Anthem bcbs of georgia sucks

[Chrismc1981]

Straight denied so fuck them

[Asdefxx]

Is that Anthem of California who denied you? Damn, that sucks. Are you going to appeal, or what's the plan now?

I have them too and I don't have your history of trying injections and a penis pump, so I might be in rough shape myself.

Although, I live in PA and work remotely for a California company, so I'm not sure if it's Anthem that I need to be worried about or if it's BCBS of PA that I need to be worried about. Their whole business structure is confusing. My card even says "Claims: Submit to local BCBS plan".

[LastHope]

Came across a clinical trial by Boston Scientific. If the surgeon is skilled and experienced, maybe worth giving it a try as an alternative.


https://www.uchicagomedicine.org/find-a ... /irb220270

https://clinicaltrials.gov/study/NCT04200937

[Chrismc1981]

No anthem bcbs of georgia..fuck8ng asshats......

[ElbowRoom]

My work uses Anthem / BCBS of Georgia. They have a note right on their website stating procedures for sexual dysfunction are not covered. If anybody gets it paid for by them, I’d sure like to know how.

My wife has Cigna through her job so I have switched to her insurance in anticipation of implant surgery (plus it’s cheaper). Though I have heard Cigna can be flaky too on paying for an IPP.

[Wooody]

I don't understand how they can justify this. I am self-employed with an Obama Care special - bronze level Anthem BC/BS in California, with huge deductible, and mine was approved in February. The health insurance industry is corrupt and frankly, a criminal enterprise playing God with life or death decisions. Obviously an implant isn't life or death, but generally speaking!

[ElbowRoom]

I don't understand how they can justify this. I am self-employed with an Obama Care special - bronze level Anthem BC/BS in California, with huge deductible, and mine was approved in February. The health insurance industry is corrupt and frankly, a criminal enterprise playing God with life or death decisions. Obviously an implant isn't life or death, but generally speaking!

For the policy holder it's an important medical decision, for the insurance company it's business, and that is frustrating.

Just FYI for anybody that cares, my Dad was an insurance executive for a major company, and he explained to me one time how insurance companies *actually* work. They don't actually make money on the policy premiums they collect, believe it or not. Between the premiums that they collect and the money they pay out for claims (and operating expenses), most insurance companies are at a 10-15% loss.

So...how do they make money?!? On the float. The money they take in as premiums gets invested, and make a return that then gets reinvested until that money gets paid out as claims. So the returns on the float between the time a premium is collected and a claim gets paid out have to cover more than the overhead loss, or it becomes a true net loss. Most insurance companies also offer products like annuities which are more profitable than health care policies.

I'm not defending insurance companies with shitty policies, but understanding how they work at least helps to get WTF is happening. Even though they take in tons of money, the profit margin for insurance companies is quite low, usually about 5-6% per year when all is said and done. Because it's highly competitive, they have to walk a tightrope of having exclusions we hate (like implants!) and having very high premiums, which we also hate...all so the company can get enough returns on those invested dollars to offset the claims expenses.

Sorry if nobody cares about this, but it does help see see why they do what they do sometimes.

[LastHope]

Choose your insurance wisely guys! Easier said than done, I know.

Percentage of insurance approvals at a center in Miami region for submitted IPP claims between January 2016 and December 2017:

Medicare: 100.0%
Coventry: 100.0%
United Healthcare: 70.0%
Molina: 65.5%
Humana: 62.5%
Sunshine Health: 50.0%
Blue Cross Blue Shield: 56.3%
Aetna: 36.4%
AvMed: 15.8%
Cigna: 14.3%
Magellan: 0.0%
Medicaid: 0.0%

Commercial Insurance Overall: 52.0%

Reference:
Commercial Insurance Coverage for Inflatable Penile Prosthesis at a Tertiary Care Center
Published in 2019
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6675033/

[Bigdog4all]

If I lived in Georgia, I’d only trust Dr. Tariq Hakky or Dr. Charles Kaplan to cut my penis, no one else. Experience counts, not just for surgical precision but also for nailing insurance claim submissions.

Amen to that statement. Dr. Charles Kaplan is the best. From the start to the finish.....He was outstanding. He did a GREAT job. No pain, no problems, nada. Dr. Kaplan, even did a little fix on my birth mark down there. I never wanted anyone to fix that mark, but he fixed it while he was down there. If you in Georgia, Dr. Charles Kaplan is the URO to see.

[Mark1974]

Choose your insurance wisely guys! Easier said than done, I know.

Percentage of insurance approvals at a center in Miami region for submitted IPP claims between January 2016 and December 2017:

Medicare: 100.0%
Coventry: 100.0%
United Healthcare: 70.0%
Molina: 65.5%
Humana: 62.5%
Sunshine Health: 50.0%
Blue Cross Blue Shield: 56.3%
Aetna: 36.4%
AvMed: 15.8%
Cigna: 14.3%
Magellan: 0.0%
Medicaid: 0.0%

Commercial Insurance Overall: 52.0%

Reference:
Commercial Insurance Coverage for Inflatable Penile Prosthesis at a Tertiary Care Center
Published in 2019
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6675033/

Do you think the commercial carriers in blue states might be more likely to cover than commercial carriers in red states?