Yes, Medicare and most private insurance plans cover penile implants. Dr. Chung’s office will conduct a complete evaluation in collaboration with your insurance carrier.
What qualifies you for a penile implant?
Men between the ages of 50 and 90 who have had prostate, bladder, or colon cancer therapy, as well as those who have a penile deformity or atrophy, are the ideal candidates for a penile implant.
Does Blue Cross Blue Shield Cover penile implants?
Patients who do not respond to oral therapy with drugs like Viagra, Cialis, Levitra, or Stendra, or who have a contraindication to these medications, usually have penile implant surgery covered by Blue Cross policies.
How much does the average penile implant cost?
One of the most bothersome and frequently asked issues when dealing with healthcare and insurance companies is whether or not a procedure is covered and what the costs are. When it comes to erectile dysfunction therapies and penile prosthesis implants, the good news is that Medicare and other major insurances cover these procedures.
Not all insurance firms, though, will follow suit. If you have erectile dysfunction, it’s critical to establish care and contact with your primary care physician or urologist to discuss treatment options. The answer is as simple as contacting your urologist’s office to find out how much a penile prosthesis or implant would cost you and what is covered by insurance. Other choices, such as tablets and injections, can be considered and costs determined in the same way.
What if I’m not old enough to be eligible for Medicare, or if my insurance covers a penile implant?
There is still hope in these situations. Most urologists’ offices provide package pricing options that include the implant, surgeon’s cost, surgical center fee, and anesthetic fee. Depending on your surgeon or institution, this cost could range from $12,000 to $19,000. Payment options with no interest may also be available.
How long do penile implants last?
Dr. Starke cautions, “It’s vital to remember that a penile implant is a mechanical device that can break.” “However, this is a rare occurrence that can be remedied with a simple surgical surgery.”
- Learn about the Men’s Health Center at Houston Methodist, which does 100 to 150 penile implants per year, which is more than 99 percent of all other centers in the globe.
What are the disadvantages of a penile implant?
Although penile implants provide many advantages, there are a few disadvantages to consider before obtaining one. The advantages and disadvantages are listed below.
Pros
- Long-lasting, with a lifespan of up to 20 years, albeit this is contingent on a combination of use and chance.
- When not in use, your penis returns to a flaccid state (by deflating for the two or three-piece or bending the semirigid cylinders for the one-piece)
- If your ED isn’t responding to medication or other treatments, or if those treatments aren’t working, this is the best option.
Each device also has its own set of advantages. The three-piece implant, as previously said, produces the most natural-looking erections by combining superb firmness with utter flaccidity. Because of its basic construction, the one-piece gadget has a very low possibility of malfunctioning and is ideal for people with limited dexterity.
Cons of penile implants
The most significant disadvantage of penile implants is their indefinite nature. In most circumstances, once you’ve had a penile implant, you won’t be able to have an erection any other way. This is likewise true if the implant were to be removed.
- Constant pressure on the penis (with the one-piece), which could result in harm in some cases.
- Infection risk is small (very rare, as many modern implants come with an antibiotic coating to prevent this from happening).
- Dr. Brant’s infection rate is less than 1% when he uses modern procedures and protocols (outside of unusual circumstances).
Before recommending penile implants, Dr. Brant thoroughly investigates all nonsurgical treatment options for your ED, including medication and therapy. If you are concerned about penile implants, he will answer all of your questions and ensure that you are aware of both the benefits and drawbacks before proceeding.
The operation will take around an hour, and you will be able to return home thereafter. Dr. Brant inserts the implant through a very little incision in the upper part of your scrotum during the operation. The incision will heal in about a week, and you’ll be ready to have intercourse again in two to six weeks (depending on the procedure and type of implant).
You may be a suitable candidate for penile implants if you’ve been suffering from erectile dysfunction that hasn’t responded to treatment. To schedule a consultation with Dr. Brant, call our Salt Lake City, Utah, office at 801-207-7922 or send us a message through our website.
How long can the average man stay erect?
Erections usually last a few minutes, although they can continue up to a half hour in some situations. If you develop an erection that lasts more than four hours (priapism) or isn’t related to sex, consult your doctor or go to the emergency room straight away.
Is penile implant surgery safe?
Inflatable prosthesis operations are successful in 90 to 95 percent of cases, meaning the implants produce erections adequate for intercourse. The prosthesis has a high percentage of satisfaction, with 80 percent to 90 percent of men delighted with the outcomes and saying they would choose the procedure again.
Are penile implants safe?
