Fight insurance or pay for it?

[Oldcrohny62]

I know this is frustrating. Before my implant I did not think insurance was going to cover since they did not cover ANY genital surgeries. Had Peyronies diagnosis.
A few years later, following prostate cancer and continued severe ED and Peyronies, with post Prostatectomy incontintence the request was made as a reconstruction following cancer and insurance covered it all - implant and pelvic sling. Before learning of coverage, new Surgeon said he would negotiate down price with AMS and hospital to get cost down due to lack of coverage.
I don’t recommend the cancer, but a good Urologist May be able to help you with some negotiations.

[Rogers]

What type of insurance? I have ANthem Blue Cross/Blue Shield and they say it is not covered. I had prostatectomy in February and no erections from pills or injections...

Would REALLY appreciate your input! Thanks

[Biker60]

Many insurance companies follow the lead of Medicare. I have a self funded Aetna plan. Aetna considered implants medical necessarily for Ed and Peyronies. It’s the employer who adds the exclusion to not cover the implants. I am scheduled for implants next month. Since I am paying 25k I am having 2nd thoughts. Pd killed my penis and xiaflex just made it worse. I can still get a 90 degree erection. I can still ejaculate which is painful.! I also just always have penis pain. ultrasound shows plaque everywhere. So I get pain in the glands and shaft. When I mentioned the pain In penis to the implant surgeon. He did not know why I would have pain ????? So I am questioning if I am doing the right thing. So I am off for a 3rd or 4th opinion to see a urologist who specializes in trauma and reconstruction. Some of my problems can be treated with surgery and insurance will cover. Adding implants = pay out of pocket. I would like have my old self back. But the fear of dropping 25k for more issues is an issue.

[WhiteCane]

I’m in the process of setting up a payment plan with Chesapeake urology… It is case to case but they’ve got a bunch of different plans… I’m working on my MD so any little bit helps… I’m going to owe about 2900 estimated out-of-pocket… maybe ask which ever doctor you are dealing with if they have a similar set up? Maybe look for a medical loan? Sexuality is a very important part of life… I think this would be demonstrated By your insurance/employers ability to cover breast implants and sex changes… . I personally think your situation should be equally as important… Best of luck!

[drjeeps]

Same issue here: https://www.franktalk.org/phpBB3/viewtopic.php?t=12370

Have gone multiple rounds, Boston has been helpful, but I'm fighting what my employer has exempted. Sexual discrimination is what I'm now after and they aren't budging. Got a complaint filed with EEOC, but just to TALK to them in person is a 3+ month wait.

I've talked to several legal folks - the cost will be equal or more potentially if I go to court with no guarantee I win. So, piss that money away and still be hosed or just say screw it and pay for the implant. I'm tired of not having sex and starting to really get tired of this entire experience.

Good luck, whichever way you go.

[WhiteCane]

Yeah, I completely understand that frustration… I’m angry for you right now…