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Today I got a call from the urologist telling me my insurance will not cover the replacement of my broken implant. This means I have to cover the costs myself. I imagine it is around $20k to $30k from what I hear.

I believe I have the AMS 700 with the dial cylinders. It was obviously smaller than what I was naturally before getting ED. So since I am paying for it is there another make/model that would be at last an inch longer? I was able to use the one I have but in certain ways it was just smaller. You all know how your ego can me! But at the same time I feel something is better than nothing...

Thanks,

Warren

Be sure to take advantage of your appeal rights to see if you can get insurance to cover. Did they pay for the first one?

The lady at the office handling this asked if I wanted to appeal it and I said no cause I spoke with someone at blue cross blue shield and they said they do not cover this type of surgery. I had United Healthcare when I had the implant put in 4 years ago. Even if BCBS said they do not cover this should I still try the appeal?

Thanks!

AMS should cover the cost of the implant itself, leaving you with the cost of the surgery.

warrenw123 wrote:The lady at the office handling this asked if I wanted to appeal it and I said no cause I spoke with someone at blue cross blue shield and they said they do not cover this type of surgery. I had United Healthcare when I had the implant put in 4 years ago. Even if BCBS said they do not cover this should I still try the appeal?

Thanks!

I don't know all the details of your case but it seems weird they don't cover this type of surgery. You may have a unique or self insured plan where it is excluded but BCBS usually covers. I would always appeal at least to one level more. What do you have to lose? And as ED2013 stated in his reply AMS has a lifetime replacement I believe on the implant. You, or your insurance company if you win the appeal, should only have to pay for labor to install (hospital and physician). Good luck.

Make sure the insurance company knows your ED is from a leak, prostatectomy, injury, high blood pressure, diabetes or whatever and NOT the purpose for conception. I fought that for several years with my insurance company and WON. Hope this helps. Most policies have a clause that they will not pay for any expenses that promote conception. Mine did too. They are hard headed %@¢#er$ those insurance companies. You can also call AMS/Boston Scientific at 1-952-930-6026. They have reps that will get on the phone with you and your insurance company and help sort it out. In the U.S., the diagnostic code would be N52.9 and the procedure code would be 54405. Hope this helps. Good luck. Don't give up. It took me 5 years, but I refused to take no for an answer. It's not possible is not acceptable. EVERYTHING has to be right, the codes, purpose, doc in or out of network, hospital in or out of network, whether it is raining, pen is full of ink, reviewers wife is currently having an affair, moon and Saturn are in alignment, reviewers daughter was not knocked up by their neighbor boy afterall, you boys know how it goes.

I had BCBS Alabama before going on Medicare. They were going to cover it if surgery was scheduled before my Medicare effective date. You might want to ask again, as suggested above.

Never give up till you have shaken all the snakes out of the basket and sent them running for cover.

I had to fight BCBS and finally won, had doctor send letter to insurance co. telling them why I needed the surgery. Disk surgery and diabetes was the cause. All other methods had been tried and failed. I threatened to come in person to hearing. They finally listened and paid. Keep fighting!!!

My insurance company covered it because my E.D. was physical. They said that it would not be covered if it were psychological.