{"id":"https://openalex.org/W2931863530","doi":"https://doi.org/10.1016/j.jsxm.2019.01.249","title":"242 Commercial Insurance Coverage for Inflatable Penile Prosthesis at a Tertiary Care Center","display_name":"242 Commercial Insurance Coverage for Inflatable Penile Prosthesis at a Tertiary Care Center","publication_year":2019,"publication_date":"2019-03-29","ids":{"openalex":"https://openalex.org/W2931863530","doi":"https://doi.org/10.1016/j.jsxm.2019.01.249","mag":"2931863530"},"language":"en","primary_location":{"id":"doi:10.1016/j.jsxm.2019.01.249","doi":"https://doi.org/10.1016/j.jsxm.2019.01.249","is_oa":false,"landing_page_url":"https://doi.org/10.1016/j.jsxm.2019.01.249","pdf_url":null,"source":{"id":"https://openalex.org/S159512450","display_name":"The Journal of Sexual Medicine","issn_l":"1743-6095","issn":["1743-6095","1743-6109"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","dongbi-b","doyens","jufo-1","ki-jl-1","medline","norway-1","poland-140","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320990","host_organization_name":"Elsevier BV","host_organization_lineage":["https://openalex.org/P4310320990"],"host_organization_lineage_names":["Elsevier BV"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"The Journal of Sexual Medicine","raw_type":"journal-article"},"volume":null,"type":"article","indexed_in":["crossref"],"open_access":{"is_oa":false,"oa_status":"closed","oa_url":null,"any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5049204727","display_name":"John Michael Masterson","orcid":"https://orcid.org/0000-0002-0388-1670","observed_orcids":["https://orcid.org/0000-0002-0388-1670"]},"institutions":[{"id":"https://openalex.org/I145608581","display_name":"University of Miami","ror":"https://ror.org/02dgjyy92","country_code":"US","type":"education","lineage":["https://openalex.org/I145608581"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"J. Masterson","raw_affiliation_strings":["University of Miami Miller School of Medicine"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"University of Miami Miller School of Medicine","institution_ids":["https://openalex.org/I145608581"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5025348800","display_name":"Ranjith Ramasamy","orcid":"https://orcid.org/0000-0003-1387-7904","observed_orcids":["https://orcid.org/0000-0003-1387-7904"]},"institutions":[{"id":"https://openalex.org/I145608581","display_name":"University of Miami","ror":"https://ror.org/02dgjyy92","country_code":"US","type":"education","lineage":["https://openalex.org/I145608581"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"R. Ramasamy","raw_affiliation_strings":["University of Miami Miller School of Medicine"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"University of Miami Miller School of Medicine","institution_ids":["https://openalex.org/I145608581"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5109212099","display_name":"BruceR Kava","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I145608581","display_name":"University of Miami","ror":"https://ror.org/02dgjyy92","country_code":"US","type":"education","lineage":["https://openalex.org/I145608581"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"B. Kava","raw_affiliation_strings":["University of Miami Miller School of Medicine"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"University of Miami Miller School of Medicine","institution_ids":["https://openalex.org/I145608581"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":1,"corresponding_author_ids":[],"corresponding_institution_ids":["https://openalex.org/I145608581"],"apc_list":{"value":2625,"currency":"USD","value_usd":2625},"apc_paid":null,"fwci":0.3996,"has_fulltext":false,"cited_by_count":3,"citation_normalized_percentile":{"value":0.6320514,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":{"min":89,"max":94},"biblio":{"volume":"16","issue":"Supplement_1","first_page":"S116","last_page":"S117"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10459","display_name":"Sexual