Diabetes-Related Urological Issues: Circumcision and Health Insurance Concerns

Q: Diabetes-Related Urological Issues: Circumcision and Health Insurance Concerns

Hello： The coverage provided by health insurance is regulated, and since there are only a few specified items, many circumcision surgeries are out-of-pocket expenses. <br>Of course, you can consult several hospitals to see if the procedure can be covered by insurance. <br>As for

Caused by diabetes mellitus?

Good morning, doctor.
I apologize for disturbing you and taking up your valuable time to seek your professional opinion.
Here’s the situation: I started experiencing symptoms of cracked and bleeding skin on my genitalia, diagnosed as balanitis, at the end of last year.
After visiting Chang Gung Memorial Hospital in Taoyuan, I was advised to maintain good hygiene.
However, by early April this year, my symptoms had not improved and had worsened, so I went to a nearby regional hospital.
The doctor took a quick look and diagnosed me with diabetes.
After an X-ray examination, I was informed that I had left renal hydronephrosis and that we needed to address the hydronephrosis first, while the genital issue could be treated with topical medication (eye ointment) for the time being.
After the hydronephrosis (due to kidney stones) was treated, during my follow-up visit, I casually inquired about my previous genital issues.
The balanitis had resolved, but I still experienced tightness of the foreskin during erections, leading to pain and discomfort.
The doctor then suggested scheduling a circumcision for the following week, but it would only be available as a self-paid laser surgery, without insurance coverage.
This raised two questions in my mind: First, is it safe to perform surgery on my genitalia less than a month after starting diabetes medication? Second, can the circumcision related to diabetes complications be covered by insurance?
The urologist at the regional hospital did not provide a direct answer and asked me to look for information on my own before making a decision.
So far, I have not found clear information on how long diabetes treatment should be established before undergoing circumcision.
Additionally, I found that circumcision is eligible for insurance coverage only under five specific conditions: (1) paraphimosis, (2) history of recurrent balanitis with documented medical records, (3) scarring of the foreskin affecting urination or penile erection, (4) foreskin removal required for pathological examination, and (5) foreskin removal necessary for other surgical procedures.
Therefore, I would like to ask if my condition truly does not qualify for insurance coverage? Under what circumstances can circumcision be performed in relation to diabetes? I apologize for the lengthy description and for bothering you with these two questions.
I would greatly appreciate any professional advice you could provide for my reference.
Thank you very much, and I wish you good health.

David Wo, 30~39 year old female. Ask Date: 2018/06/03

Dr. Du Shixi reply Urology

Hello: The coverage provided by health insurance is regulated, and since there are only a few specified items, many circumcision surgeries are out-of-pocket expenses.
Of course, you can consult several hospitals to see if the procedure can be covered by insurance.
As for diabetes, as long as blood sugar levels are well controlled, surgery can be performed; there is no specific waiting period recommended before surgery.
However, it is important to monitor blood sugar levels after the surgery to ensure proper wound healing.
Wishing you good health.

Reply Date: 2018/06/03

More Info

Hello! Thank you for reaching out with your questions regarding diabetes-related urological issues, particularly concerning circumcision and health insurance concerns. I appreciate your detailed description of your situation, which helps in providing a more informed response.

Firstly, it’s important to understand that diabetes can lead to various complications, including urological issues such as balanitis (inflammation of the glans penis) and phimosis (tight foreskin that cannot be easily retracted). These conditions can be exacerbated by poor glycemic control, which is why managing your blood sugar levels is crucial.
Regarding your first question about whether it is safe to undergo circumcision shortly after starting diabetes medication, the answer is generally yes, but with some considerations. If your diabetes is well-controlled and you are not experiencing any acute complications, it is typically safe to proceed with elective surgeries, including circumcision. However, it is essential to have a thorough discussion with your healthcare provider about your current health status, including your blood sugar levels, any ongoing symptoms, and how well your diabetes is being managed. They may want to ensure that your blood glucose levels are stable before proceeding with surgery to minimize the risk of infection and promote healing.

Now, concerning your second question about whether the circumcision procedure can be covered by health insurance, this can vary based on specific criteria and regulations in your region. As you mentioned, there are specific conditions under which circumcision may be eligible for insurance coverage, such as:
1. Paraphimosis: A condition where the foreskin cannot be returned to its normal position after being retracted.

2. Recurrent balanitis: If you have a documented history of recurrent infections that have not responded to conservative treatment.

3. Scarring affecting urination or erection: If the tightness of the foreskin is causing significant issues with urination or sexual function.

4. Pathological findings: If there are abnormal findings that necessitate removal of the foreskin for further examination.

5. Other surgical needs: If circumcision is required as part of another surgical procedure.

Given your situation, if your tight foreskin is causing pain during erections and has been documented as a problem, you may have grounds to appeal for insurance coverage. It would be beneficial to gather all relevant medical records, including any documentation of your symptoms and treatments, and present this information to your urologist. They can help advocate for you regarding insurance coverage based on your medical history.

In summary, while it is generally safe to proceed with circumcision shortly after starting diabetes medication, it is crucial to ensure your diabetes is well-managed. Regarding insurance coverage, if your condition meets the criteria for medically necessary procedures, you may be able to obtain coverage. I recommend discussing these points with your healthcare provider and possibly seeking a second opinion if you feel uncertain about the information provided.

I hope this information helps clarify your concerns, and I wish you the best in managing your health. Please feel free to reach out if you have any further questions or need additional assistance.

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