterian Hospital/Weill Cornell, and Michael Lipkin, a medical student, are co-authors of the study.
Dr. Goldstein and his colleagues at the Center for Male Reproductive Medicine and Microsurgery at NewYork-Presbyterian Hospital/Weill Cornell Medical Center have been recognized as leaders in the field of male reproductive surgery and have garnered awards for their educational DVDs. They won the “Audio-Visual Award” (first prize) from the American Urological Association in 2003 for “Ultra-Precise Multilayer Microsurgical Vasovasostomy: Trick of the Trade.” Their “Three Techniques of Microsurgical Intussusception Vasoepididymostomy: Cost-Effective Options for Obstructive Azoospermia: Cost-Effective Options for Obstructive Azoospermia” got the American Society for Reproductive Medicine’s “Best Video Award” in 2002.