Fight insurance or pay for it?

[Biker60]

Got turned down just because it’s a penile implant. Just don’t pay for such a thing.
Breast implants covered, gender change covered. Xiaflex 40k covered and did more harm then good. Work for a hospital system. Yes a hospital system that excludes implants out. I was told the implant surgeon would fight for exception. I have ready bad Peyronies. Now lost 3 inches. My options pay $$$. Or contact Boston scientific? Does anyone know where That they can do?! Now might need surgery to remove plaque. Covered, just no implants. So need to find surgeon who will do the covered work and I will pay for the implants cash. This way. Surgical center is covered, surgery cost etc. any ideas ? Any chance to fight over the exclusion ?

[NeedleD]

Got turned down just because it’s a penile implant. Just don’t pay for such a thing.
Breast implants covered, gender change covered. Xiaflex 40k covered and did more harm then good. Work for a hospital system. Yes a hospital system that excludes implants out. I was told the implant surgeon would fight for exception. I have ready bad Peyronies. Now lost 3 inches. My options pay $$$. Or contact Boston scientific? Does anyone know where That they can do?! Now might need surgery to remove plaque. Covered, just no implants. So need to find surgeon who will do the covered work and I will pay for the implants cash. This way. Surgical center is covered, surgery cost etc. any ideas ? Any chance to fight over the exclusion ?

Coloplaste is fighting for me, they are very aggressive and will put up a good fight. They contacted the Insurance Co etc and I am waiting to hear back. I suggest you do contact Boston Scientific they probably will do the same.

[andrew1959nj]

I looked into a bad faith case and it would have cost at least 3-10 times the cost of the implant to fight it.

[Gt1956]

Got turned down just because it’s a penile implant. Just don’t pay for such a thing.
Breast implants covered, gender change covered. Xiaflex 40k covered and did more harm then good. Work for a hospital system. Yes a hospital system that excludes implants out. I was told the implant surgeon would fight for exception. I have ready bad Peyronies. Now lost 3 inches. My options pay $$$. Or contact Boston scientific? Does anyone know where That they can do?! Now might need surgery to remove plaque. Covered, just no implants. So need to find surgeon who will do the covered work and I will pay for the implants cash. This way. Surgical center is covered, surgery cost etc. any ideas ? Any chance to fight over the exclusion ?

Just a layman's opinion. It seems to me that if something is specifically excluded that fighting it might be difficult.
You could also resign yourself that at least getting some of the surgery covered by having the covered condition done. That you have a partial victory. Best of luck.

[Lost Sheep]

Is there the option to purchase a rider for additional coverage? Or switch policies? This would require waiting a year for the "preexisting condition" exclusion to run out, but using a V.E.D. in the meantime should limit any further size loss.

[Biker60]

Got turned down just because it’s a penile implant. Just don’t pay for such a thing.
Breast implants covered, gender change covered. Xiaflex 40k covered and did more harm then good. Work for a hospital system. Yes a hospital system that excludes implants out. I was told the implant surgeon would fight for exception. I have ready bad Peyronies. Now lost 3 inches. My options pay $$$. Or contact Boston scientific? Does anyone know where That they can do?! Now might need surgery to remove plaque. Covered, just no implants. So need to find surgeon who will do the covered work and I will pay for the implants cash. This way. Surgical center is covered, surgery cost etc. any ideas ? Any chance to fight over the exclusion ?

Coloplaste is fighting for me, they are very aggressive and will put up a good fight. They contacted the Insurance Co etc and I am waiting to hear back. I suggest you do contact Boston Scientific they probably will do the same.

Did contact Boston, since the denial is not Aetna, its my employer. They are contacting employer and explaining the need for a exception to the exclusion.

[Biker60]

Got turned down just because it’s a penile implant. Just don’t pay for such a thing.
Breast implants covered, gender change covered. Xiaflex 40k covered and did more harm then good. Work for a hospital system. Yes a hospital system that excludes implants out. I was told the implant surgeon would fight for exception. I have ready bad Peyronies. Now lost 3 inches. My options pay $$$. Or contact Boston scientific? Does anyone know where That they can do?! Now might need surgery to remove plaque. Covered, just no implants. So need to find surgeon who will do the covered work and I will pay for the implants cash. This way. Surgical center is covered, surgery cost etc. any ideas ? Any chance to fight over the exclusion ?

Just a layman's opinion. It seems to me that if something is specifically excluded that fighting it might be difficult.
You could also resign yourself that at least getting some of the surgery covered by having the covered condition done. That you have a partial victory. Best of luck.

Good point, since I will need plaque and grafting, insurance will pay for all of that 100%, the implant cost should be cheaper, since I insurance is paying for hospital, doctor, anesthesia. My cost should be just the implant and the surgeons time to implant. I will pay for it, but I don't want to pay for procedures that are covered.

[Biker60]

Is there the option to purchase a rider for additional coverage? Or switch policies? This would require waiting a year for the "preexisting condition" exclusion to run out, but using a V.E.D. in the meantime should limit any further size loss.

I can't wait any more, no treatment for PD has worked. I work for large company 13500 employees. The insurance options are hmo, pos, or ppo. No riders, so I am going to pay.

[Gt1956]

Got turned down just because it’s a penile implant. Just don’t pay for such a thing.
Breast implants covered, gender change covered. Xiaflex 40k covered and did more harm then good. Work for a hospital system. Yes a hospital system that excludes implants out. I was told the implant surgeon would fight for exception. I have ready bad Peyronies. Now lost 3 inches. My options pay $$$. Or contact Boston scientific? Does anyone know where That they can do?! Now might need surgery to remove plaque. Covered, just no implants. So need to find surgeon who will do the covered work and I will pay for the implants cash. This way. Surgical center is covered, surgery cost etc. any ideas ? Any chance to fight over the exclusion ?

Just a layman's opinion. It seems to me that if something is specifically excluded that fighting it might be difficult.
You could also resign yourself that at least getting some of the surgery covered by having the covered condition done. That you have a partial victory. Best of luck.

Good point, since I will need plaque and grafting, insurance will pay for all of that 100%, the implant cost should be cheaper, since I insurance is paying for hospital, doctor, anesthesia. My cost should be just the implant and the surgeons time to implant. I will pay for it, but I don't want to pay for procedures that are covered.

Well it is a partial win in my book. Still won't be cheap. But again, another way to look at it as just a high co-pay. Makes it a little easier to swallow. I don't have exact price data but I've read that the implant itself runs around $8k. My advice, and it is worth exactly what I'm charging for it. If you know that you'll be getting a Titan. Start beating on their door for a price break. It never hurts to ask for a discount, politely.
Geez, they gave an implant away on that doctors show on television. I think Haky installed it for free to boot. Good luck.

[rdnkbiker]

I feel for you biker my insurance said they would cover it and gave my doc a confirmation # the whole bit then 3 days before said no I talked with who I could that short time period they all said the insurance already gave a conformation # it will be fine so I did the surgery was a lot more surgery then expected 5 hours worth after all said and done I had to pay out of pocket still paying I'm sure it will be wore out before I get it payed for lol whatever the cost get it in writing don't be like me and wake up to a 90k dollar implant bill

Jim