Did Insurance Cover Your Implant?

The final frontier. Deciding when, if and how.
Flounder
Posts: 271
Joined: Mon Jul 23, 2018 3:17 pm
Location: PA

Re: Did Insurance Cover Your Implant?

Postby Flounder » Thu Oct 26, 2023 7:22 am

Kiawahgolf wrote:I have read where some claimed insurance covered their procedure and others stating it did not. I spoke to someone at Dr Hakky’s office this afternoon and she said insurance would cover the consultation but not the procedure since it’s considered cosmetic. I thought that was very strange. So for those of you that insurance did cover who did you use and what insurance? If I have to pay out of pocket that will make my decision rather quickly at this time.

Thank you!


Most private insurance plus Medicare will only cover the implant if the doctor determines and submits the claim as medically necessary to correct organic ED. Almost all insurances will not cover it for psychological ED, cosmetic, or enhancement reasons. Since you’ve not yet been seen by the doctor, your diagnosis is unknown by the girl in the office. So she probably gave you the worst case possibility. But she also gave you the pathway to find out the real answer.

My advice, schedule the consultation so Dr Hakky so he can arrive at a diagnosis for your ED and his recommendation for solution. His girl already told you that’s covered. And then it’s time to ask the question, is it covered by my insurance.
A-69, M-44, Battling ED since partial NS-Prostatectomy 2012 plus SRT for PCa return 2016
Pills & injections ran their course. Implant 11/11/22 by Dr. Eid.
Titan Classic 22cm, LH cylinder trimmed, Ectopic reservoir placement.

Kiawahgolf
Posts: 85
Joined: Sat Dec 17, 2022 9:56 am

Re: Did Insurance Cover Your Implant?

Postby Kiawahgolf » Thu Oct 26, 2023 11:57 am

I sincerely appreciate everyone’s input here. As suspected it sounds like under the right circumstances insurance will cover the procedure. The bad news is I called my insurance provider (United UMR) just a few moments ago and the lady said she would need a code to see if it would be covered and I gave her the code I found for the procedure (54405) and she said my plan does not cover it. I don’t know if that’s a definitive answer in every case but she said my current plan does not cover the implant. So I guess I will need to look for a new provider if I want to proceed.

Floridaspeedo
Posts: 305
Joined: Fri Jun 17, 2022 11:15 am

Re: Did Insurance Cover Your Implant?

Postby Floridaspeedo » Thu Oct 26, 2023 12:47 pm

You need to have your doctor work with the ins company. There are many variables and many codes.
ED survivor 5 years. Tried pills, Gainswave, PRP, Bi-Mix/Tri Mix (worked 50% but very painful for 24 hours after injection.) 55 Gay - Single Titan Coloplast implanted June 1st, 2022, scrotal in Miami by Dr Billy Cordone..,very happy. Zero regrets

Kiawahgolf
Posts: 85
Joined: Sat Dec 17, 2022 9:56 am

Re: Did Insurance Cover Your Implant?

Postby Kiawahgolf » Thu Oct 26, 2023 4:19 pm

I will most certainly be leaning on the doctor and his team to do the leg work I just need to make sure UMR will cover it under any circumstances and if not I need to find another insurance company.

Gt1956
Posts: 3043
Joined: Fri Apr 05, 2019 2:47 pm

Re: Did Insurance Cover Your Implant?

Postby Gt1956 » Thu Oct 26, 2023 6:14 pm

I think that insurance approval is just one more reason to search for a skilled dr that also has a top notch billing staff. Many drs do more than implants. As long as he can get enough patients to pay the bills he is good. Ok, so he does even a fair number of implants. He might be only doing the easy to get approved ones. If you're not easy to get approved then you fall out of his line unless you can pay cash.
This process can be easy or hard. Maybe impossible with some policies. I think the only way to truely find out is to pick a decent dr. Get a visit, give his staff all your insurance info.
The dr decides who needs an implant. His staff finds out who is going to pay for it. Keep that in your mind.
68yo, HBP at 40, high triglycerides at 45. Phimosis at 57. Type 2 at 60. Dr. William Brant May 1, 2023 CX 21cm w/no rte's penoscrotal 6" girth @ 6 months


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