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Wow.
My employer had Cigna last year when I had my implant, as well as an ankle replacement.
They payed all but my out of pocket limit on all claims.
I just looked at my record, and I had claims totaling over $429k last year submitted. Of course, the amounts paid were a lot less, due to insurance agreements with providers.

I suspect it's limitations mandated by your employer, and not necessarily the insurance company.
Definitely keep fighting. This is every bit as important to men as gynecological care is to a woman.

This blows my mind! - does your surgeon do a lot of implants? A lot of the commercial insurers have really strict criteria and the surgeon has to carefully document the medical need. As mentioned above they may need to do a doc to doc review with the insurance folks.

check this out https://static.cigna.com/assets/chcp/pd ... nction.pdf

Keep fighting!

jwdetails wrote:This blows my mind! - does your surgeon do a lot of implants? A lot of the commercial insurers have really strict criteria and the surgeon has to carefully document the medical need. As mentioned above they may need to do a doc to doc review with the insurance folks.

check this out https://static.cigna.com/assets/chcp/pd ... nction.pdf

Keep fighting!

Oh, I have already started the fight.

My doc (Matthias Hofer) is drafting a letter for me, and I am preparing some statements. And it does have to do with my employer. Funny thing is they cover the same procedure under gender affirming care, and I am using that as a point in my appeal.

So, a bit of an update.

Cigna has an “advocate” helping with the appeals process. Might hear something more next week. Boston Scientific has a type of patient support team that is a little helpful as well.

Here’s to hoping things get done soon.

I have Cigna. It was approved for Perroto but then I decided to use Cordone where it was denied.

Made no sense.

My Doc kept up with them and they approved it 24 hours before surgery.

Keep pushing

Here’s a little update. I am taking my employer, and Cigna, to task on this one.

I made it a point to scrutinize the exclusion, and looked at covered options. My employer covers gender reassignment procedures, and this included the IPP. I asked why I am being excluded, and pointes that out so it looks like things might be moving in the right direction finally.

I asked people that do the claims thing for their living - if we have Cigna or Aetna, it's not going to cover it.

LastHope wrote:I asked people that do the claims thing for their living - if we have Cigna or Aetna, it's not going to cover it.

Aetna Advantage picked upwhat ever Medicare didn't cover on mine. Admittedly it might of been a very low amount, maybe even zero. I never heard a word either way.

jdsatx1977 wrote:

jwdetails wrote:This blows my mind! - does your surgeon do a lot of implants? A lot of the commercial insurers have really strict criteria and the surgeon has to carefully document the medical need. As mentioned above they may need to do a doc to doc review with the insurance folks.

check this out https://static.cigna.com/assets/chcp/pd ... nction.pdf

Keep fighting!

Oh, I have already started the fight.

My doc (Matthias Hofer) is drafting a letter for me, and I am preparing some statements. And it does have to do with my employer. Funny thing is they cover the same procedure under gender affirming care, and I am using that as a point in my appeal.

You know, it’s funny but I brought up the bit about gender affirming care a year or two back when we had a rash of insurance denials on here.

My recommendation would be a letter to the insurance carrier claiming to be an impotent MTF pansexual equipped with a faulty penis and due to your gender fluidity they need to make sure you’re functional.

It was strange and I was fortunate. When Viagra hit the market we had absolute hell getting the Army to put it on the formulary and even then you’d get 6 pills per month. By the time I retired and on Tricare didn’t bat an eye about paying as long as it was properly coded.

Iirc between surgeon, hospital, anesthesiologist, and lab it came to $43K, they got paid just less than $19K, which was essentially the same as the doctor’s out-of-pocket/self pay price of $17,200.

Txagq8 wrote:

jdsatx1977 wrote:

jwdetails wrote:This blows my mind! - does your surgeon do a lot of implants? A lot of the commercial insurers have really strict criteria and the surgeon has to carefully document the medical need. As mentioned above they may need to do a doc to doc review with the insurance folks.

check this out https://static.cigna.com/assets/chcp/pd ... nction.pdf

Keep fighting!

Oh, I have already started the fight.

My doc (Matthias Hofer) is drafting a letter for me, and I am preparing some statements. And it does have to do with my employer. Funny thing is they cover the same procedure under gender affirming care, and I am using that as a point in my appeal.

You know, it’s funny but I brought up the bit about gender affirming care a year or two back when we had a rash of insurance denials on here.

My recommendation would be a letter to the insurance carrier claiming to be an impotent MTF pansexual equipped with a faulty penis and due to your gender fluidity they need to make sure you’re functional.

It was strange and I was fortunate. When Viagra hit the market we had absolute hell getting the Army to put it on the formulary and even then you’d get 6 pills per month. By the time I retired and on Tricare didn’t bat an eye about paying as long as it was properly coded.

Iirc between surgeon, hospital, anesthesiologist, and lab it came to $43K, they got paid just less than $19K, which was essentially the same as the doctor’s out-of-pocket/self pay price of $17,200.

Yo Tx, any updates ? I’ve been denied by Cigna too- this week, trying now to get it approved.