Insurance status

[bionicbrother]

I am sorry to say that my insurance rejected it because looks like my company has excluded this coverage in my plan I have asked what the cash options looks like but I am not sure if there is any discount available. They are saying cost is around $18k. Looks like they will be financing it too.. I havent made a decision on whether to move forward or not.. Cigna is my provider

Anyone else experienced such insurance declines? Did you end up paying for it?

[ViaSwiss]

If your insurance has an exclusion then they will not cover it.

If you do CX or LGX, then AMS has a financing program if your physician is signed up for it.
$18,000 is actually pretty good out of pocket. Here is a list of phsyycians and their out of pocket cost.
viewtopic.php?t=12950

Another option is to use Surgeo.com which adds "insurance" for any complications you could run into.

[bionicbrother]

If your insurance has an exclusion then they will not cover it.

If you do CX or LGX, then AMS has a financing program if your physician is signed up for it.
$18,000 is actually pretty good out of pocket. Here is a list of phsyycians and their out of pocket cost.
viewtopic.php?t=12950

Another option is to use Surgeo.com which adds "insurance" for any complications you could run into.

Thank you so much for this information. Very useful. I will look into it. Appreciate it

[MK1965]

Ask your insurance provider for detailed list of exclusions.
That is about 100+ pages to go through. You might find in one place that they cover implants for restoring functions lost due to illness and injury.
When you read further, they will exclude penile implants for sexual enhancement sex change and anything related to sexual pleasure.
If you have valid reason to proof that your implant will be for restoring function due to illnesses or injuries you might be approved for the procedure.
In your appeal, you have to use strong words an phrases to support your need to restore body function lost to illness or injury.
According to Aetna ( my Insurance) I mentioned that appeal was denied as policy exclusion, specifically the coverage of implant placement or replacement for the enhancement for sexual enhancement of any nature.
Strong words like “ vehemently disagree with the assertion” “ I am perplexed as to how Implant....”
Nicely written appeal letter might solve your problem if you have valid reasons like DM, HTN, prostate cancer etc.
MK

[544kenmatt]

May I ask your age? If you are close to 65, you may want to wait for medicare to kick in.

[bionicbrother]

Ask your insurance provider for detailed list of exclusions.
That is about 100+ pages to go through. You might find in one place that they cover implants for restoring functions lost due to illness and injury.
When you read further, they will exclude penile implants for sexual enhancement sex change and anything related to sexual pleasure.
If you have valid reason to proof that your implant will be for restoring function due to illnesses or injuries you might be approved for the procedure.
In your appeal, you have to use strong words an phrases to support your need to restore body function lost to illness or injury.
According to Aetna ( my Insurance) I mentioned that appeal was denied as policy exclusion, specifically the coverage of implant placement or replacement for the enhancement for sexual enhancement of any nature.
Strong words like “ vehemently disagree with the assertion” “ I am perplexed as to how Implant....”
Nicely written appeal letter might solve your problem if you have valid reasons like DM, HTN, prostate cancer etc.
MK

Thank you MK. I will request for it. Unfortunately I dont have any medical reasons for this implant.

[bionicbrother]

May I ask your age? If you are close to 65, you may want to wait for medicare to kick in.

Unfortunately nowhere near it.. I am 40 years old

[mike123]

Unfortunately I dont have any medical reasons for this implant.

Can you expand on that a bit further? You have ED, but no medical reason to explain it? Phycological ED? Or can you get a normal erection but are just looking for an enhancement?

[bionicbrother]

Unfortunately I dont have any medical reasons for this implant.

Can you expand on that a bit further? You have ED, but no medical reason to explain it? Phycological ED? Or can you get a normal erection but are just looking for an enhancement?

Yes that is correct. I always had ED even when I was 20 years old but couldnt explain why. I can never get 100% erection maybe 25%-50% hard not good enough to penetrate. When the doctor injected me with trimix(for ultrasound) I had real good erection- He said the blood flow is very good and there are no leaks. I am not sure if its psychological because I would assume there would be no erection at all rather than partial erection but get good erection when I have cialis(~75%) or trimix(100%)?

[mike123]

Phycological concerns could easily explain a partial. Performance anxiety is just one of many that could cause it. You're turned on and start to get a hardon, but worries about what will come next derail it before you get the full erection. Just because phycological concerns can cause what you're experiencing doesn't rule out an undiagnosed biological cause.