Emerging Data Regarding Disparities in Insurance Coverage of Male Sexual Health Conditions
Emily May, BA1, Meg Hanley, BS1, Sarah Schrup, BS2, Matthew Ziegelmann, MD2, Martin S. Gross, MD1.
1Dartmouth Hitchcock Medical Center, Lebanon, NH, USA, 2Mayo Clinic Alix School of Medicine, Rochester, MN, USA.
Introduction: We previously explored the lack of uniformity that exists for insurance payer coverage for penile prostheses. We sought to expand this investigation to determine insurance coverage criteria for medical and surgical management of other common men's health conditions. Medical policy bulletins are insurance company guidelines for administering plan benefits. These documents determine whether insurers consider procedures/services to be medically necessary. These bulletins, along with member benefit plans, determine which services are covered.
Materials & Methods: Common sexual medicine conditions and treatment modalities for each were identified (Table I). Securities and Exchange Commission (SEC) filings were used to find the ten largest private insurers by member enrollment. This list was cross-referenced with the National Association of Insurance Commissioners (NAIC) 2020 Market Share Report. Kaiser and Centene were excluded due to a lack of nationwide medical policy bulletin. We reviewed medical policy bulletins to determine whether the list of treatment modalities for common sexual medicine conditions were identified as medically necessary ("covered"), investigational/cosmetic ("not covered"), or not found ("unknown").
Results: Our review of medical policy bulletins yielded 143 data points - 60 (41.9%) instances of covered services, 18 (12.6%) non-covered services, and 65 (45.5%) services with unknown coverage (Table I).
Conclusion: We encountered substantial difficulty in navigating and interpreting policy bulletins to form significant understanding of which sexual medicine treatments and conditions may be covered. No information was available for nearly half of the data points collected and instances of "unknown" coverage exceeded covered conditions. While 76.9% of conditions for which there was available data were covered, we are unable to draw generalizable conclusions for most conditions as there is such a significant amount of information missing from the online insurance information sources. Further challenges in determining coverage include the additional layers of limitations in member plan benefits, which could lead to confusion for both physicians and patients. 
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