FAQs about erectile dysfunction and
penile implants, & insurance coverage

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.⁹

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.⁹

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.¹⁰

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.⁹

Locate an ED doctor in your area

Penile implant surgery generally takes about an hour. Typically, it is performed on an outpatient basis.¹¹ 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.⁹

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.⁹

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%.¹² To prolong the life of your implant, follow the advice of your urologist.

A penile 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.

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.

Read important safety information

Boston Scientific penile implants are MRI conditional — meaning a patient with this device can be scanned under certain conditions but not all.

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.

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.

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.

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.

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.

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.

The EDCure site 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 700™ Penile Implant, the AMS Ambicor™ Penile Implant, the Spectra™ Malleable Penile Implant, and the Tactra™ Malleable Penile Implant.

EDCure 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 does not accept or host any advertisement.

Except for the expert articles, which have been written by physicians practicing in the field of prosthetic urology, EDCure 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.

The EDCure site 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.