Insurance - Another Newbie

[nobogeys]

I'm 57 & had a RRP in Sept 2009. Since then, my PSA has been negative and so has the (now) little guy. I've tried pills, VED's & shots with none of them working all that well. Currently, I'm using a combination of bi-mix & VED to get the desired results. Tri-mix really burned & left me with a four hour woody. Not a big fan of the constriction rings either. I'm getting tired of all the "prep work" that has to be done to have some sort of a sex life, & have come to the conclusion that an IPP is the only thing that will get me back to halfway normal.

The problem is that my insurance company (Lifewise) will not pay for this procedure or anything that has to do with ED. I'm now in the process of appealing their decison to an Independent Review Organization... chosen by Lifewise. Does this seem a little fishy? Has anyone else out there been denied coverage for an IPP and later had it ok'd by an IRO?

Thanks,
Al

[gregorbehr]

Sad to say, you're not the first guy to run across this problem.
Many insurance companies have male sexual health as a very low priority, if they cover it at all.
Certainly sites like Frank Talk help get the word out, but it's a very slow battle.
The classic double standard, is if a woman has surgery to remove her breasts due to cancer, would an insurance company dare deny her implants afterwards?
Yet men like yourself come through prostate cancer and are left... limp and the insurance companies aren't in any rush to help with meds or veds or implants.

Some doctors will cut you a deal for cash payment, but we're still talking thousands of dollars!!!
Or in my case, where my insurance will pay 80% of the implant, I have yet to find anyone to tell me exactly what that 20% out of pocket cost will be. And if you're like me and on a VERY fixed income, just saying, "bill me later" is a horrifying thing. Will I get an $800 bill, or an $8000 one? I suppose one good thing is that a collections company would have a real difficult time repo-ing an implant

I hope you win out with the insurance company!
Best of luck,
Greg

[Dave48003]

Greg & all,

My bill was $33K before insurance discounts. It ended up at $22K. That should give you an idea. Does your policy have a maximum out of pocket? That could help.

Dave

[flyguy50]

I just had my implant surgery. I have Oxford/United Healthcare and the doc put down organic impotence following radical prostatectomy and they approved it no problem. Sorry to hear you are going through this. Unfortunately the culture in many insurance companies is to deny coverage and wear you down. Get an attorney to threaten bad faith litigation and you will see results!! I went through this with my wife needing expensive asthma control injections. The doc had fought with the carrier for over one month. I am an attorney and called the company, asked for the supervisor and explained to her that not only was I suing the company I was naming her personally. The injections were approved by the day's end. It was just some lazy rep who found it easier to just say no. ALso every state has an insurance department and I would get that agency involved in the discussion. Good luck
Rich