Insurance coverage for replacements

[Spanishxb]

Question for anyone who has had to get a replacement:

I currently am only a year or two into my Titan and hoping for another 8+ years…

However, I just got kicked off state insurance and now have to buy my own insurance. All of my options say they do not cover replacement of identical medical prosthetics…they cover the initial installation but not replacement…

Anyone have to get a replacement yet and how did that go with insurance?

I paid $100 for mine the first time around haha, hoping to not pay more than my deductible for the next replacement…God willing, many years from now.

Thanks!

[Gt1956]

I don't have any experience on this. In my case Medicare & my Advantage plan covered my implant.

But to ease your mind a little. You're at about 18 months. Seems that if an implant is going to fail, its generally early in its life. If its working ok with no glitches now you should have several good years ahead of you. Your worry will be higher in a few years from now. Policies change alot year to year. By the time your at 5-6 years perhaps your insurance outlook will be better. At least I hope so.

Oh, sometimes a supplemental or rider can be bought to cover things that aren't covered in the basic policy. I know car & home policies have these kind of options. Of course they do charge more for the added risk. Might be worth looking into those in a few years. If the price is too high. Might be wise to start setting some money aside in a seperate account just in case you're without coverage at a failure time.

[Hrc714]

BCBS gave me a hard time on the initial implant. A lot of back and forth before they would pre authorize, and then again after surgery to get them to pay. It got to the point that I paid the cost and then got reimbursed from Dr after they finally got paid. The reimbursement was another battle. After all that, they approved and paid without any issue on my replacement at 3 years.

[Old Guy]

I thought the new federal law stated insurance can't deny any pre-existing conditions. Having the implant, and if it fails, is a pre-existing condition that needs replacing. Geez, if you had a knee replaced, and it went bad in a few years are they going to make you sit in a wheelchair?

[Alex258]

BCBS gave me a hard time on the initial implant. A lot of back and forth before they would pre authorize, and then again after surgery to get them to pay. It got to the point that I paid the cost and then got reimbursed from Dr after they finally got paid. The reimbursement was another battle. After all that, they approved and paid without any issue on my replacement at 3 years.

I'm still waiting on my 2nd appeal decision BCBS from a year ago lol. I'm waiting word this week if they are going to pay. If not I'll lawyer up.

[beachbum1]

Something you might try is get in touch with your state insurance commissioner and ask them can it be denied. Just a thought