Denied Coverage by BCBS for Penile Prothesis

[Gator77]

God Morning,

I am a new member and I am looking for some advice. I am 39 and have been dealing with ED since my late teens. I have tried injections, pills etc but they didn't get the job done. I finally decided it was time to get a penile prothesis. I scheduled surgery just to receive notice from my doctor that the policy my employer chose for their employees did not cover the procedure. It was denied for "exclusion of benefits". I am appealing with my employer but I want to be prepared if the appeal is denied. My question is how do I find a policy that will cover the implant since it has be declared a medical necessity? I have searched the web with no luck. I hope someone can help. Thanks!

[Cigar56]

Just a guess, but sounds like your doctor didn't make a very convincing argument for the surgery. I would suggest considering another doctor who previously has dealt with your insurance company.

[ED2013]

I agree contact other docs. I highly recommend going with a top surgeon.

[dirtman1993]

Try Kramer and talk with Connie at office. I have BCBS as my second and they had no problem picking up what medicare did not pay.

[David_R]

Sometimes a person from a supportive office somewhere will contact your insurance company on your behalf and inquire if they cover breast reconstruction for women (which is not necessary to stay alive but which can help improve life so much). If they do, this supportive person can point out how a penis prosthesis is in the same category for men: not necessary to stay alive but it helps improve life so much. Office persons like this know how to deal with insurance companies better than persons like ordinary you and me. Best wishes, guy.

[ccrider]

Try Kramer and talk with Connie at office. I have BCBS as my second and they had no problem picking up what medicare did not pay.

I had Anthem/BCBS at the time of my procedure...they covered it 100%. You have to show that the implant is a documented medical necessity. In my case, the ED was caused by Type II diabetes. I agree w/ dirtman-call Connie at Dr. Kramer's office and discuss your insurance situation...she was extremely helpful to me.

[dg_moore]

Not all policies issued by the same insurer are the same. As the OP pointed out, his employer chose a plan from BCBS that does not cover implants, so the fact that another BCBS plan does cover them is meaningless. However, an appeal should be possible, and an application that specifies medical necessity might succeed.

[C coggin]

I was denied by BCBS 2 times before they finally approved me. They covered the procedure 100% I am now 11 days postop. just keep at it and dont give up

[Freemase]

I too am under BCBS throu8gh my wife's employer. Once me and my urologist settled on the procedure and date, it was let to my regular physician to not only clear me for surgry, but gt things approve by BCBS, or at least they should have. Procure done now, I am hoping I don't get a surprise bill! It's not like they can take back the pump

[Hopefulandworried]

My husband had the same issue with BCBS of Texas. They denied even with appeal. Had to switch to my insurance United health care. Good luck