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FAQs about Erectile Dysfunction, Penile Implants & Insurance Coverage

QUESTIONS ABOUT ERECTILE DYSFUNCTION

FAQ on Penile Implants FAQ on Insurance FAQ on EDCURE.ORG

  • What is ED?
    Erectile dysfunction (ED) is defined as the persistent inability to achieve or maintain a penile erection sufficient for satisfactory sexual performance.2  ED can limit your intimacy, affect your self-esteem and impact your most important relationships. Beyond the physical manifestations, ED causes emotional damage and there is a strong link found between ED and depression.3
  • How common is ED?
    ED is a surprisingly common condition experienced by more than 39 million men in the United States.34
  • What are the causes of ED?
    While there are real physical and psychological reasons for ED, there’s no single cause. The chart below outlines the most common causes of ED. 5
Pie chart showing common causes of erectile dysfunction
  • How is ED diagnosed?
    You may have to start the conversation with your doctor to get an answer to the question, “Do I have ED?” A personal history and physical exam set the groundwork for most conditions. Lab tests and other tests may identify a source such as diabetes, coronary artery disease or other conditions that affect the nerves and blood flow to the penis.
  • If I have ED symptoms, could I have heart disease?
    Hardening of the arteries caused by plaque buildup – atherosclerosis – limits blood flow to various parts of the body. The arteries supplying blood to the penis are much smaller than the ones supplying blood to the heart. As a result, heart disease may first show itself as difficulty achieving an erection.13 Learn more about heart disease and erectile dysfunction.
  • Why does diabetes cause ED symptoms?
    Diabetes damages the blood vessels and nerves that supply the penis with blood to form an erection. The constant change in blood sugar levels can also cause nerve damage, which can lead to loss of sensation in the feet and hands, and can affect having sex.7 Learn more about diabetes and ED.
  • What are some of the side effects from prostate cancer treatment?
    The two most feared radical prostatectomy side effects are loss of erections and bladder leakage. These side effects can occur, but there are successful treatment options available. Also, after total removal of the prostate, there is no ejaculation,36 although the ability to have an orgasm remains unchanged. 
  • When can a man resume sexual activity after prostate cancer treatment?
    If the cancer is detected early and patients are treated by an experienced surgeon using nerve-sparing techniques, then sexual activity may return to normal after surgery. This can take 3 to 6 months with continued improvement for 2 or 3 years.43 If sexual activity does not return on its own, there are many different ways to support an active sex life (medications, pumps, injections and penile implants). Learn more about sex after prostate cancer.
  • How is ED treated?
    ED treatment is available to all men with ED. Oral medications are a common first step, but they don’t work for everyone. If men don’t respond to oral medications, they may try other options such as pump devices, injections and penile implants.

QUESTIONS ABOUT PENILE IMPLANTS

FAQ on Insurance FAQ on Erectile Dysfunction FAQ on EDCURE.ORG

  • Will my penis look different to me or will others notice a penile implant?
    Once in place following your surgery for ED, your implant will be completely undetectable. It’s fully concealed in the body. No one will know unless you tell them—even in the locker room.35
  • Is the inflation process painful?
    To inflate a Boston Scientific penile implant, you squeeze the pump in your scrotum, which will send fluid into the cylinders in the penis. This requires good manual dexterity but should not be painful. If you experience pain, contact your doctor.35
  • What will my partner think?
    When inflated, the implant makes the penis stiff and rigid, similar to a natural erection. Your erection will last as long as you desire. And you’ll still share the same intimate experience. Typically, ejaculation and sensation will feel similar to the way they felt before the implant.44
  • Do I need to go to a specialist to get a penile implant?
    You can learn about your unique causes of ED and begin research on surgery for ED with any physician but eventually, you will need to see an ED specialist. At first you can speak with your primary care doctor about erectile dysfunction treatments. Later, you will discuss the situation with an ED specialist or clinic with experience in all forms of treatment for ED, including penile implants.35 Locate an ED doctor in your area.
  • What’s the penile implant surgery like?
    Penile implant surgery generally takes about an hour. Typically, it is performed on an outpatient basis.76 While you’re under anesthesia, a small incision is made at the base of the penis or in the scrotum, and the implant is placed through that incision. Pain should not be severe during the healing process following surgery for ED.35
  • How long is the recovery time after surgery for ED, and when can I have intercourse?
    Most men return home within a day of ED implant surgery and are back to all their normal activities within a week, typically having intercourse around 6 weeks post-surgery.35
  • How long does an implant last? Will I ever need to replace it?
    It is impossible to predict how long a particular implant will function in a particular patient. As with any medical device, penile implants are subject to wear and mechanical failure over time. A recent study of more than 39,000 patients showed that the 7-year mechanical survival of a Boston Scientific penile implant is 91-94%.37 To prolong the life of your implant, follow the advice of your urologist.
  • Will my implant set off airport security?
    An implant should not affect your ability to travel and to go through airport security. Of course, implants like those for knees or hips contain metal and will be detected by a wand or a walk-through scanner. Since most inflatable penile implants have minimal metal parts, they should not set off a metal detector. Some of the non-inflatable penile implants may, however, contain more metal. You will receive a patient ID card that identifies you as a medical device patient. To help avoid these types of situations, just carry it with you.
  • What are the risks of getting a penile implant?
    Because each type of implant offers unique features, you will want to discuss the risks and benefits of each device with your doctor prior to scheduling your penile implant surgery. Then choose the option that is right for you. View Important Safety Information.
  • Are Boston Scientific penile implants MRI compatible?
    Boston Scientific implants are MRI conditional – meaning a patient with this device can be scanned under certain conditions but not all.