function and dysfunction studies","score":0.9980000257492065,"subfield":{"id":"https://openalex.org/subfields/2738","display_name":"Psychiatry and Mental health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T10459","display_name":"Sexual function and dysfunction studies","score":0.9980000257492065,"subfield":{"id":"https://openalex.org/subfields/2738","display_name":"Psychiatry and Mental health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11815","display_name":"Urological Disorders and Treatments","score":0.0007999999797903001,"subfield":{"id":"https://openalex.org/subfields/2748","display_name":"Urology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10279","display_name":"Urinary Bladder and Prostate Research","score":0.00019999999494757503,"subfield":{"id":"https://openalex.org/subfields/2748","display_name":"Urology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/inflatable-penile-prosthesis","display_name":"inflatable penile prosthesis","score":1.0},{"id":"https://openalex.org/keywords/insurance-denials","display_name":"insurance denials","score":0.6430000066757202},{"id":"https://openalex.org/keywords/insurance-exclusions","display_name":"insurance exclusions","score":0.8529999852180481},{"id":"https://openalex.org/keywords/erectile-dysfunction","display_name":"erectile dysfunction","score":0.984000027179718},{"id":"https://openalex.org/keywords/medicare","display_name":"Medicare","score":0.6489999890327454},{"id":"https://openalex.org/keywords/radical-prostatectomy","display_name":"radical prostatectomy","score":0.9150000214576721},{"id":"https://openalex.org/keywords/diabetes-mellitus","display_name":"diabetes mellitus","score":0.5960000157356262},{"id":"https://openalex.org/keywords/organic-erectile-dysfunction","display_name":"organic erectile dysfunction","score":0.6990000009536743},{"id":"https://openalex.org/keywords/health-care-costs","display_name":"health care costs","score":0.33000001311302185}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.7011134624481201},{"id":"https://openalex.org/C2779929075","wikidata":"https://www.wikidata.org/wiki/Q184674","display_name":"Erectile dysfunction","level":2,"score":0.607361376285553},{"id":"https://openalex.org/C2779513377","wikidata":"https://www.wikidata.org/wiki/Q964984","display_name":"Current Procedural Terminology","level":2,"score":0.6063334345817566},{"id":"https://openalex.org/C2776165071","wikidata":"https://www.wikidata.org/wiki/Q2069010","display_name":"Penile prosthesis","level":3,"score":0.5265940427780151},{"id":"https://openalex.org/C2991842025","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Tertiary care","level":2,"score":0.50859534740448},{"id":"https://openalex.org/C2779466945","wikidata":"https://www.wikidata.org/wiki/Q1765251","display_name":"Prostatectomy","level":4,"score":0.47824326157569885},{"id":"https://openalex.org/C512399662","wikidata":"https://www.wikidata.org/wiki/Q3505712","display_name":"Family medicine","level":1,"score":0.34033316373825073},{"id":"https://openalex.org/C141071460","wikidata":"https://www.wikidata.org/wiki/Q40821","display_name":"Surgery","level":1,"score":0.23629364371299744},{"id":"https://openalex.org/C2780192828","wikidata":"https://www.wikidata.org/wiki/Q181257","display_name":"Prostate cancer","level":3,"score":0.16216927766799927},{"id":"https://openalex.org/C126322002","wikidata":"https://www.wikidata.org/wiki/Q11180","display_name":"Internal medicine","level":1,"score":0.12407052516937256},{"id":"https://openalex.org/C121608353","wikidata":"https://www.wikidata.org/wiki/Q12078","display_name":"Cancer","level":2,"score":0.0}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.1016/j.jsxm.2019.01.249","doi":"https://doi.org/10.1016/j.jsxm.2019.01.249","is_oa":false,"landing_page_url":"https://doi.org/10.1016/j.jsxm.2019.01.249","pdf_url":null,"source":{"id":"https://openalex.org/S159512450","display_name":"The