Insurance says Implant is Not Medically Necessary

[Larry10625]

Same shit here. Dr. Was supposed to write everything up as it was a painful condition for me and dropped the ball so my insurance was saying the exact same thing.

Let me get this straight - you have a malfunctioning implant and your insurance provider is refusing to cover it...
based on what?? That it won't kill you?

Is this what I have to look forward to for the rest of my life?

Hope you get that straightened out (no pun ).

I think those points are valid but I'm not a doctor. The reason that I told you to ask for your doctors help is because they have does this before and they know what to say. I would offer your suggestions to your doctor to add to his own. I hope you get this worked out in a way that will give you satisfaction.

Larry

Thanks Larry. I hope my doctor can pull the clutch save.

Maybe so of the other members can give you some ideas of things their doctors said. Come on gang lets help Genesis out.

Larry

[medhatg]

I bet if you get a doctor who does a big volume of implants, his staff will be able to get it done for you because the staff is trained to handle that. It is a 100% doctor and office staff

Did you try to talk to Dr. Kramer's office or Eid's about it?
Hey, and infertility does not count. A while back, my family doctor wrote to my drug insurance to ask them to approve "Cialis" for me and his reason was "infertility", and it did not fly. Wrote back and said "ED due to hypogonadism" and it got approved.

[ThePlumber1964]

I am surprised that you doctor and staff do not do that. ALL physicians have to justify any medical procedure. That is how they make money!!! It is not just in your best interest, but theirs too.

[Genesis]

I bet if you get a doctor who does a big volume of implants, his staff will be able to get it done for you because the staff is trained to handle that. It is a 100% doctor and office staff

Did you try to talk to Dr. Kramer's office or Eid's about it?
Hey, and infertility does not count. A while back, my family doctor wrote to my drug insurance to ask them to approve "Cialis" for me and his reason was "infertility", and it did not fly. Wrote back and said "ED due to hypogonadism" and it got approved.

Good idea Matt! My uro is mid to high volume but he travels North to Orlando and South to Miami where the clients are. His office is not very familiar with the ins and outs dealing with insurers in this matter.

I am surprised that you doctor and staff do not do that. ALL physicians have to justify any medical procedure. That is how they make money!!! It is not just in your best interest, but theirs too.

Tell me about it! It feels like I have to do all the heavy lifting sometimes. Called the Uro office today and the AoR( Authorization of Representation) form they sent along with my denial of coverage(needs to be filled out and sent back to challenge the ruling) was actually never sent!

Had my doctor send a letter to them justifying it in the meantime.

[ThePlumber1964]

Sent you a PM.

[calixtus]

The bottom line is the question whether the capacity for an active sex life is medically necessary. We of FrankTalk think it is. For an insurance company, perhaps a letter from a recognized and authoritative psychiatrist could be persuasive.

[medhatg]

The bottom line is the question whether the capacity for an active sex life is medically necessary. We of FrankTalk think it is. For an insurance company, perhaps a letter from a recognized and authoritative psychiatrist could be persuasive.

Good point. My doctor usually includes an "ED Patient Impact Survey" which I needed to fill and includes questions like: how important sex life for you? and for your partner? Do you feel depressed if you cannot do it (I'm just paraphrasing)? How often do you think about your failures? How does that affect your relationship? How does failure affects your work and motivation? and so on.