Many men want to know which health insurance plan covers penile prosthesis due to the high cost of the procedure. Most health insurers cover the surgery and ANS authorizes the malleable prosthesis. Clear your doubts on Dr. Paulo Egydio’s blog!
The question about which health insurance plans offer coverage for penile prosthesis surgery usually arises among patients who live with severe erectile dysfunction or anatomical changes resulting from Peyronie’s Disease. In these cases, the possibility of undergoing the procedure can represent a therapeutic alternative, to be considered according to the individual clinical assessment and the criteria established by the attending physician.
Knowing how penile prosthesis coverage works within the plan is important for the patient’s financial planning. This is because each health insurer has its own rules: while some cover both the surgery and the implantation of the penile prosthesis, others offer coverage only for the device, leaving surgical costs to the patient.
Below, we will clarify whether a health plan covers penile prosthesis and also what the criteria are for penile prosthesis through SUS.
Which health insurance plan covers penile prosthesis in Brazil?
To know specifically which plans cover inflatable and malleable penile prostheses and the price of the procedure, it is necessary to contact the health insurers.
First of all, it is important to know that ANS (National Supplementary Health Agency) is the body responsible for setting the rules for performing penile prosthesis surgery through private health plans. It is a regulatory agency linked to the Ministry of Health, whose function is to supervise and regulate the private health market in Brazil.
According to the technical opinion in force since 1 April 2021, coverage for penile prosthesis is authorized in plans contracted from 1 January 1999 onwards.
The rule also applies to contracts signed between 2 September 1998 and 1 January 1999, provided they have been adapted to the guidelines of Law No. 9.656/1998.
What are the types of prostheses?
The types of prosthesis most often used are the malleable and the inflatable.
The malleable prosthesis is composed of two metal rods coated with silicone. These two rods are inserted into the corpora cavernosa of the penis, leaving it slightly rigid permanently.
To have sexual intercourse, the man should position the penis upward. When the act is over, he simply repositions it downward.
The inflatable prosthesis, on the other hand, has a system composed of three items: a small pump housed in the scrotum, a reservoir with saline solution and two cylinders inserted inside the penis.
To obtain an erection, the man manually activates the pump, which transfers the saline to the cylinders, inflating them. After intercourse, a new activation makes the fluid return to the reservoir, deflating the cylinders and returning the penis to a flaccid state.
But if the urologist has indicated that the inflatable prosthesis is the most suitable for your case and you have a health plan, check whether the plan covers this type of prosthesis and what the insurer’s rules are.
Penile prosthesis through SUS: is it possible?
Yes, it is possible to receive a penile prosthesis through SUS, but only the malleable type.
According to the procedure review of COSAÚDE (Health Care Regulation Committee), the inflatable penile prosthesis has not yet been incorporated into SUS due to insufficient scientific evidence proving its superior efficacy compared with the malleable version.
Another justification is that SUS already offers the malleable penile prosthesis, considered an effective therapeutic option for selected cases of erectile dysfunction and sufficient to meet the needs of most patients.
How to choose the best penile prosthesis option for you?
The penile implant is not chosen by the patient. The best choice is always made in collaboration with the surgeon who is managing your case.
This partnership is important and necessary for the doctor to present to the man the advantages and disadvantages of each model, allowing the patient to reflect on his expectations regarding the treatment.
Studies report that, in well-indicated and well-followed cases, many patients mention improved quality of life.
Is it worth having health insurance to implant a penile prosthesis?
You do not need a health plan specifically for penile prosthesis in order to undergo this treatment. However, although it is not always affordable, having this service can be beneficial.
Taking out a health plan solely for penile prosthesis is not always a good idea.
Therefore, having health insurance is ideal for taking care of your health as a whole, which includes surgical treatment for Peyronie’s Disease, erectile dysfunction or curvature in young men.
Now that you have discovered which health plan covers penile prosthesis, explore other content here on the Dr. Paulo Egydio blog for more up-to-date tips on men’s health.
