Did Insurance Cover Your Implant?

[Kiawahgolf]

I have read where some claimed insurance covered their procedure and others stating it did not. I spoke to someone at Dr Hakky’s office this afternoon and she said insurance would cover the consultation but not the procedure since it’s considered cosmetic. I thought that was very strange. So for those of you that insurance did cover who did you use and what insurance? If I have to pay out of pocket that will make my decision rather quickly at this time.

Thank you!

[Journeyman]

I have Anthem/ Blue Shield and they covered the cost . THIS IS NOT A COSMETIC PROCEDURE !! Fucking insurance companies....you pay , and pay, and pay and when you need them they come up with some bullshit . I'd push back on that dumb ass narrative that it's " cosmetic " . The penis is an organ , like the heart or lungs . It has multiple functions. When I was going through my insurance approval process, I had multiple people helping . I had a patient advocate that acted like a middle man between me, the Dr and the insurance company. Keeping track of everything and keeping everyone informed. The surgical coordinator at the Dr.'s office that handled almost everything , including dealing with the insurance company. Lastly...Dr. Clavell himself got involved when the insurance company approved some , but not all of what I needed . He scheduled what he called a " peer to peer " review with what I'm guessing was a Dr. for the insurance company to go over my case . After the peer to peer review with Dr. Clavell, everything was approved and I flew to Houston to get my implant weeks later . Research, ask questions and don't let them brush you off . Finding the right Dr might help improve chances of getting approval. Good luck , I'm rooting for you

[Time2Change]

I fully agree with Journeyman.

Fight like hell with your insurance company. I had to push and push for months to get mine approved by the insurance company. My doctor also did a peer-to-peer review.

Anybody I got on the phone, I talked and talked with them. I finally got a sympathetic insurance rep and she made the right moves to get the procedure approved. I still have her voice mail saved when she told me about the approval.

Like Journeyman said, this isn't cosmetic surgery. Healthy sexual function is a critical part of life. I knew that if I had a fucked up shoulder or knee, I wouldn't have had such resistance from the insurance company to approving surgery.

So, I kept pushing for it. Get documentation; get the surgeon to back you up; and then keep after them.

[Odecko]

My insurance paid for mine. Understand though, I am a prostate cancer survivor. Pills never worked. Needle caused severe pain. I have Fedblue. The only issue is that the surgery had to be conducted at a hospital not Hakky's office.

[Bigdave]

Insurance covered mine with little issue.
IIRC, I did have to apply for pre-approval, but that's common for non-emergency surgery.
My Dr. sent them the required info, and they approved it fairly quickly.

All that said, I did have several years of documented ED, and had used pills for years, and tried injections, but they didn't work well. I suspect that history helped cement my case.

[Jage64]

My Kaiser plan would have, with a $200 copay. After meeting with the urologist I decided he was a nope. Paid 100x that out of pocket and am thrilled I did .

[Witheringhog]

I have read where some claimed insurance covered their procedure and others stating it did not. I spoke to someone at Dr Hakky’s office this afternoon and she said insurance would cover the consultation but not the procedure since it’s considered cosmetic. I thought that was very strange. So for those of you that insurance did cover who did you use and what insurance? If I have to pay out of pocket that will make my decision rather quickly at this time.

Thank you!

I have blue cross blue shield, they covered it minus my deductible. Clavells billing took care of everything.

[portageriver]

Medical Mutual here - surgery covered but for the deductible.

So my assumption based on my experience is the "diagnosis" your physician submits. I looked at some of my medical records and noticed my Doc listed me as "impotent." I think this might be an important step in getting past the insurance bots that prescreen approvals(?)

I found this place before my prostate surgery and started preparing for this journey mentally then. My doc was advised that this is what I wanted to do following surgery for cancer and we made it happen 11 months after my RAP.

But I never complained of being "impotent." I was, of course, rendered impotent, but maybe another doctor might have said "Give it time." Fuck that, I was approaching 60 and don't have time.

Fight my brother, starting with the doc who might be in line to refer you for the surgery. Nothing says you have to go with THAT surgeon - but at least you will be past the brick wall. Good luck my friend.

[jwitten567]

most commercial insurance (blue cross, etc) will cover implant surgery and of course medicare. Usually the doctor needs to write in their notes and possibly due an authorization ie. failed medications or some other reason why you qualify for an implant. You should be able to google a document that talks about ED and plan coverage that has all the language.

If dr hanky's office said that they are dead wrong and just likely that they don't want to deal with insurance hassles (more money from cash pay patients)

[dg_moore]

There have been numerous accounts over the years of insurance covering or denying coverage for implant surgery. In most instances of emp!oyer provided insurance coverage is dictated by your company and their contract with the insurer. If your claim is denied you may need to follow up with your HR people to get the full picture.