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It's been two yrs since I went to see Eid. Back then insurance denied coverage. I don't feel like I have lost any length in this time, so I made an appointment in Raleigh to see Lentz. He is only 3 hrs away instead of 10.5 hrs to see Eid.

I was surprised when Lentz's office called, and said it was billable.

I'm a bit of a contrarian. Just because they say it is billable doesn't tell me that it is payable. Hearing from your own insurance company that you have coverage & that they'll pay is what I'd want to hear.
In essence, you are a co-signer on the bill. If your insurance fails to pay then the bill is yours to pay.
What has changed with your insurance since it was denied last time. Different policy, higher coverage levels etc. Please be careful.

Eid from what I see from others is limited on the insurance he takes. Your new doc may take yours. It is really common that not all docs take the same insurance.

Your new doc can get a pre authorization for payment from insurance to make sure you do not get a big surprise. Not sure if eid is really a big fan of fighting insurance to make sure you are covered.

I called Lentz's office back, and said the same thing ( IPP surgery is valid and billable ). I'm like you, I won't believe it until insurance company is actually billed, and says they will pay. Maybe Lentz's office are just thinking BCBS most always covers IPP.

We actually called the insurance company back (3-way), and asked about codes again. I am not up on ins and outs of insurance filing, but that's what she does daily. She said that everything is good. Now, it could fall apart when I schedule surgery, and insurance denies codes 54405 , 54235.
So, this makes 3 calls to insurance. Originally his office, then I called insurance about benefits, and then we both called on 3-way.

I remember getting that denial email (2019) from Eid's office. I called the insurance back then. Back then they immediately said it's not covered.

Make sure you get the correct codes that will be billed from your doctor.
I am about to have another surgery and the remove replacement code given is 54410 (removal and replacement of multi-component inflatable penile prosthesis at the same operative session. ). (54411 removal and replacement of multi-component inflatable penile prosthesis through an infected field at same operative session including irrigation and debridement of infected tissue). I have United healthcare insurance through my employer. I’ve had numerous surgeries concerning my implant. United reps are nice but not really informed. One will say it’s not covered, one will say it must be pre-approved, one will say it’s covered and yet another said it depends on if it’s done as outpatient vs inpatient. I always ask for a supervisor after my conversation with the agent. Each time the supervisor has just given me a reference number for or conversation and said it was covered under outpatient care. With all that being said make sure the anesthesia group that puts you to sleep in covered. I had three surgeries within two months. The doctor and hospital was in network and was double checked through my insurance. After the surgeries I learned that the insurance had broke their contract about two months before my first surgery. United did not inform me of the breach of contract. United paid approx $330 per each time i was put to sleep. The bill was $3300 per surgery. United said they paid responsible and customers rate which left me on the hook for a lot of money. So make sure they are covered under your plan !!!
I ask the insurance rep if they thought they was just going to give me a few shots of whiskey and put a stick in my mouth for me to chew on which wasn’t well received but they knew they were going to put me to sleep. I was informed that it was my responsibility to make sure...

I will add that I have had several surgeries since 2013 when I got my first implant .....I would never go back and change anything. It’s all been worth it and I’ve never looked back!

Hi coldbrew, Dr. Lentz did mine, email me with any questions you have and I will be glad to answer them. Jim