Is My Vasectomy Covered by Insurance?

The short answer to this question, most likely, is yes; most insurance plans include a vasectomy as a “covered” service. Despite this, many patients end up paying sometimes large amounts to have a vasectomy in many healthcare settings.

In June 2024, a patient with good insurance coverage had a vasectomy at a nearby large medical center. The patient was billed almost $12,000 for a vasectomy with local anesthetic. The vasectomy was “a covered service,” but the patient paid over $3000 out of pocket.

Cost at Twin River Urology

$1,200

At Twin River Urology you pay for the vasectomy on the day of the procedure. We charge $1200. We will give you confirmation that you had the procedure performed and, if desired, we will help you submit for reimbursement to your insurance company. Whatever portion of the fee they end up covering will go to you directly.

The money you pay at the time of the procedure includes everything, including whatever form of pre-vasectomy counseling you have chosen (see options under Vasectomy), the procedure itself, any post operative visit to our office, and performance of a semen analysis about three months after the procedure.

Most patients who have health insurance will be able to receive, at least partial, reimbursement from their health insurance company for treatment at Twin River Urology.

If you have a Health Savings Account, this is the perfect opportunity to utilize your funds.

Cost at Other Facilities

$3,000 – $12,000

The price charged for a vasectomy by the large healthcare systems in Vermont and New Hampshire ranges from $3000 to $12,000.

There is typically a requirement for a pre-procedure “consultation,” and the charge for this may be $300-$500.

Most people do not pay the charged price because their insurance plan has negotiated a “discount.” Many of us will have a hard time figuring out how much we will end up having to pay, even if we use a price calculator that tries to take the insurance plan into account (or even if one calls the insurance company ahead of time). For those interested in a breakdown of this, check out Into The Weeds of Vasectomy Billing.

Why Doesn’t Twin River Urology Just Bill My Insurance Like Everybody Else?

Twin River Urology offers a high-quality vasectomy at a much more affordable price compared to larger medical facilities. Being a smaller practice allows us to keep our overhead costs low and establish a reasonable fee to cover our expenses. This approach only works if we receive fair compensation for the actual costs of the procedure. Dr. Curtis could talk endlessly about the complexities of the payment system in US healthcare and welcomes your thoughts and feedback!

Lower Cost to you

There are two categories of patients for whom it is highly likely to cost significantly less to have a vasectomy at Twin River Urology than at the large Vermont and New Hampshire medical centers: Patients who have no insurance (Self Pay) and those with a high deductible insurance plan who have not yet met their deductible.

Self Pay

Many health systems offer a “50% discount” for patients without insurance, but 50% of an inflated price will still bring out-of-pocket expenses for a vasectomy to around $2000.

High Deductible

If you have a health insurance deductible of $2000 or more, and if you have not met that deductible, you will pay up to that amount even though your vasectomy is “covered.” It will thus cost less to pay $1200 total for the procedure and (probably) get credit towards your deductible.

Maybe Lower Cost to you

If you work for a company that Self-insures, even if they use a well-known health insurance company to manage the plan, your employer may provide an incentive to their employees to go to a lower cost facility to get the identical service. For example a company may cover the procedure at Twin River Urology for a patient co-pay of $50, but perhaps require a co-pay of $200 at a Medical Center. Self-insuring companies are starting to do more of this because they find it saves the company expenses, while providing the same, or perhaps better, service. If you work for a company that self-insures consider asking your HR department about this.

Maybe the same, or higher, cost to you

It is possible that having a vasectomy at Twin River Urology will cost you more than if it is done elsewhere. What we can promise is that it will not cost you more than $1200. We can also promise that months down the road you will not receive a bill for some additional aspect of the experience using coded language that leads you to wonder where these surprise charges are coming from. Please contact the office at any time for questions/concerns.

But I really have no money at all. Barter?

If you would like to exchange a product or service in return for a vasectomy, we are open to your proposal. Please contact the office and we will happily discuss.

Sliding Scale?

We understand if you’re facing significant financial hardship and paying the out-of-pocket fee for a vasectomy is not possible for you. In light of your circumstances, we are willing to perform the procedure at a discounted rate. Let’s discuss your situation and see if we can work together to find a solution that works for you.