Hopeful Implant Journal

[Lost Sheep]

Update:

Unfortunately, they say that while I do meet the criteria for an implant, it's not covered by my plan. They said I could resolve this by talking to HR and having our benefits coordinator and having them write a letter of approval. So basically, with no guarantee of success, start conversations with our HR department about my sexual dysfunction. I don't know if I feel ready to do that. Has anyone gone through this and had insurance end up covering?

What a discouraging mess...

That sucks. To have to admit to people you know, face to face, that you have a delicate medical condition.

Take heart in the fact that they are bound by law and moral principle not to discuss facts of your case with anyone not needing to know those facts. HIPPA is very clear on this.

I was reticent to tell my primary care physician that i could not perform sexually. I wasted a lot of good vagina over those years. Finally, I bucked up and levelled with him.

It was worth it.

If you are embarrassed about the WHY of your need, I would not, if I could help it, reveal the underlying medical condition. It should be enough that your physician's opinion is that you need this medical procedure/device. Be polite, but be steadfast unless you think it will hurt your case for approval.

Good luck.

[hopeful_future]

That sucks. To have to admit to people you know, face to face, that you have a delicate medical condition.

Take heart in the fact that they are bound by law and moral principle not to discuss facts of your case with anyone not needing to know those facts. HIPPA is very clear on this.

I was reticent to tell my primary care physician that i could not perform sexually. I wasted a lot of good vagina over those years. Finally, I bucked up and levelled with him.

It was worth it.

If you are embarrassed about the WHY of your need, I would not, if I could help it, reveal the underlying medical condition. It should be enough that your physician's opinion is that you need this medical procedure/device. Be polite, but be steadfast unless you think it will hurt your case for approval.

Good luck.

Thanks, you have good advice as always, Lost Sheep. Hope you've been well lately!

[Waynetho]

Update:

Unfortunately, they say that while I do meet the criteria for an implant, it's not covered by my plan. They said I could resolve this by talking to HR and having our benefits coordinator and having them write a letter of approval. So basically, with no guarantee of success, start conversations with our HR department about my sexual dysfunction. I don't know if I feel ready to do that. Has anyone gone through this and had insurance end up covering?

What a discouraging mess...

My advice is to get past your fears and privacy concerns. I was at this exact point when my doctor was doubtful that my IPP implant would be approved by my insurance. I spoke to the girl in HR using generic terms, stating that I might run into complications with the insurance and might need their help since my employer's policy clearly stated that my issue was covered.

I wasn't ashamed or embarrassed to talk to anybody I had to, to get my implant. In the end I didn't have to but I'd already opened the line of communication and was ready to talk to anyone at my corporate office that I needed to, to make it happen. You're talking about your sexual health and while it can be embarrassing from one point of view, you are trying to do something to get past it which shouldn't be embarrassing and should be commended.

[Lost Sheep]

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I wasn't ashamed or embarrassed to talk to anybody I had to, to get my implant. In the end I didn't have to but I'd already opened the line of communication and was ready to talk to anyone at my corporate office that I needed to, to make it happen. You're talking about your sexual health and while it can be embarrassing from one point of view, you are trying to do something to get past it which shouldn't be embarrassing and should be commended (italics added for emphasis).

For you single guys, remember; a man willing to address his issues directly and to overcome them is a LOT more attractive than one not.

[hopeful_future]

As an update, I'm still going back and forth with insurance. It turns out if I had gone straight to HR, they would have turned me down as well, since the insurance provider had on record that anything associated with sexual dysfunction is not covered. However, I did reach out to HR and get a copy of the policy they had provided to me previously (I didn't remember anything about sexual dysfunction in there), and I read all 80 or so pages of it. There is no mention of this as an exclusion, and I couldn't find any reason in the plan why an implant would not be covered.

