Insurance carriers cover implant

[GLE Man]

Hi Guys,

Back at it again guys, I'm having a ton of problems getting Aetna to pay for an implant. They are refusing to do a peer to peer with my doctor by just saying it's not covered. At one point they said if I had testosterone replacement therapy and it failed, they would cover an implant. However, now they are saying they won't cover it regardless.

I don't have the money so paying out of pocket is not an option for this desperately desired and, per my doctor, needed. I'm looking for any ideas you may have and, more importantly, an insurance carrier that will without a doubt 100% will cover it. I will change if I'm able to switch insurance carriers even though Open Season recently ended. Please hit me up.

GLE Man

[Gt1956]

Aetna must have several different plans. I've read of men getting implants covered then some that don't. My doctor claimed that Aetna would pay but I decided to wait for Medicare coverage instead.
I can only suggest that you take your policy to your doctors billing/insurance office & have them work the problem. Some companies require you to try & fail on pills & injections before they'll pay for an expensive surgery.
If all this fails. Then just present the policies that are available to you at your next open season to the billing office. See if they can pick a winner for you.
It can be a battle. Good luck.

[ViaSwiss]

What state are you in? Its less about the carrier and more about the particular plan. Your Dr can fight for you to get them to cover unless your plan specifically says its not covered.

[Fonzie]

Just out of curiosity how much does one cost without insurance?

[notaes]

Medicare Covers Implant


I am sixty eight yrs old and had my implant in January of 2020. My bill was $68,000. Medicare covered all but $1400. My supplement plan with Farm Bureau picked it up and paid the balance. I did not pay one cent out of my pocket.I even call the Medical Center that did my implant to confirm no balance. They confirmed I had .0 balance. Very happy fucker!

[Gt1956]

Just out of curiosity how much does one cost without insurance?

Try using the search function. Try "cost" or "self pay" to search with. There are many threads that we've had on this issue. Most of them seem to cost from $19,000 usd up to the high $20k region.

[GLE Man]

Great news!

I was told just today that I have been approved. I will become bionic. Implant surgery scheduled for March 9th. Peer to peer worked. I couldn't be happier. I will keep you all posted.

GLE Man

[GAPatriot]

Great news!

I was told just today that I have been approved. I will become bionic. Implant surgery scheduled for March 9th. Peer to peer worked. I couldn't be happier. I will keep you all posted.

GLE Man

How did you get them to cover your implant? My doctor received authorization from Aetna auto system, I had the procedure, next I received an EOB stating Aetna wouldn’t cover... I’m now looking at a possible $69k bill from the hospital. To add insult to injury, during the procedure the Doctor “incised” the mesh from a previous hernia op and somehow miss located the reservoir. Now the damn thing is trying to slip down into my scrotum. So now he wants to perform a revision. I’m working with him and the hospital to get the first surgery approved before I get stuck with another gigantic bill. Ten weeks out and haven’t been able to inflate as the pump is up against the reservoir, horizontally behind and next to the left testicle.

[Old Guy]

Great news!

I was told just today that I have been approved. I will become bionic. Implant surgery scheduled for March 9th. Peer to peer worked. I couldn't be happier. I will keep you all posted.

GLE Man

Awesome. Insurance companies are a royal pain to deal with.