There is no procedure that is completely free of risks. The following are some of the risks connected with penile implants:
- After surgery, there is uncontrolled bleeding; this condition may necessitate additional surgery.
Is erectile dysfunction covered by insurance?
The inability to produce or sustain a penile erection sufficient for satisfactory sexual performance is known as erectile dysfunction (ED). 2ED can hinder intimacy, lower self-esteem, and have a negative impact on your most essential relationships. ED produces mental harm in addition to physical manifestations, and there is a strong correlation between ED and depression. 3
More than 39 million men in the United States suffer from ED, which is a surprising widespread ailment.
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There is no singular explanation for ED, despite the fact that there are significant physical and psychological causes. The most common causes of ED are listed in the chart below. 5
To gain an answer to the question, “Do I have ED?” you may need to start the dialogue with your doctor. The foundation for most conditions is laid by a personal history and physical examination. Diabetes, coronary artery disease, or other disorders that impact the nerves and blood flow to the penis may be identified through lab tests and other examinations.
Atherosclerosis, or plaque buildup in the arteries, restricts blood flow to numerous regions of the body. The arteries that carry blood to the penis are significantly smaller than those that supply blood to the heart. As a result, heart illness may manifest itself first as a problem obtaining an erection. 13 Learn more about erectile dysfunction and heart disease.
The blood arteries and nerves that provide blood to the penis to generate an erection are damaged by diabetes. The frequent fluctuation in blood sugar levels can cause nerve damage, resulting in loss of sensation in the feet and hands, as well as affecting sex. 7 Learn more about diabetes and erectile dysfunction.
Loss of erections and bladder leakage are the two most common radical prostatectomy adverse effects. Although these side effects are possible, there are effective treatment alternatives available. Also, there is no ejaculation after total prostate removal,36 though the ability to achieve an orgasm is unaffected.
Sexual activity may return to normal following surgery if the malignancy is found early and treated by a skilled surgeon utilizing nerve-sparing procedures. This could take 3 to 6 months, with improvements lasting 2 to 3 years. 43 If sexual activity does not resume on its own, there are a variety of options for maintaining an active sexual life (medications, pumps, injections and penile implants). Find out more about sex in the aftermath of prostate cancer.
All men with ED can receive ED treatment. Oral drugs are a frequent first line of defense, but they don’t always work. If oral drugs don’t work, men may consider alternative treatments like as pump devices, injections, and penile implants.
QUESTIONS ABOUT PENILE IMPLANTS
Your implant will be absolutely invisible after it is in place following your ED surgery. It’s completely hidden within the body. Even in the locker room, no one will know unless you tell them. 35
Squeeze the pump in your scrotum to inject fluid into the cylinders in the penis to inflate a Boston Scientific penile implant. It is necessary to have strong manual dexterity, but it should not be uncomfortable. Contact your doctor if you are experiencing pain. 35
When inflated, the implant stiffens and rigidizes the penis, simulating a natural erection. You can have an erection for as long as you want. And you’ll still have the same close encounter. Ejaculation and sensation will usually feel the same as they did before the implant. 44
Any physician can help you learn about your specific reasons of ED and begin research on ED surgery, but you will eventually need to consult an ED specialist. To begin, discuss erectile dysfunction therapy with your primary care physician. Later, you’ll speak with an ED specialist or clinic that has experience with all types of ED treatment, including penile implants. 35 Find an emergency room doctor in your region.
The procedure for a penile implant usually takes around an hour. It is usually done as an outpatient procedure. 76 A small incision is created at the base of the penis or in the scrotum while you’re under anesthesia, and the implant is put through that incision. During the healing period after ED surgery, pain should be kept to a minimum. 35
- When can I have intercourse following ED surgery and how long does it take to recover?
Most men return home the same day as their ED implant surgery and are back to their regular activities within a week, with intercourse occurring approximately 6 weeks after surgery. 35
It’s impossible to say how long a specific implant will last in a specific patient. Penile implants, like any other medical device, are prone to wear and mechanical failure over time. A recent study of almost 39,000 patients found that a Boston Scientific penile implant has a mechanical survival rate of 91-94 percent after seven years. 37 Follow your urologist’s guidance to extend the life of your implant.
Your ability to travel and pass through airport security should not be hampered by an implant. Metal implants, such as those for the knees or hips, will, of course, be identified by a wand or a walk-through scanner. Metal detectors should not be triggered by most inflatable penile implants because they have very few metal pieces. Non-inflatable penile implants, on the other hand, may contain more metal. A patient ID card will be given to you that identifies you as a medical device patient. Carry it with you to help avoid these kinds of scenarios.
