Questions about Erectile Dysfunction

_{Insurance: Am I covered?}

What is ED?
Erectile dysfunction (ED) is defined as the persistent inability to achieve or maintain a penile erection sufficient for satisfactory sexual performance.⁶ ED can limit your intimacy, affect your self-esteem, and impact your most important relationships. Beyond the physical manifestations, ED causes emotional damage and there is a strong link found between ED and depression.⁷

How common is ED?
ED is a surprisingly common condition, approximately 1 million men in Australia suffer from ED.^1a

What causes ED?
While there are real physical and psychological reasons for ED, there’s no single cause. The chart below outlines the most common causes of ED. ⁹

How is ED diagnosed?
You may have to start the conversation with your doctor to get an answer to the question, “Do I have ED?” A personal history and physical exam set the groundwork for most conditions. Lab tests and other tests may identify a source such as diabetes, coronary artery disease or other conditions that affect the nerves and blood flow to the penis.

If I have ED symptoms, could I have heart disease?
Hardening of the arteries caused by plaque buildup – atherosclerosis – limits blood flow to various parts of the body. The arteries supplying blood to the penis are much smaller than the ones supplying blood to the heart. As a result, heart disease may first show itself as difficulty achieving an erection.³⁶ Learn More

Why does diabetes cause ED symptoms?
Diabetes damages the blood vessels and nerves that supply the penis with blood to form an erection. The constant change in blood sugar levels can also cause nerve damage, which can lead to loss of sensation in the feet and hands, and can affect having sex.¹⁹ Learn More

What are some of the side effects from prostate cancer treatment?
The two most feared side effects of a radical prostatectomy are loss of erections and bladder leakage. These side effects can occur, but there are successful treatment options available. Also, after total removal of the prostate, there is no ejaculation, although there is the sensation of climax and orgasm. ³⁷ Learn More

When can a man resume sexual activity after prostate cancer treatment?
If the cancer is detected early and patients are treated by an experienced surgeon using nerve-sparing techniques, then sexual activity may return to normal after surgery. This can take three to six months with continued improvement for two or three years.¹¹ If sexual activity does not return on its own, there are many different ways to support an active sex life (medications, pumps, injections and penile implants). Learn More

How is ED treated?
ED treatment is available to all men with ED. Oral medications are a common first step, but they don’t work for everyone. If men don’t respond to oral medications, they may try other options such as pump devices, injections and penile implants.

INSURANCE: Am I covered?

_{Questions about Erectile Disfunction}

Implantable medical devices, that are intended for long term use, are covered under the Prostheses List which is released by the Department of Health and Ageing. Any device listed on the Prostheses List has its cost fully reimbursed by the patient’s applicable private health fund, so there is no cost to the patient.

Most private health funds (and/or Medicare) cover the medically necessary diagnosis and treatment of ED. Dependent on the patient’s level of private health cover, there may be some expenses incurred not reimbursed by the health fund.

Below are steps a patient can take to minimise 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 before you receive a service.
• If you still have questions about your coverage, 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.

Professional fees for surgeons, surgical assistants and anaesthetists and hospital fees for having the device implanted may vary. Private health insurance will largely cover these costs. Experienced prosthetic urologist will provide their patients with informed financial consent.

For patients with no private health insurance cover, they can choose to self-finance to do this a detailed description of the out-of-pocket costs should be obtained from the urologist. The costs will vary.

Any patient that falls under Veterans Affairs policies will have the total cost of the surgery covered by the Commonwealth Government.

To avoid delays in payment or reimbursement, work with your Urologist’s office and health fund to verify coverage and reimbursement payment levels before beginning a treatment path.