I called up the insurance provider's customer support line and spent a couple of hours on the phone with the person on the other side, going through each document I had available to me, through their notes, through the material my doctor had sent me...He came to the same conclusion, the documents I had cover an implant. But there's still the issue that their system says our plan doesn't cover it. So he helped me submit an appeal with all of the information I had sent him.

In the meantime, Dr. Karpman's office has been going the extra mile for me, and the person I've been working with for approval and scheduling has helped out so much. She has submitted a report on their end as well, stating clearly that this is treatment for venous leak causing functional loss, and has them expediting the process...Apparently, there's still a chance I could be getting things done in August, just not next week. The woman who has been helping me is named Kristina and she is amazing.

I'm still of the opinion that my employer has zero need or right to know about any of my medical conditions or treatments. If I absolutely have to go to them, I'll do it, but it's just a fucked up situation. Thankfully, my own research and persistence has been yielding results in the meantime.

[Lost Sheep]

(edited for focus)

In the meantime, Dr. Karpman's office has been going the extra mile for me, and the person I've been working with for approval and scheduling has helped out so much. She has submitted a report on their end as well, stating clearly that this is treatment for venous leak causing functional loss, and has them expediting the process...Apparently, there's still a chance I could be getting things done in August, just not next week. The woman who has been helping me is named Kristina and she is amazing.

I'm still of the opinion that my employer has zero need or right to know about any of my medical conditions or treatments. If I absolutely have to go to them, I'll do it, but it's just a fucked up situation. Thankfully, my own research and persistence has been yielding results in the meantime.

A great deal of the bureaucratic foulups with insurance is the numerical codes they have for treatments and conditions. If the codes the Doctor's office use don't match up with the codes the insurance company uses...denial. Most medical offices staffs, if they are good and persistent, can get the two lists to align. It soulnds like you are on the right track.

[hopeful_future]

UPDATE!!

We did it! Insurance appeal was approved, they have now approved the surgery, just in time for my pre-op appointment. We kept me on the schedule, which means next week is my surgery! First one of the day, 8am! My poor husband is going to need to get me there by 6am, but I'll make it up to him later when the implant is functional.

To continue documenting the process, I went in for me pre-op today. Dr. Karpman talked me through the process and what I should do over the first week. They're going to keep me overnight and take out my cath and I think the drain before sending me home. He explained that they're going with the titan for me due to my size (15-16cm stretch test), and that he does both but prefers titan for anyone around my size or larger. He described that they size it during (I saw how he does it in his surgery vid on youtube), and that really any surgeon these days should not be undersizing their patients.

He walked me through the first week, they'll leave me at 70% and I should start pulling down on the pump the day after I'm sent home and keep doing it as often as I can through the day. Starting that day I should do hot showers as much as possible, and as soon as I can tolerate it, 2 hot baths daily. He described the cycling process after he does the first deflate. Twice daily, 30 minutes each to start. Should feel a little uncomfortable. I'm sure I'll get more instructions later.

So that's about it! They gave me colase (stool softener), they're starting me on an antibiotic, and they prescribed me an opiate of some sort for after the surgery.

Bonus Round: Insurance denied coverage for the pain medication (probably out of spite), so I just paid the $40 out of pocket. I have zero doubt they're going to try to hook me on hospital costs.

Happy to answer any questions...going to try to keep updating as things continue!

[Lost Sheep]

Wow! next week. I am happy for you. Hate going through bureaucratic hoops. But in the end, you will find it worth the trouble.

[notaes]

So happy for you!

[Gt1956]

Hopeful_future, I've ran into a catch 22 on pain meds before. My insurance will only cover one pain prescription every 30 days. They don't care if it is for 4 pills or 30 pills. My wife was having a lot of dental work done last year. Dentist would give her a prescription qfor a few pills. If her next appointment was less than 30 days away. I got nailed paying for the next one.
Likely not important for you this time. But if you are ever looking at repeated prescriptions in a short time period this might happen. We ended up making sure her dental procedures were a little over 30 days apart.