Journal of Sexual Medicine","issn_l":"1743-6095","issn":["1743-6095","1743-6109"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","dongbi-b","doyens","jufo-1","ki-jl-1","medline","norway-1","poland-140","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320990","host_organization_name":"Elsevier BV","host_organization_lineage":["https://openalex.org/P4310320990"],"host_organization_lineage_names":["Elsevier BV"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"The Journal of Sexual Medicine","raw_type":"journal-article"}],"best_oa_location":null,"sustainable_development_goals":[{"score":0.9537000060081482,"id":"https://metadata.un.org/sdg/3","display_name":"Good health and well-being"}],"sustainable_development_goals_aurora":[{"score":0.46000000834465027,"id":"https://metadata.un.org/sdg/10","display_name":"Reduced inequalities"}],"study_designs":[{"id":"https://openalex.org/study-designs/observational-study","display_name":"Observational Study"}],"awards":[],"funders":[],"has_content":{"grobid_xml":false,"pdf":false},"content_urls":null,"referenced_works_count":0,"referenced_works":[],"related_works":["https://openalex.org/W2892189094","https://openalex.org/W2926853154","https://openalex.org/W4253341504","https://openalex.org/W4385968874","https://openalex.org/W2997889207","https://openalex.org/W2997475086","https://openalex.org/W4385969141","https://openalex.org/W4312937986","https://openalex.org/W2795790352","https://openalex.org/W3015869248"],"abstract_inverted_index":{"Inflatable":[0],"penile":[1,134],"prosthesis":[2],"(IPP)":[3],"has":[4],"become":[5],"an":[6,132],"important":[7],"treatment":[8],"modality":[9],"for":[10,83,113],"men":[11,59,96,114,125,149,160,184],"with":[12,60,163],"erectile":[13],"dysfunction":[14],"(ED)":[15],"that":[16],"is":[17,40,137],"refractory":[18],"to":[19,48,94,171,175],"medication.":[20],"Despite":[21],"high":[22],"levels":[23],"of":[24,44,52,107,131,142,146],"patient":[25],"satisfaction":[26],"following":[27],"IPP":[28,31,53,65,111,117,151,162,173],"placement":[29],"and":[30,74,154,206],"coverage":[32,35,51,179],"by":[33,36,54],"Medicare,":[34],"commercial":[37,55,164],"insurance":[38,56,165,190],"providers":[39],"unknown.":[41],"The":[42],"objective":[43],"this":[45],"study":[46,92],"was":[47],"determine":[49],"the":[50,91,138,157,183],"providers.":[57],"All":[58],"ED":[61],"interested":[62],"in":[63,177,188],"obtaining":[64],"at":[66],"our":[67],"tertiary":[68],"care":[69],"center":[70],"between":[71,152],"January":[72],"2016":[73,153],"December":[75],"2017":[76],"were":[77,169,193,197,209],"evaluated.":[78],"We":[79,100,123],"reviewed":[80,102],"billing":[81],"records":[82],"current":[84],"procedural":[85],"terminology":[86],"(CPT)":[87],"code":[88],"54405":[89],"during":[90],"period":[93],"evaluate":[95],"who":[97,115,126,185],"received":[98,127],"IPP.":[99,122],"also":[101],"a":[103],"manually":[104],"maintained":[105],"record":[106],"excluded":[108,124],"or":[109,129,180,192],"denied":[110],"claims":[112],"desired":[116],"but":[118],"could":[119],"not":[120],"obtain":[121,172],"repair":[128],"replacement":[130],"existing":[133],"prosthesis.":[135],"Medicare":[136],"most":[139],"common":[140],"insurer":[141],"IPP,":[143],"insuring":[144],"76":[145],"200":[147],"(38.0%)":[148],"seeking":[150,161],"2017.":[155],"Among":[156,182],"remaining":[158],"124":[159],"coverage,":[166],"61":[167],"(49.2%)":[168],"unable":[170],"due":[174],"exclusions":[176,187],"their":[178,189],"denials.":[181],"had":[186,203],"policies":[191],"denied,":[194],"47":[195],"(77.0%)":[196],"status-post":[198],"radical":[199],"prostatectomy,":[200],"36":[201],"(59%)":[202],"organic":[204],"ED,":[205],"27":[207],"(44.3%)":[208],"diabetic.":[210]},"counts_by_year":[{"year":2022,"cited_by_count":1},{"year":2020,"cited_by_count":1},{"year":2018,"cited_by_count":1}],"updated_date":"2026-09-26T08:19:03.415552","created_date":"2019-04-11T00:00:00"}