Getting hosed over again by insurance

[JohnHC]

I am starting to get really frustrated. Appealed my previous surgeries with notice to get another revision. Got the letter saying my appeal went through and they are reversing the decisions, yay I thought. Wrong. Since it wasn't 100% clear in the letter ( but very much insinuated ) I called to make sure this revision was covered. I was told as long as the Dr gets a pre auth/pre cert and references the prior surgeries I should be good to go ( yeah the "should be" should have been a red flag )

Well I called to find out if my Dr had sent in the pre cert request, no isn't not in the system, ask if there is a note regarding the revision coverage, nope no such note. Call my HR to get in touch with them and ask them to call me and explain since I keep getting different messages every time I call.

Just got a call today from insurance, no revision isn't covered, previous surgeries were not to be covered either but because of their wrong info they covered them and since I now know it isn't covered it's now up to me to figure out how to pay for the revision. I explained things to her and she finally pulled up my record and read everything and basically said she doesn't understand why they aren't. Said she would try to look up some things and see if there is anything she can do help but as of now from her higher ups it's not covered and they've put a red note on my account that the revision will not be covered. She said to file yet another appeal for just this revision and explain everything again and wait yet again for a response.

I asked her if she thought it was fair that I'm stuck with a non working implant that I can't go back to the way it was before and am locked forever into getting the implant replaced everytime it fails all because of their incompetence and out right misinformation. That has I known and been told this wasn't covered I would have never had the surgery to begin with. And she just repeated to file again and hope they see fit to reason.

So again I'm stuck with a broken device going on 7 months now with no end in sight, a sad wife, and me going for yet another roller coaster ride if the ups and downs which is never good for your mental health. I'm hoping that Boston Scientifics legal department can really help me out otherwise I'm not sure what will happen.

[jwdetails]

I am starting to get really frustrated. Appealed my previous surgeries with notice to get another revision. Got the letter saying my appeal went through and they are reversing the decisions, yay I thought. Wrong. Since it wasn't 100% clear in the letter ( but very much insinuated ) I called to make sure this revision was covered. I was told as long as the Dr gets a pre auth/pre cert and references the prior surgeries I should be good to go ( yeah the "should be" should have been a red flag )

Well I called to find out if my Dr had sent in the pre cert request, no isn't not in the system, ask if there is a note regarding the revision coverage, nope no such note. Call my HR to get in touch with them and ask them to call me and explain since I keep getting different messages every time I call.

Just got a call today from insurance, no revision isn't covered, previous surgeries were not to be covered either but because of their wrong info they covered them and since I now know it isn't covered it's now up to me to figure out how to pay for the revision. I explained things to her and she finally pulled up my record and read everything and basically said she doesn't understand why they aren't. Said she would try to look up some things and see if there is anything she can do help but as of now from her higher ups it's not covered and they've put a red note on my account that the revision will not be covered. She said to file yet another appeal for just this revision and explain everything again and wait yet again for a response.

I asked her if she thought it was fair that I'm stuck with a non working implant that I can't go back to the way it was before and am locked forever into getting the implant replaced everytime it fails all because of their incompetence and out right misinformation. That has I known and been told this wasn't covered I would have never had the surgery to begin with. And she just repeated to file again and hope they see fit to reason.

So again I'm stuck with a broken device going on 7 months now with no end in sight, a sad wife, and me going for yet another roller coaster ride if the ups and downs which is never good for your mental health. I'm hoping that Boston Scientifics legal department can really help me out otherwise I'm not sure what will happen.

Can understand the frustrations - what a saga! Hang in there brother and keep fighting.

Few questions - What insurance do you have? What state do you live in? Who is your surgeon?

[easymoney]

i'd go with a mallabble if you get it worked out ..less chance of a revision in the future ..

[JohnHC]

I am starting to get really frustrated. Appealed my previous surgeries with notice to get another revision. Got the letter saying my appeal went through and they are reversing the decisions, yay I thought. Wrong. Since it wasn't 100% clear in the letter ( but very much insinuated ) I called to make sure this revision was covered. I was told as long as the Dr gets a pre auth/pre cert and references the prior surgeries I should be good to go ( yeah the "should be" should have been a red flag )

Well I called to find out if my Dr had sent in the pre cert request, no isn't not in the system, ask if there is a note regarding the revision coverage, nope no such note. Call my HR to get in touch with them and ask them to call me and explain since I keep getting different messages every time I call.

Just got a call today from insurance, no revision isn't covered, previous surgeries were not to be covered either but because of their wrong info they covered them and since I now know it isn't covered it's now up to me to figure out how to pay for the revision. I explained things to her and she finally pulled up my record and read everything and basically said she doesn't understand why they aren't. Said she would try to look up some things and see if there is anything she can do help but as of now from her higher ups it's not covered and they've put a red note on my account that the revision will not be covered. She said to file yet another appeal for just this revision and explain everything again and wait yet again for a response.

I asked her if she thought it was fair that I'm stuck with a non working implant that I can't go back to the way it was before and am locked forever into getting the implant replaced everytime it fails all because of their incompetence and out right misinformation. That has I known and been told this wasn't covered I would have never had the surgery to begin with. And she just repeated to file again and hope they see fit to reason.

So again I'm stuck with a broken device going on 7 months now with no end in sight, a sad wife, and me going for yet another roller coaster ride if the ups and downs which is never good for your mental health. I'm hoping that Boston Scientifics legal department can really help me out otherwise I'm not sure what will happen.

Can understand the frustrations - what a saga! Hang in there brother and keep fighting.

Few questions - What insurance do you have? What state do you live in? Who is your surgeon?

I have UMR ( United Healthcare based ) I live in Ga (USA) and my surgeon is Dr Rajanahally with Urology of Greater Atlanta.

Now he's a great surgeon and fully trust him, it's insurance that's started this whole can of worms by saying it's covered, then no it isn't, then appealing it, them saying it's reversed, then saying oh only the previous surgeries. Its just really aggravating that had they been truthful up front I wouldn't have had the surgery until I could afford it or gotten different insurance.

[JohnHC]

i'd go with a mallabble if you get it worked out ..less chance of a revision in the future ..

My issue with malleable is that it's so much harder to hide and for most don't give you back your girth, length appears to be ok, but the girth on them is very much lacking. I'm already lacking enough in that dept and don't want to end up with a hard #2 pencil so to speak.

[tobenormalagain]

I recently had a malleable implant (Boston Scientific) surgery and concealability really has not been an issue for me. I am of average endowment and just went from boxers to briefs-problem solved! Also, I did lose a small amount of girth but it was really negligible and a small trade off for an always rigid cock. I think easymoney gave you some good advice and he certainly speaks from experience. Personally, if I were facing another revision surgery and the money, pain, suffering, and time needed for healing, I would absolutely think long and hard (no pun intended) about a malleable.

[ragingbull]

If I can’t get Mercedes factory warranty (insurance/medicare), there’s no way I’m buying an endless money pit Mercedes (inflatable).

I’d gladly drive a Toyota (Malleable).
It lasts forever.
It always starts right up.
It reliably gets me from point A to point B.

I can still fuck my GF repeatedly all night like a rabbit.
I can still make her cum.
I can still enjoy the same orgasm whenever I want and however long I want.

I will lose the worry of "when is this fucking thing going to break down".