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I’m in Tx looking to get insurance since my company won’t cover an implant and enrollment is around the corner. Anyone out there know an insurance company covering implants?

Really appreciate y’all’s help in advance

Thanks,
Pat

Pamen116 wrote:I’m in Tx looking to get insurance since my company won’t cover an implant and enrollment is around the corner. Anyone out there know an insurance company covering implants?

Really appreciate y’all’s help in advance

Thanks,
Pat

Blue Cross handled me almost 100%

HikerMan wrote:Blue Cross handled me almost 100%

I also have Anthem Blue Cross through my work. Could you talk me through your whole experience? Like, did they force you to have a whole paper trail of trying different treatments unsuccessfully, or did your surgeon just tell them "hey this guy really needs an implant" and they went "sounds good!"

Aetna and Cigna are terrible for covering this procedure. If you have the time, energy, and patience to fight through their appeals process, you might get lucky and secure coverage after a lot of tedious paperwork.

LastHope wrote:Aetna and Cigna are terrible for covering this procedure. If you have the time, energy, and patience to fight through their appeals process, you might get lucky and secure coverage after a lot of tedious paperwork.

Even though it’s an exclusion you think they may approve it?

Pamen116 wrote:

LastHope wrote:Aetna and Cigna are terrible for covering this procedure. If you have the time, energy, and patience to fight through their appeals process, you might get lucky and secure coverage after a lot of tedious paperwork.

Even though it’s an exclusion you think they may approve it?

They pre-approve it and pull the rug 48 hours before the surgery. I talked to a lady who does this for a living and some don't have exclusions and get lucky during the appeals process but that's like 1% of the time in her experience.

Asdefxx wrote:

HikerMan wrote:Blue Cross handled me almost 100%

I also have Anthem Blue Cross through my work. Could you talk me through your whole experience? Like, did they force you to have a whole paper trail of trying different treatments unsuccessfully, or did your surgeon just tell them "hey this guy really needs an implant" and they went "sounds good!"

Mine was very easy thru Blue Cross.
I didn't have tons of paperwork, it was simply part of the "insured allotment " Blue Shield provides for.

Now, since I had a Prostatectomy beforehand, it might be viewed as a necessary surgery.

I don't know.
I simply looked down the list of things that are covered and Penile Implants WAS one of them.
My plan goes thru Motion Picture and they are regarded as the Cadillac health plan.

On your health plan you should be able to see the list that YOU'RE covered with.
If you are Blue Cross, you should be covered.

Hope this helps.

Hikerman

Probably no help, Pat, but Medicare paid the entire thing for me. I have a medigap so the deductions are very low.

Are you too far from age 65 and Medicare?

HikerMan wrote:I simply looked down the list of things that are covered and Penile Implants WAS one of them.
My plan goes thru Motion Picture and they are regarded as the Cadillac health plan.

On your health plan you should be able to see the list that YOU'RE covered with.
If you are Blue Cross, you should be covered.

Brilliant, thank you. Any advice on finding that document myself? I scoured my plan's website but didn't find anything. Is it like a 100-page insurance policy document that you ask someone in customer service for and they email it to you? Or would it instead make sense to ask the representative for a "list of treatments that are covered"

Pamen116 wrote:I’m in Tx looking to get insurance since my company won’t cover an implant and enrollment is around the corner. Anyone out there know an insurance company covering implants?
Really appreciate y’all’s help in advance
Thanks,
Pat

Yes, open season time is getting near. Let me give you a small caution to think about. Health insurance companies tend to add or drop covered procedures when the new policies come into effect at the first of the year. So a plan that covers IPP's this year "might" not cover them on January 1st 2025. Also plans vary from state to state. So finding the best insurance by name is not very possible.

My best suggestion is to get busy. Find all of the medical procedure codes that relate to your situation. I don't think you've had prostate cancer so skip those if you can identify them. Then CALL your prospective insurance coverage department & ask them if those codes are covered THIS year. Then ask if they are on the list to be covered in 2025. This is a two part question & I feel that you need both parts answered.