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Denied me surgery on 26th.filed a grievence and a appeal to try to get them to approve.have bad venous leak and type 2 diabetes.anyone know what i need to do?im freaking devasted as im deeply depressed and now this...any help would be greatly appreciated as i dont even want to keep goin on with life..fucking ed sucks the life out of you

Look at your policy. There should be a page that lists exclusions. See what it says. Does the exclusion clause specifically deny penile implants?

Ask your surgeons office to intervene. They have likely experienced this before and may have other ways they can code the surgery.

I also have BCBS. They fully covered my surgery. Well, minus the deductible, but that’s to be expected. But BCBS made it clear that an implant is considered a final option procedure that they will only cover *after* you have tried (and failed) all other options. Your urologist will need to document the results of your failed attempts with pills and shots and any other methods you’ve utilized to regain erectile function. Then they can submit that history to BCBS for approval. This is what my urologist did, after all other methods had failed. Only then did the insurance finally agree to cover the surgery.

Have you tried all other methods while under the care of your urologist?

I have tried everything.i have a venous leak which i why he recomended implant.cannot get a erection for nothing.injections just leak into my legs and cause severe muscle lockup

Lousy office staff no doing the proper coding is very likely. A dr's staff will make or break a practice and many dr's have no clue if their staff is doing what they are supposed to.

The doctor's billing department should be specialists in coding a procedure to get it approved. Try again and keep trying until it gets approved. Make sure the doc has documented on all your tries and failures.

Chrismc1981 wrote:I have tried everything.i have a venous leak which i why he recommended implant.cannot get a erection for nothing.injections just leak into my legs and cause severe muscle lockup

Is your urologist a high-volume implant specialist? If not you should consider switching your urologist to Dr Hakky in Atlanta. He's one of the implant super star surgeons in the US, and probably has a lot of experience getting past insurance barriers.

I was told by my hospital billing billing staff that the worst ones are Aetna and Cigna and that they have had much better acceptance rates for BCBS/UHC/Humana. My Aetna sucked and I paid full cash.

easymoney wrote:Lousy office staff no doing the proper coding is very likely. A dr's staff will make or break a practice and many dr's have no clue if their staff is doing what they are supposed to.

I have a appt tommorow with him and im not gonna be a nice guy bc i took off work for this surgery and they screwed me

Chrismc1981 wrote:Denied me surgery on 26th.filed a grievence and a appeal to try to get them to approve.have bad venous leak and type 2 diabetes.anyone know what i need to do?im freaking devasted as im deeply depressed and now this...any help would be greatly appreciated as i dont even want to keep goin on with life..fucking ed sucks the life out of you

I had my surgery over 2 years ago, BCBS agreed to pay and didn't after the surgery. After many appeals and my paperwork going from one place to another it now sits in the hands of the Dept of Labor. My doc's office has been great and is doing everything in their power in helping me while not asking me for a dime. $45,000 on the line.