How Can I Pay for an Implant?

[Casey.Mods]

This is a great topic. Insurances may have an outright exclusion for make sexual dysfunction. It's terrible. I work for an insurance company, processing and dealing with pre medical reviews and escalations.

I went through all the appointments this year looking for another solution after a life long bout of organic venous leak that's progressively getting worse. I found implants as an option, visited a Dr who performs IPPs and was given all the info and was researching so much about the pros and cons etc etc. I even left my appointment telling the Dr I'd think about it (cold feet). And I got to my car and said fck it.. Called my insurance verified the cpt and they said it was covered based on medical necessity. I even messaged in again to confirm and I got the same response.

Well I scheduled a tentative date with the scheduler and was waiting for the confirmation. I got letters in the mail: one said we are reviewing medical necessity and asked your provider to submit records. And he next said denied because it is an exclusion on my SOBs.why was this missed idk. But now I don't know what to do. I'm having a feeling of being defeated tbh. I am depressed a bit. But I'll pick myself back up and figure something out. I have to... Unless I settle for a dysfunctional dick at 30.

[Larry10625]

This is a great topic. Insurances may have an outright exclusion for make sexual dysfunction. It's terrible. I work for an insurance company, processing and dealing with pre medical reviews and escalations.

I went through all the appointments this year looking for another solution after a life long bout of organic venous leak that's progressively getting worse. I found implants as an option, visited a Dr who performs IPPs and was given all the info and was researching so much about the pros and cons etc etc. I even left my appointment telling the Dr I'd think about it (cold feet). And I got to my car and said fck it.. Called my insurance verified the cpt and they said it was covered based on medical necessity. I even messaged in again to confirm and I got the same response.

Well I scheduled a tentative date with the scheduler and was waiting for the confirmation. I got letters in the mail: one said we are reviewing medical necessity and asked your provider to submit records. And he next said denied because it is an exclusion on my SOBs.why was this missed idk. But now I don't know what to do. I'm having a feeling of being defeated tbh. I am depressed a bit. But I'll pick myself back up and figure something out. I have to... Unless I settle for a dysfunctional dick at 30.

Can you appeal the decision?

Larry

[Casey.Mods]

This is a great topic. Insurances may have an outright exclusion for make sexual dysfunction. It's terrible. I work for an insurance company, processing and dealing with pre medical reviews and escalations.

I went through all the appointments this year looking for another solution after a life long bout of organic venous leak that's progressively getting worse. I found implants as an option, visited a Dr who performs IPPs and was given all the info and was researching so much about the pros and cons etc etc. I even left my appointment telling the Dr I'd think about it (cold feet). And I got to my car and said fck it.. Called my insurance verified the cpt and they said it was covered based on medical necessity. I even messaged in again to confirm and I got the same response.

Well I scheduled a tentative date with the scheduler and was waiting for the confirmation. I got letters in the mail: one said we are reviewing medical necessity and asked your provider to submit records. And he next said denied because it is an exclusion on my SOBs.why was this missed idk. But now I don't know what to do. I'm having a feeling of being defeated tbh. I am depressed a bit. But I'll pick myself back up and figure something out. I have to... Unless I settle for a dysfunctional dick at 30.

Can you appeal the decision?

Larry

I do have the decision to appeal. Although if it were for lack of medical necessity I feel an appeal would be more realistic. If it's for an exclusion... There's no medical indications that would lead to an approved appeal. Or so goes the lingo.

[David_R]

I do have the decision to appeal. Although if it were for lack of medical necessity I feel an appeal would be more realistic. If it's for an exclusion... There's no medical indications that would lead to an approved appeal. Or so goes the lingo.

You are probably aware of this because of being in the insurance field, but I have heard several guys say that their urologist's office will call the insurance company to argue your case, and if they cover breast reconstruction after a mastectomy -- which is not a life-threatening situation but one that greatly impacts one's life, the same as E.D. -- then they should cover an implant as well.

[Casey.Mods]

I do have the decision to appeal. Although if it were for lack of medical necessity I feel an appeal would be more realistic. If it's for an exclusion... There's no medical indications that would lead to an approved appeal. Or so goes the lingo.

You are probably aware of this because of being in the insurance field, but I have heard several guys say that their urologist's office will call the insurance company to argue your case, and if they cover breast reconstruction after a mastectomy -- which is not a life-threatening situation but one that greatly impacts one's life, the same as E.D. -- then they should cover an implant as well.

You're right, sometimes knowing the process is less beneficial than trusting it. I'm going to teach it to the Dr's office today.. I haven't heard from at all. Thanks for the comment. Thanks to all for your advice and words, I just want a resolution. I was even doubting the implant.. Thinking of ask the things that could go wrong.. And just when I was mentally prepared.. Bam.. Haha as is life, gotta keep going.

[roksolid]

As to your other question, I dont qualify for Medicare so I dont know.

Oh, OK. For some reason I had equated you with Medicare. No problem.

Medical Insurance can be a finicky bitch. When approaching my insurance about this procedure I had been prepared for the fight I got from United Healthcare 13 years ago with my gastric bypass. For far for me this has been as easy as going down to CVS for a flu shot.

rok

[alterr]

There are good surgeon that will do it for less than $20,000.

Which doctors are considered good docs who will perform it for less than $20,000? Need a doc in NYC where I live.

[Larry10625]

This is a great topic. Insurances may have an outright exclusion for make sexual dysfunction. It's terrible. I work for an insurance company, processing and dealing with pre medical reviews and escalations.

I went through all the appointments this year looking for another solution after a life long bout of organic venous leak that's progressively getting worse. I found implants as an option, visited a Dr who performs IPPs and was given all the info and was researching so much about the pros and cons etc etc. I even left my appointment telling the Dr I'd think about it (cold feet). And I got to my car and said fck it.. Called my insurance verified the cpt and they said it was covered based on medical necessity. I even messaged in again to confirm and I got the same response.

Well I scheduled a tentative date with the scheduler and was waiting for the confirmation. I got letters in the mail: one said we are reviewing medical necessity and asked your provider to submit records. And he next said denied because it is an exclusion on my SOBs.why was this missed idk. But now I don't know what to do. I'm having a feeling of being defeated tbh. I am depressed a bit. But I'll pick myself back up and figure something out. I have to... Unless I settle for a dysfunctional dick at 30.

Can you appeal the decision?

Larry

I do have the decision to appeal. Although if it were for lack of medical necessity I feel an appeal would be more realistic. If it's for an exclusion... There's no medical indications that would lead to an approved appeal. Or so goes the lingo.

It's all about how it's presented to the appeal board. I think they have sex on the freakin brain. They think you want a penile so you can get a big raging hard on and fuck like a rabbit. Ask them if they cover silicone breast implant for a woman who has had a mastectomy... if they say yes, ask they why they are discriminating against men. Get the doctors office to help with the insurance company, they seem to have a lot more success then the patient. If your doctors office won't help, ask around on here, I know that some doctors offices have helped their patients. Good luck...

Larry