Best insurance, please help

[tobenormalagain]

56yo, health man (no meds, no health concerns, I'm fit and exercise) with long-standing ED. I am completely done with pills, shots, vacuum devices, traction devices.... My latest attempt with a shot last week was a complete failure (yes, I used good technique and a dosage that should have been effective). Anyhow, long story short, I have accepted a position with a federal agency and will be soon start the process for healthcare insurance enrollment. Does anyone have a recommendation for which insurance carriers are more inclined to approve a penile implant. I had Blue Cross Regence before and they were no go. Trying to ascertain online is a trip down the rabbit hole. Please help

[Gt1956]

Good news first. As a new hire you have a choice between all the health insurances available in your region in the FEHB plan. Best that I can offer is to call each of the top couple of plans available. Be honest about what you're needing done. See what each one says. Btw, there are some really basic plans on there. Its my opinion that they likely won't cover implants.
Remember, if the insurance denies your pre approvel. Come open season in October/November you can change carriers fairly easily online.

[Totitoti]

United healthcare in Florida approved me no issues, also to consider is a good doctor that knows how to submit your paperwork.

[GoodWood]

I too am a federal employee.

I have not yet tried to get an implant approved but my Blue Cross Blue Shield Federal Employee Program plan specifically excludes implant for sexual function. I think if it was due to prostatectomy it would cover.

I’m going to have to investigate as well and consider a change next open enrollment as I’m in a similar situation r/t ED as you.

I think calling each plan and asking for their list of exclusions and be specific about urology and ED.

[Gt1956]

I would advise to ask if having peyronies is an acceptable condition to have in order to get an implant. I've read that an implant is pretty much the gold standard treatment for peyronies. If you have a minor case of peyronies? You might find it to your advantage to slightly exaggerate the syptoms to your doctor. I think his notes from your visits along with a treatment plan is submitted to the insurance company. So.....even if sexual function is an excluded reason. It might be to your benefit to harp on the peyronies diagnosis.
Good luck guys. Just an opinion.

[Rider1400]

I have BCBS of Illinois and they do(did) cover it in May of ‘22 of course there was my deductible and max out of pocket. I was out a total of $2,000. At first I was denied by the phone call and later got the implant codes from Dr office and called insurance back and gave codes and they were immediately accepted. Not all BCBS insurance cover implants and according to your employer it can change year to year. So you’ll have to do your homework as nobody can tell you any particular insurance that does in fact cover it unless it’s identical to yours and covered by the exact same employer.

[CHIEF3]

I had BCBS of California and was denied at first. I had an interview with a representative and explained all the methods and medications I used to have sex and they were all failing. I also said, “we want to have children.” I am not sure what they wanted to hear but they approved coverage, after deductibles of course.

Best wishes.

[squirrel]

Take a look at Blue Cross Blue Shields benefit brochure. This is BCBS for federal employees. On page 58 under orthopedic and prosthetic devices it states as covered " Surgically implanted penile prosthesis limited to treatment of erectile dysfunction and gender affirming surgery". This is the Only federal health insurance plan I could find that stated they covered Implants. I had to wait for open season to change from GEHA to BCBS because GEHA would not cover it.

[tobenormalagain]

Thank you all for the info! You guys are awesome.