No insurance coverage for a penile implant or no insurance? Steps you can take to afford a penile implant
No coverage, or benefit exclusion
If you have health insurance that does not cover penile implant surgery, or if you have a benefit exclusion for ED Treatment and/or a penile prosthesis procedure, you still have options.
Please contact a Boston Scientific Patient Procedure Access Specialist (available at (855) 284-1676, option #1) for help. Your doctor’s office may also be able to offer additional support as well.
Before an access specialist can help, you will need a copy of your full benefit plan booklet. They are often called a Summary Benefit Plan (SBP) or Summary Plan Description (SPD). You can typically get this large document from your employer’s personnel department or from your insurance plan website.
No insurance
Alternatively, some patients plan for the procedure and utilize pre-tax flex spending plans to cover their costs. Some men currently without health insurance decide to get insurance during an open enrollment period. If you do this, you will want to confirm the insurance plan you choose covers ED treatment and a penile prosthesis/implant.
Package pricing or cash pay
Some doctors offer package pricing or a set price if you are paying 100% out of pocket for your penile implant procedure. You can research prices at facilities either in or outside of your health plan’s network and learn what packages are available at what prices. ED specialists may offer package pricing or financing assistance even if they do not advertise these options.
Another resource is www.surgeo.com. Surgeo is a website that lists doctors who offer cash pay options for penile implant procedures. With package pricing options, it is important to confirm what is included in the package. For example, you will want to know if the package includes the fees for the pre-op visit, doctor’s surgery, procedure facility, anesthesia, device, and all follow-up care.
Financing
There may be financing options available to you if you do not have insurance or cash to pay for your penile implant. Financing programs exist.
Program eligibility and availability varies, so it’s important to work with your doctor or ED specialist’s business office to tell them your need for a financing program. You can apply for financing opportunities as they are available.
Kerry and Vilma learned that their procedure wasn't covered but then worked with a financial counselor at the hospital and found an affordable package price. Kerry says, "I regret not having it done sooner."
Caution: U.S. Federal law restricts this device to sale by or on the order of a physician.