Understanding Medicare Coverage for Stress Incontinence Treatment

As we grow older, we become more likely to develop various health issues — including stress incontinence. Though this condition can occur at any age, it's more common in older adults.

One effective treatment for stress incontinence is bladder sling surgery. It's a minimally invasive procedure and is often covered by insurance.

Keep reading to find out more. In this article, we'll discuss stress incontinence, how bladder sling surgery treats the condition, and whether Medicare will cover the expenses.

What Is Stress Incontinence?

Incontinence is the loss of control over urination or bowel movements. It's a common problem that can affect people of all ages and impact their life.

Stress incontinence is a type of urinary incontinence caused by physical activity (e.g., coughing, sneezing, or lifting). These physical movements put pressure on the bladder, causing it to leak urine.

Stress incontinence is more common in women than men and can be caused by several factors — including pregnancy, childbirth, menopause, obesity, prostrate surgery, and certain medical conditions.

What's Bladder Sling Surgery?

A bladder sling surgery (AKA a mid-urethral sling procedure) treats stress urinary incontinence. It most commonly treats females but can also be performed on males.

During the procedure, a surgeon creates a "sling" out of synthetic material or human tissue and places it under the urethra (the tube that carries urine out of the body). The sling prevents urine leakage — supporting the urethra and keeping it closed when you are not urinating.

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‎Bladder Sling Surgery | A.M.I

How Long Does Bladder Sling Surgery Take?

The procedure usually takes only 30-60 minutes. However, recovery time can vary depending on the individual.

Most people can return to normal activities within a few weeks of the surgery.

How Is Bladder Sling Surgery Performed?

‎Bladder sling surgery is an outpatient procedure. You'll receive local or general anesthesia, depending on your specific condition.

During the surgery, the surgeon makes a small incision:

• In females — between the urethra and the vagina

• In males — in the abdomen or through the perineum (the area between the scrotum and anus)

The surgeon then inserts a synthetic mesh material (in the form of a sling) and positions it around the urethra. This provides support and helps keep the urethra closed.

The surgeon may draw up the ends of the sling over the pubic bone or near the thigh creases — depending on their preferred technique. They'll test the sling to make sure it provides sufficient support during coughing and adjust its tension if necessary.

What Are Potential Complications of Bladder Sling Surgery?

Bladder sling surgery is a minor outpatient procedure. But like every surgery, it has risks.

Potential complications include:

• Bleeding

• Injury to the urethra, bladder, intestine or vagina

• Erosion of the sling

• Urinary tract infection

• Pain

• Difficulty peeing or increased urgency to pee

Does Medicare Cover Bladder Sling Surgery?

Yes. Medicare covers bladder sling surgery — as long as your doctor declares it medically necessary.

That said, exact coverage depends on your specific plan.

• For example, Original Medicare typically covers 80% of the approved cost for the surgery, while you pay the remaining 20%

• However, if you're enrolled in a Medigap plan or Medicare Advantage plan, they may cover the remaining 20%

Check with your healthcare provider and review your plan's coverage rules. You want to know how much you'll owe, as well as any requirements or limitations that may apply.

How Much Does Bladder Sling Surgery Cost?

The cost of bladder sling surgery ranges anywhere from $6,000 – $25,000.

However, the exact cost depends on the following factors:

• The type of procedure being performed

• The experience and training of the surgeon

• The location of the surgery

With Original Medicare, you could be stuck with 20% coinsurance of the approved amount. To save thousands of dollars on bladder sling surgery, we recommend Medicare Supplement Plan G, limiting out-of-pocket costs to the Part B deductible.

Takeaway

Stress incontinence occurs when physical activity or movement puts pressure on the bladder, causing accidental urine leakage.

Bladder sling surgery — an outpatient procedure with minor complications — treats stress incontinence and helps you lead a normal life.

Medicare provides at least partial coverage for bladder sling surgery. But your exact out-of-pocket costs depend on your plan.

Talk to your healthcare provider about your plan's coverage options for bladder sling surgery. If you need help, call us at 1-888-376-2028. Our advisors can break down the complexities of Medicare and answer any questions you may have.