Well it’s come down to it. You have decided that more children (or none at all) is not something you are going to pursue. After my third child – who was a surprise – my wife and I decided that we were done having kids. When you find yourself in a similar situation you will probably be looking at your health insurance plan. But is a vasectomy covered by insurance?
Like all medical procedures there are a lot of things you will need to check on to determine if your medical insurance company will help pay for a vasectomy. The good news is that it is not difficult to find out how your insurance company handles getting snipped.
What Is A Vasectomy?
Put simply, a vasectomy is male sterilization. It is a surgical procedure in which a doctor cuts or blocks the vas deferens, which are tubes that carry sperm to the rest of the body to be mixed with fluids that create semen.
After a vasectomy your body will still produce semen, it just will not contain sperm, meaning you cannot get someone pregnant. The sperm that is blocked by the vasectomy end up getting absorbed by the body.
After your vasectomy, you will be asked by your doctor to ejaculate a lot to make sure you get rid of all of the extra sperm that could get into your semen. This can be done through sex or ejaculation. Once you have done that you will have to give a semen sample to a lab to check to see if the vasectomy is effective.
It is important to note that a vasectomy is not 100% effective. It is possible for the vas deferens to reconnect so that sperm can mix with semen once again. I had to sign several waivers noting that I understood the risk.
Is A Vasectomy Painful?
The actual vasectomy procedure is not painful if done correctly. When my doctor started cutting he asked what my pain was on a scale of 1 to 10. When I said a 2 he said that was good because if the local anesthesia wasn’t working then I would have been at a 10.
That being said, the days after the vasectomy surgery were very painful for me. It was hard to walk, and just sitting in a chair was painful. My balls were killing me.
My doctor gave me a small prescription of pain killers. I ended up having to ask for a refill, which got me to the end of the pain period. In all, it was about 3 weeks before I felt no pain at all.
Bottom line…if your doctor tells you you’ll feel better in a week, don’t believe him.
Are You Awake For A Vasectomy?
This was one of my first questions. I wanted to know if I’d be awake for my vasectomy. The answer was yes, I was wide awake. The anesthesia was a local anesthesia, so I was able to actually talk to the doctor while the procedure was taking place.
I liked being awake for the vasectomy, because there was no recovery time and it didn’t take as long to get in and get out of the doctor’s office.
The vasectomy only took about 15 minutes once the doctor got started, so I was in and out in on time.
What Is The Average Cost Of A Vasectomy?
The cost of a vasectomy depends on if you have insurance. Without insurance, the cost of the procedure is around $1,000.
With insurance, the cost is a few hundred dollars less. A look at my Blue Cross Blue Shield online portal shows that the procedure costs anywhere between $453 – $906 in my area, depending on which provider performs the surgery.
The cost an individual member would pay would depend on the plan design of their health insurance plan. We’ll get into that more down below.
But first, you need to determine if a vasectomy is covered by your insurance plan.
Is A Vasectomy Covered By Insurance Plans Available To Me?
Most insurance plans cover vasectomies. They are routine procedures, and they are preventive in nature, meaning that while an insurance plan will spend a few hundred dollars, the procedure will most likely keep other more claims, i.e. pregnancy, from ever occurring.
But to find out for sure if a vasectomy is covered by your medical insurance plan, do these 3 things.
Check Your Plan Summary
All insurance plans come with a detailed plan summary. If you have a plan through your employer, you can ask for the Summary Plan Description, or SPD. This may have information on vasectomy coverage.
Call The Insurance Company
I work as a health insurance consultant. I sometimes get calls from clients about coverage for individual procedures. While I am always happy to help, I also advise the customer that they will get a more complete answer if they call the insurance company directly.
The number to your insurance company is on the back of your ID card, and while many people don’t like to use the phone, it’s still the best way to find out how your insurance plans work.
When you talk to the insurance company directly, you will be talking to someone that has all of your information and all of your plan’s information right in front of their eyes. Plus, that person will be able to tell you where you stand with your deductible and out of pocket maximum, so you will know how much you will have to pay for the vasectomy.
Talk To Your Human Resources Department
If your health insurance plan is through your employer or your spouse’s employer, they can also help find out if a vasectomy is covered by your health insurance plan.
I would still try to go straight to the insurance company first, but you can also get help by contacting your Benefits Manager. If he or she doesn’t know offhand if you’ll have coverage, then they will know the right people to ask.
The Benefits Manager had a hand in designing the benefit plan, so they will definitely be able to get you an answer.
What Will A Vasectomy Cost You If You Have Insurance?
Up above I discussed the average overall cost of a vasectomy. But if you have health insurance you may not have to pay that entire cost. It all depends on what your plan design calls for.
The best way to get an idea of how much the sterilization procedure will come out of your own pocket, you can take a look at your plan’s Summary of Benefits and Coverage, or SBC. An SBC is a requirement of the Affordable Care Act, and it clearly outlines your deductible, coinsurance, copays, and other aspects of your plan.
When it comes to deductibles, if you are covering your family on your plan you will need to know if your deductible is an embedded or aggregate deductible. An embedded deductible will be more beneficial to you, and it could be the difference between paying for the entire cost of a vasectomy or just part of it.
You will also want to pay attention to your out-of-pocket maximum. Once you and/or your family have reached the out-of-pocket maximum you will no longer be required to pay anything for a network medical or pharmacy service. Some people plan out a vasectomy and other surgeries during years where they have already reached their out-of-pocket maximum.
In fact, many times a vasectomy can be done without any out-of-pocket costs. How? Well, many times men get vasectomies after the birth of a child, and the mother and baby might have enough claims to get a family to the out-of-pocket maximum. If this happens, and you get a vasectomy in the same plan year, you won’t have to pay anything as long as the procedure is performed by a doctor in your network.
How To Find An Insurance Plan That Covers Vasectomies
If you need to find a health insurance plan that covers vasectomies, the best way to find one is through an online marketplace or exchange. When you do this you will be able to compare multiple plans for the benefits and price that are right for you.
The marketplace I recommend is eHealthInsurance. They are able to quickly get you the best rates side-by-side so you can make the best decision for your family.
Getting a vasectomy is a big decision. There is enough to worry about without having to stress over how to pay for it.
Follow the steps above, and you can be sure that you will know exactly how a vasectomy will impact you financially.