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Insurance Coverage and ED Therapy After Prostate Surgery

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Worries about what your health insurance policy covers have caused many a sleepless night.

As if a diagnosis of prostate cancer weren’t enough to deal with, such a pronouncement triggers a whole set of related questions and concerns. Will I need invasive surgery to remove cancerous tissue? If so, how will this affect my ability to function sexually after surgery? And will my health insurance cover postsurgical therapy to help me recover erectile function?

Well aware of the impact that prostate surgery can have on their patients, doctors today try to select the least invasive surgical option that will effectively remove the cancer while limiting the damage this can cause to sexual function, at least temporarily.

Impact on Sexual Function Varies

Despite employing the least invasive surgical options available, most prostate surgery causes a loss of sexual function, the severity and term of which can vary sharply from one patient to another. On the bright side, there are options that men can pursue to function sexually after surgery, albeit in a somewhat different way than they did before.

The primary option for postsurgical prostate patients whose sexual function has been only slightly affected is treatment with Viagra or one of the other PDE5 inhibitors that are designed to temporarily improve blood flow to the penis. However, in cases where the prostate surgery has caused damage to the nerves that play a key role in the erection process, such medications may be of little use, at least in the early stages of recovery.

Inflatable Prosthesis Is Another Option

In such cases, a patient may opt instead for an inflatable penile prosthesis (IPP), which can simulate erection by pumping fluid from a subcutaneously implanted reservoir into the penile prosthesis. When sexual activity is completed, the patient can reverse the pump process to drain fluid from the prosthesis back into the reservoir.

These options allow prostate surgery patients to continue some degree of sexual activity during the recovery period. In some cases, nerve damage is reversed as nerve tissue regenerates, and a return to a near-normal sex life is possible. In other cases, prostate cancer survivors may need to use implantable penile prostheses or oral ED drugs for the rest of their lives.

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Will My Insurance Cover It?

All of which begs the question about insurance coverage for such postsurgical therapy. Unfortunately, there is no single answer to the question. It depends very much on your health insurer’s policy with regard to such matters. And many large health insurers offer a wide array of coverages, so to find out for certain you probably should speak to a customer service representative for your insurer.

A supplement to the May 2018 issue of “The Journal of Urology,” carried the results of an analysis of insurance coverage data from the verification benefits databases of two major IPP manufacturers. Of the 4,592 cases submitted for insurer reimbursement, 3,795, or nearly 83 percent, were eligible for at least some degree of reimbursement. In contrast, insurers offer virtually universal breast reconstruction coverage to women who’ve undergone breast cancer surgery.

Among major health insurers, UnitedHealthcare and Aetna Inc. appear to have the broadest coverage of ED therapy and the fewest exclusions of IPP surgery coverage. Under UnitedHealthcare policies, 94.4 percent had ED treatment benefits and only 3 to 4 percent had IPP exclusions. For Aetna, the comparable figures were 93.2 percent and roughly 6 percent.

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About Don Amerman

Don Amerman has spent more than three decades in the business of writing and editing. During the last 15 years, his focus has been on freelance writing. For almost all of his writing, He has done all of his own research, both online and off, including telephone and face-to-face interviews where possible. Don Amerman on Google+