Getting insurance company to pay for an implant.

[GoodWood]

After several years of escalating Trimix to quadmix dosing I think I’m reaching the point of needing an implant.

The problem: I’m too young for medicare (52yo) and my insurance policy has implants in an exclusion clause.

I have documented ED for 7 or 8 years (my primary care MD started writing scripts for viagra and Levitra back then) and my urologist has been writing escalating strengths of Trimix and quadmix for several years.

How can I get this done without having to pay out of pocket?

[mikestap]

An implant was also specifically excluded in my employer provided insurance, but my doctor’s office staff was successful at overcoming that obstacle. Ask them to make your case for the medical necessity of the procedure.

Mike

[dg_moore]

If you have employer-provided insurance the exclusion is probably dictated by your employer, not the insurance company.

[truckrglenn]

You don't mention the make of the implant that your Dr does. But call their area rep and they should be able to help. Mine was billed as medically necessary.

I was told that the surgery was $20,000 and I would only be billed $1,400. But the hospital over billed the insurance company at $38,000 leave my share at $5,600.

[GoodWood]

You don't mention the make of the implant that your Dr does. But call their area rep and they should be able to help. Mine was billed as medically necessary.

I was told that the surgery was $20,000 and I would only be billed $1,400. But the hospital over billed the insurance company at $38,000 leave my share at $5,600.

I’m in NYC so my first choice would likely be Dr Eid. My girth would probably lean towards Coloplast Titan.

Even $5600 would be tolerable. I’m just trying to wrap my head around $20,000-$30,000.

[Old Guy]

I would think insurance would pay if they were sent doctor notes of your history. As far as I'm concerned a broken dick is the same as a broken knee. If you had a knee so bad you couldn't walk insurance would pay. Now you have a dick so bad it doesn't fuck. I bet 100% if you walked into the insurance office and said "Who here doesn't want sex anymore?" no one would raise their hand.

[GLE Man]

Goodwood,

That's the story of my life. Read some of my posts to see what I went through with my insurance company. Send me a message and I will be more than happy to elaborate. Mine was a fight all the way from a flat no in December 2020 after being scheduled to being implanted in March 2021. I have both the rejection letter and the approval letter in my records

I'm available

GLE Man

[North329]

Hi Goodwood,

I am dealing with a similar issue. My URO office called to say it was an exclusion. I am trying for an appeal. I am using wording that previously suggested on FT past posts.........this surgery will restore my lost function, and the necessity for the procedure is venous leakage.

North329

[GoodWood]

Please let me know how that works out. I’m really curious.

[Blah1109]

What insurance do you guys have I have Aetna POS Choice II