How Much is a Penis Implant Covered by Insurance?

Many men find penile implants to be the most reliable form of managing their erectile dysfunction (ED), restoring sexual spontaneity and emotional intimacy in their relationship. However, the cost of the treatment is often a major concern, especially for those not covered by Medicare or who do not have private health insurance.

Cost

Typically, most major insurance companies and Medicare cover the device and surgery. For patients who do not have insurance, El Camino Urology Medical Group can arrange a fixed cost package for the operation, including the device and all necessary hospital and anesthesia charges.

Penis implants are a permanent solution to erectile dysfunction (ED). They offer natural-looking, long and firm erections for sexual activity. They can also be inflated to a more “erect” position for intercourse, and then deflated back to a soft, natural-looking appearance. Typically, 90-95% of those who use this procedure report that it restores their self-confidence and sexual enjoyment.

When you select this treatment, your healthcare provider will examine you to make sure you’re a good candidate. This includes taking your temperature, pulse and blood pressure. Your doctor will also check to make sure you can empty your bladder and don’t have severe urinary problems. You may need to discontinue certain medications before your operation, such as anti-inflammatories or herbal supplements.

Your surgeon will put the implant in during a minor outpatient procedure, using local anesthesia to reduce any pain and discomfort. The incisions will be closed with dissolvable stitches. Your doctor may insert small silicone tubes, called surgical drains, to remove any blood or fluid from the incision sites. This can help to speed up the healing process.

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Insurance coverage

Penile implants are a type of prosthetic device that makes the penis erect. They are often performed for men who have erectile dysfunction (ED) that can’t be adequately treated with medication, such as sildenafil (Viagra). A urologist will discuss your medical history and your symptoms with you to determine whether penile implant surgery is right for you.

If your doctor decides that penile implant surgery is necessary, Medicare typically covers the procedure as an inpatient or outpatient procedure. Your Medicare Part B plan will cover the surgery and any follow-up visits with your physician, and Medicare Part D will help cover any prescribed medications.

You’ll also need a supplementary insurance policy, such as a Medicare Advantage or Medigap plan, to pay for any out-of-pocket costs. These include a premium, the Medicare Part B deductible and coinsurance for your prescription medications.

If you have a supplemental insurance policy, your insurance company will need to know about the planned procedure before it takes place. Your urologist may submit a request for prior-authorization or pre-determination with your insurer to get a sense of how much the procedure is expected to cost and what your financial responsibilities are likely to be. Then, you’ll have a better idea of how to plan for the costs. If the request is denied, you can appeal the decision.

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Procedure

Before undergoing this surgical procedure, you will undergo a thorough medical exam. The urologist will check your general health, taking your temperature, pulse and blood pressure. They will also examine your genital area to make sure you do not have any conditions that could affect the success of the surgery. The urologist may also perform hormone tests to ensure you have adequate testosterone levels.

The surgeon will use an incision to remove the old implant from your penis and will place a new one in its place. The surgeon can choose from several sizes of penile implants, based on your body measurements. The implant will sit inside your penis, and a tube (catheter) may be placed in your bladder. You will receive a dose of prophylactic antibiotics before the procedure to help reduce infection risks.

After the surgery, you will have some swelling and pain in and around your penis. You can resume normal activities, including sexual activity, within a few weeks. It is important to tell your partner that you have an implant. Medications can no longer work to get you an erection, and you will need the implant for this purpose. The implant will become softer over time, but it should last for up to six years before you need to replace it. It is important to visit your doctor regularly for cleanings and to have the catheter removed.

Recovery

If drug treatments and injections don’t improve your erectile dysfunction, you can discuss a penile implant with your doctor. The procedure is minimally invasive, and it usually takes less than 30 minutes to complete. If you’re worried about the cost, ask your urologist about insurance coverage options. Many insurers cover ED implants, and some offer co-pay assistance.

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Before you have your penile implant surgery, your health care provider will do a physical exam and check your vital signs. They’ll also ask you about your medical history and the cause of your ED. Be sure to tell them about any medications you’re taking, including over-the-counter drugs and herbal supplements. These can increase your risk of bleeding or affect how well the surgery heals.

After the operation, you’ll be sent home with a urinary catheter in place and will likely have some pain or discomfort. You’ll need to take pain medication and antibiotics as prescribed. Your doctor may recommend practice exercises that involve inflating and deflating your implant daily, which will help to stretch the tissue around the device.

It’s important to use your penile implant as soon as possible after surgery, because otherwise it could develop a capsule that prevents full prosthesis expansion. Your urologist will demonstrate how to cycle through the inflated and deflated states of the device and provide you with detailed instructions.

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