Clavell office and Cigna denial

[Pamen116]

I need help on what steps to take next guys…

I’ve been with a broken implant 2 years now

I finally get insurance and they deny it

Dr Clavells office is saying there isn’t anything they can do for the insurance exclusion. Unless I’ve had previous health issues such as diabetes or high blood pressure I’ll just be denied.

They’re saying Cigna won’t do a peer to peer either.


Idk what to do.. someone help please

[MiddleAgedMiami]

Very sorry to hear about your experience. Is your health insurance via an employer plan or is it a marketplace plan?

Also, considering that you’ve had two failures at such a young age you may want to seriously consider a malleable, and perhaps getting it done overseas where it can be much less costly than in the USA. While the malleable isn’t as good as the inflatable implant, it’s better than nothing and it could be a good bridge to a later date when you can opt for the better implant when you’ve got a better insurance or when Medicare kicks in later in life.

For what’s its worth, I have United Healthcare through an employer plan and they did not give me any trouble approving my procedure.

I hope you’re able to get your situation resolved. Can you file an appeal?

[Txagq8]

Let me preface this by saying that, in general, I hate insurance companies. They are your friend and glad to take your money until you file a claim.

I think I’d suck it up and see a lawyer. I would need to know more about the exclusion.

They might get away with not covering a penile implant surgery to fix ED. It would suck that they would do it but if they tell you in the policy it’s not covered, it’s not covered.

What I’m not sure of is whether they can refuse to pay for surgery to have the broken implant removed. Getting you on the table opened up is where the cost is. If the insurance paid to have your implant surgically removed (leaving non functional foreign objects inside body is generally unwise) then I suspect the added cost to stick a new one in would not be prohibitive.

Why a lawyer? He or she can tell you if they can dodge paying for removal. If they’re on the hook for that, then they can file suit and force the insurance carrier to pay.

If the device broke it ought to be covered by manufacturer. So you get a new device. The old one is going to have to come out before they put a new one in. It’s not going to cost an additional anesthesia, operating room once they have you opened up and the old device yanked out.

[Pamen116]

Let me preface this by saying that, in general, I hate insurance companies. They are your friend and glad to take your money until you file a claim.

I think I’d suck it up and see a lawyer. I would need to know more about the exclusion.

They might get away with not covering a penile implant surgery to fix ED. It would suck that they would do it but if they tell you in the policy it’s not covered, it’s not covered.

What I’m not sure of is whether they can refuse to pay for surgery to have the broken implant removed. Getting you on the table opened up is where the cost is. If the insurance paid to have your implant surgically removed (leaving non functional foreign objects inside body is generally unwise) then I suspect the added cost to stick a new one in would not be prohibitive.

Why a lawyer? He or she can tell you if they can dodge paying for removal. If they’re on the hook for that, then they can file suit and force the insurance carrier to pay.

If the device broke it ought to be covered by manufacturer. So you get a new device. The old one is going to have to come out before they put a new one in. It’s not going to cost an additional anesthesia, operating room once they have you opened up and the old device yanked out.

What’s your latest update with approvals or getting anywhere? Any luck

[atul21]

If this doesn’t work out, I recommend you to get your surgery done overseas in a country like Turkey. The cost is much lesser and the doctors seem to have high volumes and repute.