Cigna denied surgery for Clavell

[Journeyman]

Have you talked to Dr.Clavell since the surgery determination ? Does he have a plan B approach with the insurance company? He's seen it all .... in the surgical room and out . He's dealt with all these insurance companies.

[rdnkbiker]

Nope Jag just that one my new one paid cash out of pocket 24.8k but had i had insurance pay be alot more crazy how it all works i know guys on here got stuck with that much also

[indeed]

Sorry to hear it man. I don't know about your financial situation but have you thought about going for example to Dr. Karaman in Turkey and self pay?
Surgery seems to be about 8k, with lifetime warranty for the device. I guess revisions after initial surgery would be much cheaper even.

I wish you good luck with your insurance

Not sure what to do- my implants been broken for a few years and now I finally get insurance to help me and they deny me….


Anyone have a any advice on what I can do?

[Midwest Guy 333]

I have United Health Care, which is not a great company to be insured with, but that's what I have because of work. I kept getting bills after the surgery and after I had paid my total out of pocket for the year (which takes about .5 seconds when you are having ANY surgery.) After digging for answers over a two month period between the hospital, Drs' office and insurance company, an insurance processor at Dr. Clavell's office finally told me that they were told by UHC that preauthorization was NOT needed for the implant surgery, but after it was done, UHC said they DID require preauthorization and would not pay for the surgery. Seemed kinda fishy... I'm sure I'm not the first UHC patient that Dr Clavell's office has handled?!?!!!?? Anyway, she said their office was going to "eat" the surgeon charge because it was the office's fault. At least that was stand up.... I think most places would try to stick me with the bill anyway. Still, the whole thing seemed off. I posted previously on another thread that until the morning of the surgery, I still hadn't been told what the charges would be or how insurance was handling them which I thought was VERY strange as well. I kept pushing for facts and figures, but they weren't given until I got to the hospital and was admitted.

[Pamen116]

Have you talked to Dr.Clavell since the surgery determination ? Does he have a plan B approach with the insurance company? He's seen it all .... in the surgical room and out . He's dealt with all these insurance companies.

Hey Journeyman- I have no way to talk with him. I have no email or number- our last conversation was last Monday via “zoom” but I hadn’t been denied at that point so I didn’t ask.

Im talking with Maddy in the insurance department at his office, she said she would get with him Monday to see what we could do. They essentially said that the only way to bypass the exclusion is if I had an underlying condition that affects it like high blood pressure or diabetes!?? I’m like isn’t my 2 year broken implant and urine blockage enough for a medical necessity surgery???? I hate this

[Journeyman]

Have you talked to Dr.Clavell since the surgery determination ? Does he have a plan B approach with the insurance company? He's seen it all .... in the surgical room and out . He's dealt with all these insurance companies.

Hey Journeyman- I have no way to talk with him. I have no email or number- our last conversation was last Monday via “zoom” but I hadn’t been denied at that point so I didn’t ask.

Im talking with Maddy in the insurance department at his office, she said she would get with him Monday to see what we could do. They essentially said that the only way to bypass the exclusion is if I had an underlying condition that affects it like high blood pressure or diabetes!?? I’m like isn’t my 2 year broken implant and urine blockage enough for a medical necessity surgery???? I hate this

Maddie is the best ! I think she's in charge of scheduling the surgeries. I dealt with her most of the time until I got a call from a different women ( don't remember her name ) that was some kind of liason between me , the Dr. Office, and the insurance company. Don't know who assigned her to my case , but I guess her job was to mediate and keep everyone informed of what's going on . She would contact me often to make sure everything was going well , did I have any concerns or questions. Not sure she did anything to actually get the surgery approved, but it was nice having someone to talk to you and feel like they were on your side fighting for you . Probably just the placebo effect but it made me feel better . I really credit Dr.Clavell doing the peer to peer review with moving everything forward and getting past any more insurance hurdles. I don't understand why thats not available to you ..... What I do know is between Maddie and the Doc , you have a fighting chance. They'll do everything they can . Good luck

[Bigdog4all]

You got stuck with an $89k bill

I too got an Implant insurance bill of $89k. But was covered. My problem.....It seems I paid for a Marble, Rock, or Stone for a AMS Pump, which I can't use. Not by Clavell.