Implant Insurance Denial

[omega52]

My insurance just flat out denies coverage for an implant. Very disappointed. I resigned myself to pay for the surgery itself which is 18K with Dr Kramer in Maryland. The problem is this: will the insurance company pay for any complications if any including infection with revision therapy since they do not cover the implant procedure. That could require a hospital stay. Even though Dr Kramer will help me on his end there could be a huge hospital and surgical expense involve treating the complications. Hopefully this would not happen but it could be a significant financial gamble. Any thought from you guys. Thanks in advance.

Omega

[texas johnny]

Sounds like you have Blue Cross BS. I tried for 7 years to get them to pay for mine after prostate cancer. They have a lot more money, time and lawyers on payroll to cover their fine print. I waited until I was 65 and got Medicare. The more I fought the higher my premium went. Due to being in a small group(Texas Cattle Feeders) at the end I was paying $1200 a month for a 80 20 policy with a 3000 deduct. Dont ever think these bastards are there to help you. I now have AARP fpr my supp policy and have not had any problems, if Medicare covers any part of it AARP pays like a slot machine. I wouldnt have BCBS even if the gave it to me for free. These folks have a way of figuring out how to deny paying. I guess thats why they have 1500 gatekeepers working in their Dallas office. Lots of luck to you
Texas Johnny

[radiodec]

I am lucky, my insurance is through my employer - Kirby Building Systems which is part of Nucor Steel. They cover such things and since with my wife's medical expanses this year we have reached the out of pocket maximum for the year, my costs will be paid entirely. It is amazing at the price cuts the insurers get from medical providers! By theway, tomorrow I get to use my benefits for an implant. Funny though, our administrator is Blue Advantage Administrators of Arkansas (licensee of BCBS Arkansas). I will miss my insurance when I retire.

Radiodec

[omega52]

I definitely echo the sentiment that the insurance carriers are out for themselves. Plus they have a battery of attorneys. It is hard to go up against them. They have the bucks. I switched from Anthem to Optima because I was told by my urology office that Optima covered implants. Guess what, they don't. They did not let me know this until after I signed up. Now I am trying to determine if they will cover an infection after implant placement since it is not a covered procedure. Think about the ramifications of that if you have to pay out of pocket. What if you had an MI or heart attack during the procedure. I am exagerating obviously but where do they draw the line. I don't trust them to be quite honest with you. Excuse my pun but they have us by the "balls".
Omega

[Cajun Jeff]

I second the thoughts on BCBS.. They Suck when dealing with ED.

Cajun Jeff

[roninhouston]

I second the thoughts on BCBS.. They Suck when dealing with ED.
Cajun Jeff

This is an old "corvetteman3" thread I ran across and thought I should share my experience with BCBS paying for my 2015 IPP. My total out of pocket was less than $500 with most of that for the hospital stay. I saw a recap of cost and it was $65K in insurance/hospital/doctor legalese/accounting.

Dr. Cornell told me BCBS was one of the more reluctant insurance companies to pay for an IPP. Makes him jump through hoops to justify a need, i.e. nothing else will cure my ED. Consequently he did a battery of tests to justify an IPP. (Could not make it rise the the occasion, fail all tests) Plus his office worked with BCBS to make sure we dot all the i's and crossed all the t's. The approval process took four or five months.

BTW... had Testosterone Pellets inserted and my BCBS co-pay was $500. Notice I said WAS, as I an not paying more for the pellets (three time a year) than I did for my IPP. Dr. Cornell wrote me a testosterone prescription, makes five self injections syringes, last ten weeks is less than $40.

NOTE: To get BCBS to approve an IPP you need a good doctor with a good staff willing to jump through all BCBS hoops for your benefit. BCBS has many plans so your results may vary. I have BCBS/TX Medicare Advantage. I switched to this plan because Dr. Cornell's experience was they had paid for an IPP in the past.

[charlesr]

I was on my wife's BCBS and my out-of-pocket for my implant was $600.00. Maybe your urologist can re-word the forms in a way that coverage can be shown as a need versus some other kind of elective surgery. That may help. Good luck.

[woodturner]

I believe it is what type of policy you have with an insurance company more so than the actual insurance company. Several years ago I was with BCBS and the plan we had at work wouldn't cover it. I did some checking and they had other plans that would pay for a penile implant.

What I found offensive is the fact that the incidence of Prostate cancer is almost identical to Breast Cancer (prostate cancer slightly higher). By federal law insurance companies are required to pay for breast implants when a medically necessary mastectomy has been done. However, no such coverage exist for a penile prosthesis when the problem is the result of prostate cancer. Because of the discrimination and the extraordinary amount of funding and publicity breast cancer receives as compared to any other cancer, I refuse to contribute anything in terms of time or money towards breast cancer. I am more than willing to help out with other forms of cancer.

Fortunately for me my insurance changed to Tricare when I turned 60. One of the first things I did was arrange to get an implant. If it wasn't for that I would have to wait another 5 years until Medicare kicked in.

[David_R]

And don't forget that if the insurance company covers breast reconstruction following a mastectomy, they should also cover an implant following a prostatectomy for gender equality. If the company doesn't think so, some doctor's office staff will go to bat for you to point this out to them.

[treifsnyder]

That's what Dr kramer put in his letter to my insurance as justification to get mine covered. having said that- they only covered a part, don't know if his letter worked at all actually. but the analogy to breast cancer and having boobs replaced is valid, then getting a penis replaced if it doesn't work is more than valid.