Devastated

[dg_moore]

... I checked other docs in the St. Louis area and was shocked how few do implants and how many are credentialed about the same as a mail carrier...

$50K for an uncomplicated implant is awfully high. Most here report more in $20K range. Mine (in 2008) was about $17K. Have you considered traveling to a well known surgeon? I highly recommend Dr. Andrew Kramer in Baltimore ((410) 328-0800) - I'm sure you can get a preliminary phone consult with his office and find out about insurance coverage. He has done thousands of implants and his staff know everything there is to know about getting insurance approvals. If you can't find a provider in your area, it doesn't cost all that much to travel to Baltimore and stay in a hotel for a couple of days, especially if you are avoiding a $50K bill elsewhere.

Good Luck!
Dave

[alibaba]

$30k is what they quoted me if it was uncomplicated. I have had so many surgeries that had other issues that I figure I should pad it another 60% in case. That is where I came up with $50k.

[JDavid]

It sounds to me that you actually have the coverage and that the surgeon you consulted did not want to do the surgery, for whatever reasons, and tried to let the insurance company be the "bad guy." I agree that you should consider consulting one of the doctors who is well regarded on this board.

[Charlie999]

Dr Paul Perito, Coral Gables, Fl., did mine. He has done over 6000 implants. I had a great experience there. Call his office and speak to Miss Zuly. She is the office mgr, very helpful, and super good in the adm area. She scheduled everything for me. I didnt have to pay a dime for their services, surgery, or hospital. Highly recommend Dr. Perito, and his staff.

Also, I had a very good recovery. Hardly any pain, and it works like magic - just like dr. P. said it would.

Very satisfied with their procedures (and so is my wife).

Good luck. I can undeerstand your frustration.

Hang in and dont give up,

I am about 3 months post op now, and if I can answer any of your concerns or questions, please let me know, will be glad to help.

Charlie

[proactive]

I would find another doctor that will put down High Blood pressure ect as the cause. If insurance will pay for it, if the proper diagnosis code is used, then find someone that will use the proper code.

[spotya]

I have BCBS and they denied mine to start. I had to appeal to their board. With a semi threatening letter about discrimination of the male gender and a letter from my doctor saying all other options have been tried unsuccessfully and a history of back surgeries and diabetes, they changed their ruling. I have been told by my doctor that some insurance companies review board members will talk directly to your doctor to see if this is the only option. I talked to a women from my insurance company and told her I would personally come the hearing because I wanted to look into the eyes of someone telling me it was a luxury to have sex. I asked her if it was important to her if her husband could have sex with her. In the end they did the right thing, and I am very thankful. I had my surgery done by Dr. Douglas Miliam at Vanderbuilt University in Nashville TN. Very impressed with results.

[alibaba]

I have an appointment with another doc in 27 days. I agree the first doc did not want to do the surgery for whatever phobia he suffers from. Insurance has approved though it may cost me $3-6k out of pocket. After the first let down the excitement about getting this done is over but I still want it done. There still is a gender discrimination when Fed. law requires boob reconstruction but insurance can deny anything on a guy. Thanks for everyone's support.
d