Insurance Denial

[Lost Sheep]

Jeb,

As a current federal employee, I had GEHA medical and they will not cover an implant. They will not even consider an implant unless it is a transgender case.

"We only cover penile implants for women"

What a time to be alive

Gee whiz! But me getting an implant is FOR the benefit of my woman!

[Hrc714]

It took me a few tries to get approval. I think the insurance companies just try to wear you down. My first rejection said no cause sighted. History of smoking would have been acceptable. I asked if I start smoking, how long until approved and never got a response. I did win them over by mailing them hard copies of every appointment and every prescription related to ED going back as long as I could find. Those few hundred pages got me approved. My feeling is they gauge whether or not you will ever give up before they make a decision.

The next adventure is getting them to pay. Good luck to you!

[cth524]

I have cigna through my job. I had prostate cancer in 2021 and had a prostatectomy to remove cancer and prostate. I have been doing the pump, cialis, and injections for over a year and still haven't gotten my natural erection back. Granted the injections work bit it has caused more damage by causing scar tissue and peyronie's. I've had multiple dopplers as well. I am scheduled for a June 5th surgery for an implant and not sure if cigna will pay. They will pay if it under certain conditions. Mine being cancer or the surgery has caused my ED. Just my 2 cents and good luck

[jeb6294]

So, the insurance lady from the urologist called the other day. Said implants are excluded so no appeal. Thanks to what @squirrel posted, I did some quick checking and it looks like Blue Cross would cover it. One of the fortunate things of working for the gov’t is how easy it is to switch health insurance…once Open Season starts in Nov. I am going to get the BCBS info to the insurance lady just to verify.

On a side note, she also let me know it would be $21K plus anesthesia out-of-pocket if I wanted go that way. Said $13K of that was “parts”. Hard to believe that little thing is so pricey.

[Gt1956]

FEHB participant here. Build a folder of info & questions to ask during the open season. Might even help to have the medical codes ready also. Time is on your side, be prepared.
Btw, I think the $13k in parts also includes supplies for the stay. Like IV fluids, ice pack, surgical tools etc.
Most of that stuff comes in a big kit for the procedure. What they use gets thrown away. What they don't use goes the bin next.

[Floridaspeedo]

I have cigna through my job. I had prostate cancer in 2021 and had a prostatectomy to remove cancer and prostate. I have been doing the pump, cialis, and injections for over a year and still haven't gotten my natural erection back. Granted the injections work bit it has caused more damage by causing scar tissue and peyronie's. I've had multiple dopplers as well. I am scheduled for a June 5th surgery for an implant and not sure if cigna will pay. They will pay if it under certain conditions. Mine being cancer or the surgery has caused my ED. Just my 2 cents and good luck

CTH524 I have Cigna and they paid for my IPP. Of course it was a fight but they found as said above it was included in the "gender reassignment" section but a GR was not required. (Thank god)

Joe