Insurance declined IPP

[Richardwad]

Unfortunately, a week before my scheduled surgery, I was notified that BCBS wasn't going to cover the claim.
I was pretty suspicious when the office visit to go over the procedure and schedule wasn't covered at all.
That cost about $600 right there.

Requested a cash price for the operation, but will probably be more than I can afford.

Anyone pay cash? How much?

Going to retire soon.
Will look for a policy that covers "sexual disjunction "

[SteveSW]

Unfortunately, a week before my scheduled surgery, I was notified that BCBS wasn't going to cover the claim.
I was pretty suspicious when the office visit to go over the procedure and schedule wasn't covered at all.
That cost about $600 right there.

Requested a cash price for the operation, but will probably be more than I can afford.

Anyone pay cash? How much?

Going to retire soon.
Will look for a policy that covers "sexual disjunction "

If you are retiring, are you going on Medicare and adding a supplemental plan? I have Medicare plus United Healthcare/AARP and they covered 100%. Check it out.

[Richardwad]

Too young for Medicare yet.
Will be searching for a new insurance program

[tobenormalagain]

I'm in the same boat! In my call to BCBS, I gave the diagnoses and procedure codes to the representative and was promptly told that IPP was an "excluded procedure". I visit my implant urologist next month and am unsure if an appeal (I also have Peyronie's, thanks to Trimix) would be worthwhile. The OOP cost is $16,500 (Seattle area) and if insurance doesn't come through (doubtful), I'm entertaining the idea of paying for it myself. I just wanted to take the opportunity to verbalize what a scam and ripoff most health insurance (esp BCBS) providers are. Let me know what insurance carriers are likely to approve and I will switch ASAP

[SteveSW]

A doctor's diagnosis of Peyronie's will sometimes gain approval, where just sexual dysfunction won't.

[sweaterfan]

Last year I paid $100 for a video consultation with my future Houston surgeon and he immediately told me that BCBS would not pay for it. He quoted $20K which is about what another surgeon in the Austin area charges. Next year I'll be covered by Medicare and the same United Healthcare Supplemental insurance as SteveSW and hope to have the same financial result. BCBS is well-known for not covering IPPs and they won't budge.

You have to ensure that the policy covers the specific CPT codes for installing/repairing/replacing an IPP:
https://www.bostonscientific.com/conten ... cument.pdf

You will have to have a revision at some point, so make sure that all codes (except maybe 54406) are covered. It's possible that the IPP will fail in a short period of time and need repair or replacement which are different codes.

Some members have had luck with other insurance companies. Try searching FT for company names (Humana, Aetna,...).

[October26]

United Healthcare denied my requested procedure as an excluded procedure but I prepared an appeal and it was accepted. The clear language of the policy excluded it. I don’t know why it was accepted but I had both ED and PD. Whatever you do, appeal as soon as possible, since there is a deadline in most cases. Be thoughtful in your appeal and try to persuade.

[JP1977]

Lending club.com
Quick way to get cash and a decent rate if you need it.

[Pau1pau1]

I live in the uk and have private medical insurance through my job . They refused the procedure .
Thankfully the NHS stepped up and I’m on the waiting list , gunna cost me £0.
Private insurance is a rip off.

[Raleighlandshark11]

I guess I was lucky in August. I have BCBS and they paid $57k for the procedure between the surgeon and hospital. Cost me nothing