Some Good Insurance News For a Change

[ElbowRoom]

I'm scheduled to have surgery with Dr. Hakky in October. I have had Cigna insurance through my wife's work (because her plan has no premiums!), and it has a hard exclusion on IPP surgeries, so I was planning to pay out of pocket, over $22k.

To try to avoid that hit, we left the wife on Cigna and I switched to my employer's BC/BS plan. I got my new insurance card yesterday and called their member services line to confirm it's a covered benefit. The response is "it's based on medical necessity, and pre-certification is required, your doctor will have to submit a pre-cert request."

So it seems it's covered if medically necessary. I called Dr. Hakky's insurance specialist and she's going to try to get the pre-cert authorized on August 4. BC/BS will only issue the authorization within a month of the procedure typically. We'll see what happens, we might have to move up my surgery to September.

I'm sure Dr. Hakky can make a good case this is medically necessary, as other treatments have failed and my systolic flow numbers are terrible as confirmed by Doppler.

Anyway, just wanted to share that things might go my way on insurance and cost, which would be a big relief for me as I'm an average joe and not wealthy. Wish me luck!

[dan_bionic]

I'm scheduled to have surgery with Dr. Hakky in October. I have had Cigna insurance through my wife's work (because her plan has no premiums!), and it has a hard exclusion on IPP surgeries, so I was planning to pay out of pocket, over $22k.

To try to avoid that hit, we left the wife on Cigna and I switched to my employer's BC/BS plan. I got my new insurance card yesterday and called their member services line to confirm it's a covered benefit. The response is "it's based on medical necessity, and pre-certification is required, your doctor will have to submit a pre-cert request."

So it seems it's covered if medically necessary. I called Dr. Hakky's insurance specialist and she's going to try to get the pre-cert authorized on August 4. BC/BS will only issue the authorization within a month of the procedure typically. We'll see what happens, we might have to move up my surgery to September.

I'm sure Dr. Hakky can make a good case this is medically necessary, as other treatments have failed and my systolic flow numbers are terrible as confirmed by Doppler.

Anyway, just wanted to share that things might go my way on insurance and cost, which would be a big relief for me as I'm an average joe and not wealthy. Wish me luck!

Congrats an I really hope the best for you !
all the best
Dan

[ElbowRoom]

Congrats an I really hope the best for you !
all the best
Dan

Thanks Dan, your posts are inspiring and help those of us still working through this to have more confidence about the final outcome!

[dan_bionic]

Congrats an I really hope the best for you !
all the best
Dan

Thanks Dan, your posts are inspiring and help those of us still working through this to have more confidence about the final outcome!

You're welcome, I try to give hope to all guys, affected by that horrible disease
Dan