![]() ![]() Work with your doctor to appeal a denial for “not medically necessary.” The denial letter from your insurance will detail why they deemed the penile implant not medically necessary and it will outline the appeal process. ![]() If your insurance says your penile implant is not medically necessary, there is often an opportunity to appeal. This is often referred to as a “benefit exclusion.” This is often called a “denial.” Or, the plan you have may not have benefit coverage for ED treatment and/or a penile implant. Your insurance may have determined a penile implant was not medically necessary and therefore will not allow coverage. If penile implant surgery is not covered by your insurance, you will first need to determine the reason for non-coverage. Your co-pay, deductible and co-insurance will determine your financial responsibility (the amount you will have to pay). The cost you pay for a penile implant will differ depending upon your insurance plan and the type of facility where the procedure is done. Keep in mind that how much you will pay out-of-pocket will vary. All penile implants manufactured by Boston Scientific ( AMS 700 TM series penile implant, Ambicor TM penile implant and Tactra TM penile implant) are devices to treat ED and qualify as reimbursable when an insurance plan covers penile implant surgery and you qualify for the benefit. The contact information for your insurance plan is typically on the back of your insurance card. You should contact your insurance plan directly to confirm your insurance benefits include coverage for a penile implant. However, this is not a guarantee of payment. If penile implant surgery is covered by your insurance, your doctor will likely have confirmed your benefits and obtained any necessary authorization from your insurance. If erectile dysfunction treatment is a benefit exclusion, you will be responsible for all charges related to the surgery. They will help you understand the benefit exclusion and discuss your options. If the penile implant is a benefit that is excluded (also called a benefit exclusion), call Boston Scientific’s Patient Procedure Access Specialists at (855) 284-1676, option #1. However, some employers exclude benefits for erectile dysfunction treatment and do not cover the penile implant as a treatment solution. Some employers provide benefits for ED treatments and cover penile implant procedures. With this insurance, your employer chooses what benefits to cover.Some may exclude benefits for a penile implant altogether. Others will determine coverage based on medical necessity. If a commercial insurance plan covers penile implant surgery, they will often have specific requirements that must be met. Insurance plans through your employer or health insurance that you’ve purchased yourself are often referred to as “commercial” plans. ![]()
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