QUESTIONS ABOUT INSURANCE COVERAGE FOR PENILE IMPLANTS

FAQ on Penile Implants FAQ on Erectile Dysfunction FAQ on EDCURE.ORG

  • Does insurance cover penile implants?
    Most insurers cover the diagnosis and medically necessary treatment of ED. Medicare has a national policy for ED, which includes penile implants, although coverage may depend on where you live. Insurance coverage for penile implants varies so work with your doctor’s office and insurance carrier to check coverage levels prior to receiving treatment.
  • Does my private insurance cover penile implants?
    Boston Scientific recommends that you work with your physician’s office to verify insurance coverage and benefits prior to the penile implant surgery procedure being performed. There are also steps you can take to minimize the chances of an improperly processed or denied claim.

    • Read your insurance policy. It’s better to know what your insurance company will cover or require for ED treatments before you receive a service.
    • If you still have questions about your insurance coverage for penile implants, call your insurance company and ask a representative to explain it.
    • Remember your insurance company, not your doctor, makes decisions about what will be paid for and what will not.
  • How should I approach my private insurance about an implant?
    Boston Scientific recommends that your doctor’s office send a written letter of predetermination to your private insurance company to inquire about insurance coverage for penile implants. This letter should confirm that you meet the medical necessity requirements for the penile implant surgery procedure and verify that your individual policy has coverage for this procedure. Insurance companies typically send a written response back informing you if you meet both requirements.
  • If I don’t have insurance, how much does this penile surgery cost?
    For patients with no insurance coverage for penile implants, a detailed description of the out-of-pocket costs can be obtained from your urologist. The penile implant cost will vary based on a number of items starting with where (which hospital) you plan to have your penile implant surgery performed.
  • I have been denied a penile implant by my insurance. What are my options?
    Please review some of the options below that you might consider. First determine what type of denial you received regarding your insurance coverage for the penile implant surgery. Is the denial based on a contract exclusion? Review your benefit information for specific exclusion language. Some types of contract exclusions include no payment for:

    • Sexual dysfunction
    • Impotence
    • Sexual inadequacy
    • Penile prosthesis
    • Penile implants

    Review your benefit information for specific medical benefits such as:

    • Prosthetic devices
    • Reconstructive surgery
    • Surgery to repair body function

    You have the right to appeal any denial from your health plan. In many cases, there is a time limit following the denial in which your appeal must be received. Check your benefit information or any denial letter you received for specific timelines.

  • My insurance still won’t pay. What can I do?
    You have gone through the entire appeal process and your insurance still won’t pay. If the contract language has a clearly written exclusion, your insurance may legally continue to deny coverage. Alternative options to consider are listed below.

    • Review other medical policies you may have: Do you have Medicare? Are you covered under a secondary plan by someone else, such as a spouse? Have you served in the military and are covered under TriCare? Do you qualify under Cobra to be part of another plan?
    • Is your health plan a self-funded program? Check with your Human Resource Department to determine whether you are covered under a self-funded program. Employers can make a final determination for coverage in self-funded plans. Request information on the process involved in having your request reviewed for coverage.
    • Explore the opportunity for open enrollment: This usually occurs at year-end and may allow you to choose another health plan. Look for other options that offer benefits for erectile dysfunction and penile prostheses. Determine whether you are able to upgrade your current plan by paying extra premiums. (These are referred to as riders.)
    • Consider self-payment: Paying for surgery out-of-pocket may not be the most desirable option, but it may be the only option if you have exhausted all others. Here are considerations that could make self-payment more feasible:
      • If your health plan is not paying for any of the costs, you may want to research prices at facilities outside of your health plan’s network and negotiate a price you are comfortable with
      • Utilize pre-tax flex spending plans
      • Explore loan options
      • Some patients may qualify for a financial assistance program. Men should check with their doctor for details.
      • If you don’t have insurance or a penile implant isn’t a covered benefit, you can access physicians who offer a cash pay option at www.surgeo.com
      • Free Medicare assistance is also available through the State Health Insurance Assistance Program (SHIP). Counselors can provide one-on-one help with Medicare questions and problems at SHIP Assistance

QUESTIONS ABOUT Edcure.org

FAQ on Penile Implants FAQ on Insurance FAQ on Erectile Dysfunction

  • Who sponsors EDCURE.ORG?
    EDCURE.ORG is fully sponsored by Boston Scientific, a medical device manufacturer dedicated to transforming lives through innovative medical solutions. Boston Scientific manufactures a variety of devices to treat erectile dysfunction (ED) including the AMS 700TM Penile Implant, the AMS AmbicorTM Penile Implant, the SpectraTM Malleable Penile Implant and the TactraTM Malleable Penile Implant. EDCURE.ORG educates patients and their partners on causes of ED and FDA-approved treatment options for ED, including penile implants. It is in Boston Scientific’s interest to educate patients and their partners on penile implants as a treatment option for ED. EDCURE.ORG does not accept or host any advertisement.
  • Who wrote EDCURE.ORG?
    Except for the expert articles, which have been written by physicians practicing in the field of prosthetic urology, EDCURE.ORG is authored and edited by Boston Scientific professionals referencing published clinical studies and medical literature. Content is reviewed by clinical, regulatory and legal experts for accuracy.
  • Does EDCURE.ORG contain current information?
    EDCURE.ORG is updated regularly. Updated content may include but is not limited to: videos, patient resources, product information and physician-authored articles. The date of the most recent update can be found at the bottom of each page.