Medical Insurance issue

The final frontier. Deciding when, if and how.
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mtnbiker
Posts: 46
Joined: Tue Jan 24, 2017 8:32 am

Medical Insurance issue

Postby mtnbiker » Wed Mar 08, 2017 1:43 pm

My insurance carrier highmark BC/BS denied Code 54360 which is for modeling (to correct curvature) prior to having my implant installed and I am getting charged over $2,000 since my insurance said it was not a medical necessity so I was wondering if anyone else has had this issue and how they got it resolved. Connie from Dr Kramers office sent over my medical records however my insurance is still denying the claim. The good news is the rest of the charges from my implant were covered.
Implanted on December 28, 2016 by Dr Kramer with a 21 CM AMS LGX. 47 years old and have been dealing with ED due to Venous leak since my 20's.
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jonbaldbg
Posts: 658
Joined: Mon Aug 08, 2016 9:26 am
Location: Kentucky

Re: Medical Insurance issue

Postby jonbaldbg » Wed Mar 08, 2017 5:39 pm

My BC/BS covered it all. I don't know if modeling was ever mentioned, but I'm sure the code showed up in the bill, so I don't see why your BC/BS shouldn't cover it too. Good luck.
62 years old. ED for years. High BP and meds have done me in. AMS 700 CX /3.0 cm RTE Implanted by Andrew Kramer on 10/12/16. Involved revision to relocate tubes and pump performed 12/29/16 by Dr. Knoll of Nashville, TN.
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ED2013
Posts: 1273
Joined: Tue Mar 05, 2013 8:15 pm

Re: Medical Insurance issue

Postby ED2013 » Wed Mar 08, 2017 5:51 pm

That sucks. I'd keep disputing it. It is necessary. An implant that is not straight can cause all sorts of problems.
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mtnbiker
Posts: 46
Joined: Tue Jan 24, 2017 8:32 am

Re: Medical Insurance issue

Postby mtnbiker » Thu Mar 09, 2017 10:48 am

Thanks for the feedback and suggestions I do appreciate it.
Implanted on December 28, 2016 by Dr Kramer with a 21 CM AMS LGX. 47 years old and have been dealing with ED due to Venous leak since my 20's.
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