Erectile Dysfunction is an issue that hinders the sexual performance and quality of life for many men. It is characterized by a man’s inability to develop or maintain a penile erection, regardless of sexual arousal. While the contributing factors to Erectile Dysfunction can vary from case to case, these factors are often categorized by physical disability, psychological interference and age-related factors.

Medicaid Has Covered Over $100 Million Worth of Penis Pumps!

Requiring the support of government entities does not need to limit a person’s ability to live their life. As a result of this simple, undeniable fact, programs such as Medicare and Medicaid cover certain treatment options for Erectile Dysfunction. The most common of these covered treatments is a penis pump. That means that if a person qualifies for Medicaid support in your state, they are likely entitled to support with acquiring a penis pump for their personal use.

Here is a Concise Guide to Using Medicaid Benefits to Subsidize the Acquisition of a Penis Pump

Step 1: Apply for Medicaid: The first thing required to submit a Medicaid claim for a penis pump is to become part of the Medicaid benefits network. To do this, an applicant must first travel to their local Department of Human Services office in their state. The purpose of this visit is to acquire and complete the required application.

The application requires a great deal of information. Applicants should be prepared to supply their name, address and social security number, as well as the information for any of their dependents. There is also a questionnaire that requires information about pregnancy status, marital status and a number of other personal information inquiries. That last section of the application will ask about employment information, dates of employment and wages earned. These all determine your eligibility and category of benefits. Keep in mind, many states have requirements for Medicaid qualification that differ from the national guidelines. A state DHS office can give accurate information regarding eligibility.

Discussing ED With The Doc

Step 2: Choosing a Doctor: Choosing a doctor for this process might not be an option for all applicants. For people who are already in the Medicaid benefits network, there is most likely already a general doctor in place. However, if this is the beginning of a person’s Medicaid benefits journey, there are doctor selection options in place that can impact the acquisition of a penis pump down the road.

Most applicants are offered a choice between fee-for-service and managed care options. With fee-for-service, the benefits recipient must find their own doctor who accepts Medicaid patients. Managed care offers typical health maintenance organizations (HMO) and prepaid health plans (PHP) who partner with Medicaid. This might not seem like a decision that would impact future success in getting a penis pump, but it certainly can.

Fee-for-service providers offer a better chance at this than HMO or PHP structures. This is because of the recent claims of Medicare and Medicaid fraud involving penis pumps being exposed in the news. Politically, it is a bad play for someone to support an organization that uses tax dollars on penis pumps. Since Erectile Dysfunction is a very real issue, this is an unfortunate and unfair stigma. However, HMO and PHP structures are more tightly regulated than fee-for-service providers. If an applicant has a choice, they should likely choose their health service provider accordingly. Again, this varies from state to state.

Step 3: Acquire an Erectile Dysfunction Diagnosis: Since Medicaid exists to support people with health issues, the next step to acquire a penis pump that is covered by Medicaid is to demonstrate that a legitimate health need exists. To do that, a doctor is going to have to diagnose the patient with the condition. There are a myriad of conditions that can bring about Erectile Dysfunction, so diagnostic testing is required

The first step that a physician usually takes is to review the patient’s medical history and perform a thorough physical exam. There is usually no issue at all with submitting a Medicaid claim for this or any other diagnostic testing. While most of this stage will not seem abnormal, there is an interview involved that can be unexpected if a patient is not prepared.

In this interview, a variety of questions are asked for the physician to obtain background information on the symptoms that first brought about an Erectile Dysfunction concern. Some of these questions involve profile questions about stress, anxiety and other common issues that can cause the condition. However, some of the questions are considerably more personal in nature. For example, a patient will likely be asked about their sexual partners, time of erection, quality of erection, sexual techniques and relationship status. It is important to answer all of these questions with complete honesty, since the information will help the doctor to diagnose and treat the Erectile Dysfunction.

