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Does Insurance Cover Vasectomy Procedures?

Does Insurance Cover Vasectomy Procedures?

You can choose to use Private Health Insurance (PHI) to contribute to the cost of your vasectomy or you can use Medicare only. However, for those looking to make the most of the PHI cover they have, it’s important to understand some basic information.

Navigating the world of private health insurance can be difficult, particularly when you’re looking at how much coverage you have for a specific treatment or procedure. To help you steer the murky waters of insurance towards the bright light of your vasectomy, we’ve broken it right down, so you can confidently estimate how much your vasectomy will end up costing you.

What are the types of health insurance?

There are two types of private health insurance. There’s “hospital cover” and “extras cover” (sometimes referred to as ‘general treatment,’ or ‘ancillary cover’). Extras are for dental and physio for example.

Most insurance providers will offer a bundle where you’re covered for both. We’re going to be focusing on private “Hospital” cover, as this is the coverage relevant to a vasectomy when done in one of our specialist Day Hospitals.

does private health insurance cover vasectomy
‘Hospital cover’ is the coverage relevant to a vasectomy when done in one of our specialist Day Hospitals.

What is ‘hospital insurance’?

Depending on your individual policy, hospital insurance is designed to help cover some, or all, of the cost of in-hospital treatment, either as a private patient in a public hospital or a private hospital or licensed day hospital practice.

Generally, any medical service listed under the Medicare Benefits Schedule (MBS) such as vasectomy can be claimable on some form of private hospital insurance, depending on your policy. Almost all clients who have private health insurance “Hospital” cover who are paid up on their membership will be covered for vasectomy in all our hospitals.

Our hospital will run a final check for you a few days before your procedure date to confirm this. You can also contact your insurer and have them check in advance by quoting item number 37623. If you’re covered and you book at one of our day hospitals, you may have to pay an excess and/or a gap fee (both explained below) depending on your policy.

What is a ‘premium’?

Your premium is the amount that you pay your insurer for your coverage. Some people choose to pay this annually, while others are debited on a weekly, fortnightly, or monthly basis. If you miss payments you may not be covered for services.

How to get vasectomy covered by insurance
You are entitled to a Medicare rebate when you have a vasectomy.

What’s an ‘excess amount’?

An excess is an amount that you pay towards the cost of your care, in return for lower premiums. Depending on your policy and provider you might need to pay an excess every time you are admitted to a hospital or day procedure facility.

Remember to ask your health insurance provider if you have an excess amount before booking a procedure. This helps to budget accordingly for the procedure. The excess can range from $0 – $750 or more but the average is usually $250 or $500 paid once for the whole year.

How much ‘coverage’ do I need?

Before you sign up for a policy, make sure you check what it covers; especially if you have a specific procedure in mind that you want to claim, such as a vasectomy. Not all policies are comprehensive (cover everything), and some might leave you with out-of-pocket expenses.

Does insurance cover vasectomy
Before you sign up for a health insurance policy, make sure you check what it covers.

What is a ‘gap fee’?

A gap fee is the amount that remains after the Medicare rebate has been applied and your insurance has paid the amount you are covered for towards the cost of your care.

Essentially, some providers will charge more for their services than what Medicare and insurance will cover, and in those instances, the patient must pay the difference or the “gap”. This amount will vary depending on what the medical provider is charging.

In our case, we have arrangements which mean that the highest gap you will pay is $100 and in many cases, there will be no gap for your whole service including the doctor and the hospital.

This link from the Australian Health Department is also helpful in understanding Private Health Insurance out-of-pocket-costs.

More FAQs

If you require additional information about insurance cover and vasectomy, please don’t hesitate to contact us today. Below you can find some other frequently asked questions on the subject:

Does Medicare cover vasectomy?

No, Medicare doesn’t cover the total cost of a vasectomy. However, you will be entitled to a Medicare rebate, so the total out-of-pocket cost to you will be less if you have a Medicare card.

How much does a vasectomy cost?

The cost of a standard vasectomy varies depending on a number of factors. See our list of costs below:

  • From $480 with local anaesthetic in a medical centre
  • From $690 with local anaesthetic in an MSI Day Hospital
  • From $750 with intravenous sedation in an MSI Day Hospital
  • Minimal or no gap with private hospital insurance

Will my health insurance cover a vasectomy reversal procedure?

It is extremely rare for an insurance plan to cover vasectomy reversals. Normally you will have to cover all of the costs yourself. At your initial consultation, we will always emphasise that a vasectomy should be considered an irreversible procedure and only suitable for men who don’t want more, or any, children.

Can I get a vasectomy for free or at a low cost?

There is no way of getting a free vasectomy in Australia. Some clinics will offer ‘low-cost’ treatment but it’s important to remember that a vasectomy is a surgical procedure and should only be carried out by highly trained and experienced healthcare professionals.

Does the price of vasectomy differ based on what procedure you have done?

Yes, the price of vasectomy will vary depending on the type of procedure you have done and ​​a number of other factors including where you have it done and the type of sedation you choose to have.

About the Author

About the Author

Dr Justin Low

Justin received his medical degree from the University of Sydney in 1987 and completed the RACGP Family Medicine Program (FMP) in 1991. He became a Fellow of the Royal Australian College of General Practitioners in 1993. He received a Certificate of Recognition from the Australian Teleservices Association in 2012 for his work in telemedicine and has had extensive surgical and emergency medicine experience in the hospital system.

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