Some Good Insurance News For a Change

[ElbowRoom]

I'm scheduled to have surgery with Dr. Hakky in October. I have had Cigna insurance through my wife's work (because her plan has no premiums!), and it has a hard exclusion on IPP surgeries, so I was planning to pay out of pocket, over $22k.

To try to avoid that hit, we left the wife on Cigna and I switched to my employer's BC/BS plan. I got my new insurance card yesterday and called their member services line to confirm it's a covered benefit. The response is "it's based on medical necessity, and pre-certification is required, your doctor will have to submit a pre-cert request."

So it seems it's covered if medically necessary. I called Dr. Hakky's insurance specialist and she's going to try to get the pre-cert authorized on August 4. BC/BS will only issue the authorization within a month of the procedure typically. We'll see what happens, we might have to move up my surgery to September.

I'm sure Dr. Hakky can make a good case this is medically necessary, as other treatments have failed and my systolic flow numbers are terrible as confirmed by Doppler.

Anyway, just wanted to share that things might go my way on insurance and cost, which would be a big relief for me as I'm an average joe and not wealthy. Wish me luck!

[dan_bionic]

I'm scheduled to have surgery with Dr. Hakky in October. I have had Cigna insurance through my wife's work (because her plan has no premiums!), and it has a hard exclusion on IPP surgeries, so I was planning to pay out of pocket, over $22k.

To try to avoid that hit, we left the wife on Cigna and I switched to my employer's BC/BS plan. I got my new insurance card yesterday and called their member services line to confirm it's a covered benefit. The response is "it's based on medical necessity, and pre-certification is required, your doctor will have to submit a pre-cert request."

So it seems it's covered if medically necessary. I called Dr. Hakky's insurance specialist and she's going to try to get the pre-cert authorized on August 4. BC/BS will only issue the authorization within a month of the procedure typically. We'll see what happens, we might have to move up my surgery to September.

I'm sure Dr. Hakky can make a good case this is medically necessary, as other treatments have failed and my systolic flow numbers are terrible as confirmed by Doppler.

Anyway, just wanted to share that things might go my way on insurance and cost, which would be a big relief for me as I'm an average joe and not wealthy. Wish me luck!

Congrats an I really hope the best for you !
all the best
Dan

[ElbowRoom]

Congrats an I really hope the best for you !
all the best
Dan

Thanks Dan, your posts are inspiring and help those of us still working through this to have more confidence about the final outcome!

[dan_bionic]

Congrats an I really hope the best for you !
all the best
Dan

Thanks Dan, your posts are inspiring and help those of us still working through this to have more confidence about the final outcome!

You're welcome, I try to give hope to all guys, affected by that horrible disease
Dan

[UpNorth]

Congrats.
Mine was BC/BS easy smooth. Cost me two $40.copays.

“I'm sure Dr. Hakky can make a good case this is medically necessary, as other treatments have failed and my systolic flow numbers are terrible as confirmed by Doppler.”

Those docs know how and where to inject you to manipulate the numbers.

Happy Times Ahead

[duke_cicero]

I'm scheduled to have surgery with Dr. Hakky in October. I have had Cigna insurance through my wife's work (because her plan has no premiums!), and it has a hard exclusion on IPP surgeries, so I was planning to pay out of pocket, over $22k.

To try to avoid that hit, we left the wife on Cigna and I switched to my employer's BC/BS plan. I got my new insurance card yesterday and called their member services line to confirm it's a covered benefit. The response is "it's based on medical necessity, and pre-certification is required, your doctor will have to submit a pre-cert request."

So it seems it's covered if medically necessary. I called Dr. Hakky's insurance specialist and she's going to try to get the pre-cert authorized on August 4. BC/BS will only issue the authorization within a month of the procedure typically. We'll see what happens, we might have to move up my surgery to September.

I'm sure Dr. Hakky can make a good case this is medically necessary, as other treatments have failed and my systolic flow numbers are terrible as confirmed by Doppler.

Anyway, just wanted to share that things might go my way on insurance and cost, which would be a big relief for me as I'm an average joe and not wealthy. Wish me luck!

This is great news. I'm planning to switch to BCBS in November during Open Enrollment. Is that when you switched, or did you go through a separate process? If so, what was that like?

[ElbowRoom]

This is great news. I'm planning to switch to BCBS in November during Open Enrollment. Is that when you switched, or did you go through a separate process? If so, what was that like?

It was open enrollment for my wife's Cigna plan in June, so I was able to make the switch then. My open enrollment isn't until December.

[Alex258]

I'm scheduled to have surgery with Dr. Hakky in October. I have had Cigna insurance through my wife's work (because her plan has no premiums!), and it has a hard exclusion on IPP surgeries, so I was planning to pay out of pocket, over $22k.

To try to avoid that hit, we left the wife on Cigna and I switched to my employer's BC/BS plan. I got my new insurance card yesterday and called their member services line to confirm it's a covered benefit. The response is "it's based on medical necessity, and pre-certification is required, your doctor will have to submit a pre-cert request."

So it seems it's covered if medically necessary. I called Dr. Hakky's insurance specialist and she's going to try to get the pre-cert authorized on August 4. BC/BS will only issue the authorization within a month of the procedure typically. We'll see what happens, we might have to move up my surgery to September.

I'm sure Dr. Hakky can make a good case this is medically necessary, as other treatments have failed and my systolic flow numbers are terrible as confirmed by Doppler.

Anyway, just wanted to share that things might go my way on insurance and cost, which would be a big relief for me as I'm an average joe and not wealthy. Wish me luck!

Congrats! A heads up for ya cause i'd like you to have a smooth transition regarding insurance. I had my implant done well over 2 years ago. BCBS gave the go ahead and to date and after quite a few appeals they haven't paid the dr. My case has been sitting in the hands of the Dept of Labor for some time now. My Surgeons office has been great. They haven't asked me for a dime and have been so helpful in helping me. I'm on the hook for $45,000. I've heard many other stories such as mine. Approved then not paid. I'm hopeful that mine will be settled. It's been one long nightmare. GL to ya.

[LastHope]

Good luck, ElbowRoom! Please keep us posted on your journey with BCBS. If I can establish a home address in a neighboring state, I’ll qualify for BCBS of Texas through my employer. With my current address, I’m stuck with Aetna, which proved to be useless for any implant procedures.