Sometimes, this interview is done in collaboration with the patient’s sexual partner. That way, the partner can give insight as the the onset of the condition and any particular trends that might help facilitate a diagnosis and treatment plan. Since the questions at this interview are personal in nature, it can be a benefit for couples to discuss this visit prior to traveling to the doctor’s office.

Following this interview, the doctor will order one or more of the following tests:

• Complete Blood Count (CBC): This test will determine characteristics about the cellular count in a patient’s blood. This count can determine underlying causes of fatigue, anemia and other issues that create the symptoms of Erectile Dysfunction.
• Liver and Kidney Profile: This test ensures the proper function of a patient’s liver and kidneys, both of which can cause Erectile Dysfunction when operating incorrectly.
• Lipid Profile: Often done in conjunction with blood pressure and cholesterol concerns, this test can show the doctor if there are artery or blood circulation concerns. Since penile erections require sufficient blood flow, this is an important test.
• Thyroid Function Test: Thyroid function includes the production of hormones, including sex hormones. Sometimes Erectile Dysfunction is linked to the underproduction or absence of these hormones.
• Urinalysis: A test of the patient’s urine can show a wealth of information related to protein, sugar and testosterone. When the level of these three substances is not correct, the underlying issue that causes a patient’s Erectile Dysfunction is often found.
• Nocturnal Penile Tumescence: Similar to a sleep study in which a patient’s brain function during sleep is monitored, this test measures a patient’s penile activity. A normal functioning penis might become erect 5-6 times per night. If this does not occur, a nerve function issue might be the root cause of Erectile Dysfunction.
• Bulbocavernous Reflex: During this test, the doctor squeezes the head of the penis. When nerves are functioning properly, this will cause a reflexive tightening of the rectum. If that reflex is absent, nerve functioning is a prime culprit.
• PSA: A PSA is given to test the health and size of the prostate. If the prostate is enlarged or infected, Erectile Dysfunction is often the result.

There are other tests that a doctor might choose to initiate upon completion of the Erectile Dysfunction interview. However, this should serve as a sufficient primer to prepare a patient for the road ahead. Typically, the results of the interview combine with the testing data to yield a diagnosis.

Step 4: Purchase a Penis Pump: In the event that your doctor prescribes a penis pump for Erectile Dysfunction treatment, they will likely inform you how to go about purchasing the equipment. Since this type of equipment is covered under the Durable Medical Equipment section of Medicaid, a penis pump must be purchased from a licensed DME distributor.

I Recommend a Penis Pump Like the Bathmate x30 or x40 (all models pictured)

A patient will proceed to purchase their penis pump from a licensed DME distributor. A receipt will need to be obtained, and a claim form acquired from the local DHS office. This form will need to be submitted along with the receipt and any requested supporting documentation to the location identified on the claim form. Sometimes, the licensed DME distributor will be able to submit the claim for the patient.

So long as the equipment was delivered or sold by a licensed distributor and the user is trained in operation, replacement pumps should be covered. However, if the pump was originally delivered by an unlicensed agent or the pump was used incorrectly, replacement pumps will not be covered. Since most pumps come with a long term warranty, this is usually not an issue. Furthermore, some pumps come with a combination of battery operated and hand driven pumps. This allows a patient to actually have two pumps covered by insurance, since they come complete in the same package.

While the process appears lengthy and convoluted, it truly is as simple has obtaining Medicaid benefits, proving a legitimate need for the penis pump and purchasing the pump from a licensed dealer that partners with Medicaid. If any of these steps are difficult, there are plenty of people ready to offer assistance at the DHS office, your doctor’s office or the pharmacy. The important thing is to not be embarrassed by the conversation. Erectile Dysfunction is a genuine medical issue that impacts a person’s quality of life. In much the same way that a power chair or a bed lift helps disabled patients, a penis pump helps those who suffer from Erectile Dysfunction. There is no shame in developing a strategy to mitigate the effects of this condition. This is no different for people who find themselves needing government financial assistance.