Insurance has denied implant

[cth524]

Ok so as you read my insurance has denied my implant. I have cigna through my work but they use evicore I guess as a final say. I have been back and forth between different people with different answers as to if it would be approved or not. They say that evicore says it's not medically necessary when it is. I had a radical Prostatectomy done for prostate cancer almost 2 years ago. That's 2 years with Ed that nothing has seemed to help but maybe injections. I hate them cause they are causing so much scar tissue it's making my dick look deformed.
Cigna says my plan doesn't cover implants but they say my dr can argue the fact its necessary. This is all so upsetting because I thought this would be my end to ed and move on with life. I'm 53 and single and would love to met someone one day and enjoy life with. I sometimes wish I had kept my prostate cancer and died from it then to live with Ed all my life now and die from loneliness.

[rdnkbiker]

I had cigna they are terrible they did not cover mine got stuck with a huge bill
Jim
Good luck

[Txagq8]

Cth: you said something about injections that caused me to think. There have been guys on here who had insurance that wouldn’t pay for an implant for sexual reasons but would if the doc convinced them it was the only way to fix Peyronie’s. If you’ve got scarring from injections, and the start of Peyronie’s curvature, your doctor might approach insurance from that angle. Certainly it’s worth discussing with the doctor. Sometimes it’s a good idea just to wear the insurance company down, eventually they give in just to make you go away.

[Floridaspeedo]

I have Cigna and they have many plans.

I had 2 doctors being able to get it approved but they did a substantial number of implants so they know the buzzwords to use. Your doc needs to fight for this not you so be sure to get a 2nd opinion from another doc who does some volume.

[Gt1956]

I think txagq8 has the best approach. You don't want an implant to cure ED. You want an implant to treat your peyronies. Many times that is a valid treatment.
Attack the insurance company from a different direction. You're giving them a reason for them to cover it.

[cth524]

All good thoughts thanks. I canceled my surgery and everything. I might run it by doc and see if he can use it as a cure for peyronie's instead

[Bigdave]

Hmmmm, I also have Cigna, and they approved my implant without any issues.
I have had over a decade of documented pill use, as well as a try at injections, which I definitely did not like.
It had progressed to where I was tired of the planning and somewhat unreliable results from pills, and decided to go for an implant.

Definitely worth pursuing though. Good luck.

[Gt1956]

All good thoughts thanks. I canceled my surgery and everything. I might run it by doc and see if he can use it as a cure for peyronie's instead

A hard question. Does your dr have a long track record of doing implants? Perhaps his office staff isn't up for the task. Remember, they are a team & if one or the other fails. The whole thing fails.
Be prepared that you might need to change drs. If for no other reason than to get a dr with better staff.

[cth524]

Hmmmm, I also have Cigna, and they approved my implant without any issues.
I have had over a decade of documented pill use, as well as a try at injections, which I definitely did not like.
It had progressed to where I was tired of the planning and somewhat unreliable results from pills, and decided to go for an implant.

Definitely worth pursuing though. Good luck.

I think policies are different per employer. One policy may cover and another may not. This is what I have been told.

[cth524]

All good thoughts thanks. I canceled my surgery and everything. I might run it by doc and see if he can use it as a cure for peyronie's instead

A hard question. Does your dr have a long track record of doing implants? Perhaps his office staff isn't up for the task. Remember, they are a team & if one or the other fails. The whole thing fails.
Be prepared that you might need to change drs. If for no other reason than to get a dr with better staff.

My dr has a very good track record as far as the amount he does per year. I'm not sure about the staff as I have no idea. But I was told by a guy that runs insurance everyday for this stuff and he says Cigna is one of the worst to get approved. Some can get approved if their policy says it covers penile implants. Mine doesn't cover it they say. I am going to call them back tomorrow and see if they can maybe run it as a peyronie's cure and not ed.