My insurance denied the implant surgery

[macattack]

I have Anthem through my employer in Virginia. I was scheduled to receive the implant on 1/23 but now it’s on hold. The authorization department states it’s not covered. The benefits department states that it is. I’ve started an appeal process but due to scheduling I am probably delayed at least a month. I was just getting over the nervousness of it all! Any advice out there? I’ve started the appeals process and am unsure of what else to do. Thanks!

[Journeyman]

I have Anthem and it got covered. Yeah it wasn't approved without drama because insurance companies fucking suck ! They take and take and take and then when you finally need them they try to weasel their way out of paying. I was initially approved in my hometown but when I decided to fly to Houston and have Dr. Clavell do it , all of the sudden the approval disappeared. It was stressful. I sent all my paperwork , chronicling my ED journey and remedies tried , to Dr. Clavells office . His staff was great ! They jumped into action on my behalf. Dr. Clavell scheduled a " peer to peer " review with , I'm guessing, a Dr. representative with the insurance company. After that meeting my surgery got approved ( a 2nd time ) and I flew to Houston in April of 2023 for my surgery.

[macattack]

Thanks, Journeyman. I know mine will eventually go through but for now I’m annoyed. Glad to hear you got everything sorted. How is everything post op months later?

[passionatedoer]

I have Anthem and it got covered.

Can you fly out of state to any doctor with insurance?

Any specific plan of Anthem that you recommend for penile implant?

[Journeyman]

I'm not an insurance expert , I can only speak of my experience. Yes I was able to fly out of town to have Dr. Clavell do my surgery even though he was not the urologist that had been treating me for the previous 3 years. I can't recommend a plan ... this is just the insurance issued to me through work and luckily it was covered.

[Journeyman]

Thanks, Journeyman. I know mine will eventually go through but for now I’m annoyed. Glad to hear you got everything sorted. How is everything post op months later?

Incredible. I'm so happy with the implant my only regret is I didn't do it 10 years earlier

[Alex258]

I have Anthem through my employer in Virginia. I was scheduled to receive the implant on 1/23 but now it’s on hold. The authorization department states it’s not covered. The benefits department states that it is. I’ve started an appeal process but due to scheduling I am probably delayed at least a month. I was just getting over the nervousness of it all! Any advice out there? I’ve started the appeals process and am unsure of what else to do. Thanks!

\

Mine was approved and done Nov 16 2022. Just put through my 2nd appeal. They refuse to pay. Most feel that eventually that they will pay up. My good Doc hasn't asked me for a dime..yet. Just incredible.

[Hrc714]

Benefits is telling you it is a covered procedure but not disclosing the circumstances under which it will be approved. The authorization folks are saying you have not met (documented actually) the criteria for approval. Be sure to supply documentation showing you have exhausted all other forms of treatment and for how long.
This is especially important if you don’t have any underlying conditions or vices that lead to ED. When I was being denied for those reasons. (Not obese, diabetic or smoker) I asked if I would be approved if I started smoking and they did not respond.
Do gather Dr notes from all you visits and send as big a stack as you can muster. Good luck!

[Old Guy]

Keep fighting them! Your surgeons billing office should be handling the appeal. They can submit documentation to insurance company of the methods tried, which is usually what they want to see.

[ThailandBound]

There s very little of the forum from malleable brothers who provide consistent updates with their ongoing experience. I hope for the benefit of others who might choose this option that you will continue to update us with your experience.

Your recovery. Questions of size and appearance. Concealability. Experience during sex. Partner experience. All these things would be of interest over time and you are in a unique position to provide that information.

Please keep us updated.