Why Do Vasectomy Costs Vary So Widely?
Four years ago, days before his 38th birthday, Nick decided to go through with a vasectomy. For at least 15 years, he had known he didn't want children. Still, he didn't want to rush into getting the permanent sterilization surgery in case he changed his mind when he got older.
Nick was moving from full-time to part-time status at his employer, which meant he would lose his health insurance plan. So it felt like the right time since his decision not to have kids never wavered. Preventing pregnancy remained the priority, and vasectomy is the most effective birth control option for men.
"Getting a vasectomy felt like the better decision instead of my partner going on the pill and experiencing the hormonal roller-coaster ride that goes with it," said Nick, who requested his last name not be used.
Nick said financial considerations played a role, but not in the way people might think. He and his partner didn't base the decision on the cost differences between vasectomy and female sterilization, which can be about five times more costly. They didn't base it on saving money in the long term by not having to buy contraceptives.
"But the cost of having a kid with our combined salary definitely played a factor into it," he said.
An analysis of more than 450,000 insurance claims for vasectomy found procedures at ambulatory surgical centers cost the patients twice as much out of pocket, on average, as vasectomies performed in doctors' offices.
The vasectomy was performed at Urology Austin in Austin, Texas, by now-retired urologist Dick Chopp, M.D. (Yes, that is his actual name. He even made an appearance on "Jimmy Kimmel Live!").
Nick's health insurance through his employer at the time covered the cost for most of the vasectomy, though he did have to pay a few hundred dollars out of pocket. Most health insurance plans offer coverage for vasectomies, and some plans cover 100 percent of the procedure. The more common scenario, though, is one like Nick's, according to a Urology Austin spokesperson.
"When the procedure goes toward a deductible and coinsurance, the cost is shared between the member and the health plan," said Urology Austin in a statement. "When a vasectomy is performed in the office setting, a patient with insurance coverage can expect an out-of-pocket cost ranging from $0 to $750 depending on their individual plan benefits. If a patient elects to have their vasectomy done in a surgery center, under anesthesia, the cost can increase substantially."
In fact, an analysis of more than 450,000 insurance claims for vasectomy found procedures at ambulatory surgical centers cost the patients twice as much out of pocket, on average, as vasectomies performed in doctors' offices.
Exploring low-cost options
UnitedHealthcare, one of the largest health insurance networks in the United States, covers vasectomies in most of their fully insured plans, according to a UnitedHealthcare spokesperson.
"Members may be responsible for some cost sharing depending on their benefit plan," the spokesperson said.
Many Planned Parenthood health centers, clinics and hospitals throughout the U.S. offer vasectomies at a low cost or even no cost. Having a vasectomy performed at Planned Parenthood can cost between $0 and $1,000, including follow-up visits. The fee depends on location and whether you have health coverage.
Vasectomies may be free under Medicaid and other government programs. A sliding scale that lowers the cost—dependent upon a patient's income—and makes the vasectomy more affordable for the uninsured or underinsured may also be an option at some Planned Parenthood locations.
"The cost and coverage, including options for sliding scale, vary among affiliates," a Planned Parenthood spokesperson said, adding that providers may use either the scalpel or no-scalpel technique.
Generally, the cost is the same for both types of vasectomy procedures: no-scalpel and conventional.
Vasectomies traditionally cost about $900 for patients, according to Helen Bernie, D.O., a urologist and the director of sexual and reproductive medicine at Indiana University Health.
"Depending on what their insurance covers, they may have to pay all of that or a copay of that, but roughly, that's about what it is," she said.
If possible, use a urologist
Bernie recommended going to a board-certified urologist for a vasectomy unless you live in a rural area where there's no local urologist. Some family practices have general practitioners who are trained in vasectomy because there are no subspecialists in the area.
Bernie advised men to be wary of some "doc-in-a-box places" that offer vasectomies for $600 or $700 cash. These small clinics, often found in shopping centers, grocery stores and drugstores, are usually not run by urologists, she said.
Vasectomy is listed as a set Current Procedural Terminology (CPT) code, a uniform language for coding medical procedures, meaning the fees are standard.
"Whether you do a no-scalpel or you make two incisions in the scrotum or one incision, they're all the same price," Bernie explained, adding that she always uses the no-scalpel technique, which is the standard of care for most urologists.
An economic imperative
Many men choose to have vasectomies for financial reasons, according to Jesse Mills, M.D., a urologist and the director of the Men's Clinic at UCLA in Los Angeles.
"I saw a huge uptick in vasectomies in 2008 when the financial crisis hit," Mills said. "Interestingly enough, in 2011, when things recovered, I was doing a lot of vasectomy reversals. So a lot of people decided when their 401(k) bounced back that they weren't done having kids, and they decided they wanted to have additional children."
Vasectomy reversals are significantly more costly and are not covered by insurance. These procedures, which are more involved than a vasectomy, have an average cost of about $10,000.
Where you live can also play a role in what you pay for a vasectomy. In Indiana, Bernie said $900 is the average cash price, while in California, a state with a much higher cost of living, Mills said his cash price is about $2,800.
Mills sees the vasectomy price vary according to the patient's copay and deductible.
"If I do a vasectomy on January 2, a guy may have to pay $1,200 to get his vasectomy because he hasn't offset any of his deductible. And if I do it on December 31, it may be free," he said. "You can imagine that December is a very busy month for me to do vasectomies because people have already met their deductible."