Because each type of implant has its own set of advantages and disadvantages, you should talk to your doctor about the risks and benefits of each device before scheduling your penile implant procedure. Then decide which choice is best for you. Important Safety Information is available here.
Boston Scientific implants are MRI conditional, which means they can be scanned under certain circumstances but not others.
QUESTIONS ABOUT INSURANCE COVERAGE FOR PENILE IMPLANTS
The diagnosis and medically necessary treatment of ED are usually covered by most insurance companies. Although coverage may vary depending on where you live, Medicare has a national policy for ED that includes penile implants. Insurance coverage for penile implants vary, so verify with your doctor’s office and your insurance company before getting treatment.
Prior to the penile implant surgical process, Boston Scientific recommends that you check with your physician’s office to confirm insurance coverage and perks. You can also take actions to reduce the risks of a claim being incorrectly processed or denied.
- Examine your insurance coverage carefully. It’s better to know ahead of time what your insurance company will cover or require for ED treatments.
- Call your insurance carrier and ask a representative to discuss your coverage for penile implants if you still have questions.
- Remember that it is your insurance company, not your doctor, who decides what will be covered and what will not.
Your doctor’s office should send a formal letter of predetermination to your private insurance company to enquire about insurance coverage for penile implants, according to Boston Scientific. This letter should indicate that you meet the medical necessity requirements for penile implant surgery and that this operation is covered by your particular insurance policy. If you match both standards, insurance providers will usually send you a written response.
Your urologist can give you a thorough breakdown of the out-of-pocket expenditures if you don’t have insurance coverage for penile implants. The cost of a penile implant will vary depending on a number of factors, starting with where you plan to have your penile implant procedure conducted (which hospital).
Please have a look at some of the possibilities listed below. Determine the sort of denial you received from your insurance company regarding your penile implant surgery coverage. Is the denial based on a clause in the contract? Look over your benefit details for any specific exclusions. The following are examples of contract exclusions: no payment for:
Any denial from your health insurance plan can be appealed. In many circumstances, your appeal must be received within a certain amount of time after the denial. Specific timelines might be found in your benefit paperwork or any refusal letter you received.
Even after going through the entire appeal procedure, your insurance company refuses to pay. Your insurance company may legally continue to deny coverage if the contract language contains a clearly documented exclusion. Below are some other options to think about.
- Examine any additional medical insurance policies you may have: Do you have access to Medicare? Are you covered by someone else’s secondary plan, such as a spouse’s? Do you have TriCare coverage because you served in the military? Are you eligible to join another plan under Cobra?
- Is your health-care plan self-funded? Check with your Human Resources department to see if you are covered under a self-funded plan. In self-funded plans, employers can make the final decision on coverage. Request details on the procedure for having your request for coverage considered.
- Examine the possibility of open enrollment: This normally happens at the end of the year, and it may allow you to switch to a different health plan. Look at alternative options for erectile dysfunction and penile prosthetics. Check to see whether you can improve your current plan by paying more premiums. (Riders are what we call them.)
- Take into account self-payment: Paying for surgery out of pocket may not be the most appealing option, but it may be your only alternative if all other options have been exhausted. Consider the following factors to see if self-payment is a viable option:
- If your health plan does not cover any of the charges, you may wish to look into rates at facilities outside of your plan’s network and negotiate a price that is acceptable to you.
- Some patients may be eligible for financial assistance. For more information, men should consult their doctor.
- The State Health Insurance Support Program also provides free Medicare assistance (SHIP). At SHIP Assistance, counselors can provide one-on-one assistance with Medicare inquiries and problems.
How often can you use a penile pump?
When used properly, there are few hazards associated with using a penile pump. It can be used as often as your body requires depending on how well it responds to the treatment. Some men may be able to use one several times in a single day, while others may require it less frequently.
It’s critical that you follow the directions that came with the pump exactly. A penile injury can occur if there is too much air pressure in the tube. There’s also the possibility of little bleeding beneath the skin’s surface. Small red patches, known as petechiae, can appear on your penis as a result of this.
Because of the device’s design, some of the spontaneity of a sexual encounter is lost. Using a penile pump might make some men and their partners feel uneasy or embarrassed, especially at initially. Some men also complain that their erection isn’t always as strong at the base of the penis as it is further up the shaft.
Most men with moderate ED can safely use a penile pump, however if you take a blood thinner such warfarin (Coumadin), you may be at risk of internal bleeding issues. You may not be able to use a penis pump safely if you have a blood disorder like sickle cell anemia, which puts you at risk for bleeding or blood clots.