Denied by Insurance

[GoodWood]

Look up the exclusions page on your policy. I have BCBS as well. The policies vary from employer to employer, but mine says it won’t cover treatment for sexual dysfunction EXCEPT for surgical implantation of penile prosthesis for erectile dysfunction. (So there is an exclusion of their exclusion)

See what yours says.

And talk to the billing folks for your surgeon. Anthem BCBS is a big, well known insurance. They have likely seen your policy before and may have other billing codes that will satisfy the insurance company.

Just because the insurance company said no doesn’t mean it’s over.

Talk to your surgeon and see what they and their staff say.

[Alex258]

I have a policy with Anthem BCBS. They declined coverage of IPP. According to the policy's "What is Not Covered" section, "66. Sexual Dysfunction Services or supplies for male or female sexual problems."

This seems like something I won't be able to appeal.

I've had ED issues since 32. A couple years back, I told myself that I was just going to get an implent if my ED wasn't getting better at 45. Now that I'm 45 and ready to make the decision, I find out my insurance won't even cover it.

We just so happen to be switching insurance carriers at the end of the month. So I'll see what the new policy covers.

BUMMER!!

I'm over 2 years in and still fighting Insurance when I have all the proof in the world that they okayed the surgery. My Dr's office has been so kind in not asking me for one dollar and the person in charge there is fighting for my rights so now my case is in the hands of the U.S. Dept of labor. This has passed through many hands. $45,000 worth.

[Old Guy]

Your surgeon's office should have a billing specialist. They know how to word and code things so insurance will cover excluded surgeries. When my insurance rep called trying to talk me out of doing the surgery, I turned the tables on her. Asked her what if your husband had ED? She approved my claim.

[Journeyman]

I just made a post about insurance denials... its titled " Fair Hearing Trial ." Look it up . I think it's on page 4 . Might help you .Good luck.

[CarbonBurrito]

I appreciate the input here, gents!

Looks like my new policy, starting in March, will be through UMR. This is a company that services United Healthcare. From what I can see (and from what Clavell's office said) UHC is more prone to approvals than BCBS, especially given that my specific BCBS policy strictly excluded any ED service/medication coverage.

Let's hope this new policy works... and, in turn, I do too!

[Old Guy]

UHC is my insurance, and they covered my implant. Still had a big co-pay of close to 4K.
One of their reps called me a few weeks before trying to talk me out of it, giving me all the negatives up to losing my penis if I get an infection. Told her anything would be better than what I have now, a floppy tube only good to pee with. Then asked if she was married, and what if your hubby had ED? Fix it or not? She approved my claim.

[duke_cicero]

I also paid cash. Got a 5-year loan with my bank. I find it's totally worth it. Got a malleable and haven't looked back. Will be providing another update on my personal thread this weekend. Do it! You won't regret.

[LastHope]

I also paid cash. Got a 5-year loan with my bank. I find it's totally worth it. Got a malleable and haven't looked back. Will be providing another update on my personal thread this weekend. Do it! You won't regret.

Great idea, Duke. Your weekend update will motivate me!

Does the bank ask for proof of surgery just like they ask for car buying papers and stuff for a car loan?

Many implant surgeons (even dentists, plastic surgeons..) accept Care Credit with 0% APR in the first year, but the interest rate shoots up to a ridiculous amount after the first year.

[duke_cicero]

I also paid cash. Got a 5-year loan with my bank. I find it's totally worth it. Got a malleable and haven't looked back. Will be providing another update on my personal thread this weekend. Do it! You won't regret.

Great idea, Duke. Your weekend update will motivate me!

Does the bank ask for proof of surgery just like they ask for car buying papers and stuff for a car loan?

Many implant surgeons (even dentists, plastic surgeons..) accept Care Credit with 0% APR in the first year, but the interest rate shoots up to a ridiculous amount after the first year.

The bank didn't ask for anything but a credit check, in my case.