Insurance Excludes Penile Implant - Not Sure What to Do

[smallbutsure]

Well, I just got the awful news that my insurance does not cover this, as it is an exclusion in the policy. I am scheduled for surgery in 3 weeks. I am only 27 years old, and my ED has occurred over the past several years due to some sort of injury to my penis. I don't want to get into that here though. My sensitivity is low, but I can still ejaculate.

I am wondering what you guys recommend as the best course of action. Should I pay cash out of pocket for the surgery? If I do this, my only fear is if I need a revision in a couple years it will be very hard to afford. Also, if I get an infection (low probability but still could happen), does that mean I'd have to pay again to have things fixed?

I am really worried now. I thought maybe the implant was my way back to having some sort of a sex life, but with this unfortunate turn of events, I just am not sure how to proceed.

Any advice for me?

[Tybeeman]

Well, I just got the awful news that my insurance does not cover this, as it is an exclusion in the policy. I am scheduled for surgery in 3 weeks. I am only 27 years old, and my ED has occurred over the past several years due to some sort of injury to my penis. I don't want to get into that here though. My sensitivity is low, but I can still ejaculate.

I am wondering what you guys recommend as the best course of action. Should I pay cash out of pocket for the surgery? If I do this, my only fear is if I need a revision in a couple years it will be very hard to afford. Also, if I get an infection (low probability but still could happen), does that mean I'd have to pay again to have things fixed?

I am really worried now. I thought maybe the implant was my way back to having some sort of a sex life, but with this unfortunate turn of events, I just am not sure how to proceed.

Any advice for me?

Did you doctor make the case for an implant? There are steps you have to take. Pills first, then injection. If that does work then you can get an implant. If you have a injury that should be covered by insurance to repair.
Call AMS THEY have a program for people that are not covered. You also wait and change you insurance policy at the first of the year

[smallbutsure]

Yes, they made the case for the implant. That wasn't the issue. The issue was that my employer excludes the procedure (and related ones) from its health insurance plan. The issue with the injury being covered is they cannot exactly pinpoint the injury, and it has happened slowly over time, so it's not a typical injury such as a car accident.

Gosh this stinks. I don't know what the heck to do. I will call AMS.

[Ahappigui]

Do it! You are a young man and will be sexually frustrated for the rest of your life if you do not proceed. The cost and lack of coverage is a bummer, but......

[Bigred]

Most physicians and hospitals will give you a much better price if you are paying out of pocket. After all, it's only a 15 minute to 1 hour procedure. Just shop around for the best doctor with the best price.

[Cnidium]

Im 27 too and will be paying out of pocket. Insurance network wont cover any surgeon outside my small area. And on top of that, the procedure itself just isn't included.

Hustle hard is all I can say. Thats what I have been doing. Accrued enough money to have the surgery done twice. Even if the implant fails under 10 years, the cost of revision is about half the initial cost (at least with the surgeon I am going with). As for infection, ya that will screw me. But whats life without some risk.

This is the U.S., most of our insurances suck unless you are older or have a cushy job. But, you also have a rare opportunity to just pay for high quality without waiting forever.

[alibaba]

United Healthcare policies exclude and implant as "any device or treatment that promotes conception". I fought that line for several years. I finally told them it did not apply because conception was not possible after a prostatectomy. If you have had a vasectomy, then it would not apply to you either. Make sure your doctor states a reason OTHER than for inability to conceive.

[Tybeeman]

United Healthcare policies exclude and implant as "any device or treatment that promotes conception". I fought that line for several years. I finally told them it did not apply because conception was not possible after a prostatectomy. If you have had a vasectomy, then it would not apply to you either. Make sure your doctor states a reason OTHER than for inability to conceive.

I think it needs to be call reconstruction surgery

[Tenk11]

United Healthcare policies exclude and implant as "any device or treatment that promotes conception". I fought that line for several years. I finally told them it did not apply because conception was not possible after a prostatectomy. If you have had a vasectomy, then it would not apply to you either. Make sure your doctor states a reason OTHER than for inability to conceive.

Surely a good reason is to keep a vital body part from withering away? However they can be put in medical terms.

Also, if you are looking at it out of pocket, take a look at the CareCredit credit card. You might be able to get interest free. I know Eid takes it. It's not great but it's something.

[Funny9097]

To add to what Tenk said Eid also has a policy for the first 10 years (complete care) so if a revision were to come up and someone were paying out of pocket it would be a lot less expensive