Got denied by BCBS

[Jayham]

Got scheduled by my urologist 2 weeks ago for an implant which I thought was odd since i hadn't got approval from BCBS. Was told today they would not cover any part of the surgery and I will have to pay 20 grand out of pocket. What's worse is the city I work for changed insurance carriers this year and the last one covered implants. I feel like I got kicked in the damn nuts. If I can't secure a loan or get the hospital to work with me I'm screwed. Anybody know of any back alley implant doctors?

[Tybeeman]

Got scheduled by my urologist 2 weeks ago for an implant which I thought was odd since i hadn't got approval from BCBS. Was told today they would not cover any part of the surgery and I will have to pay 20 grand out of pocket. What's worse is the city I work for changed insurance carriers this year and the last one covered implants. I feel like I got kicked in the damn nuts. If I can't secure a loan or get the hospital to work with me I'm screwed. Anybody know of any back alley implant doctors?

Your doctor needs to make a case for you.

[Jayham]

Hey brother I hope you're healing nicely! It's the insurance plan from bcbs the city chose that doesn't cover it. The lady that handles the insurance for my Dr. coordinated my plication surgery 5 months ago and said she thought I still had United Health Care which is why she put me on his schedule.

[alibaba]

Get a copy of the policy and read it word for word. Call Blue Cross Bull Shit and have the rep point out the page and paragraph of your policy that states the denial, then dissect what it says. Some newer policies specifically deny implants for any reason. Others deny them for the purpose of breeding. If you have had a vasectomy you have that one licked already. It might be cheaper to buy insurance and pay premiums a year than pay for an implant but finding a policy is a bitch. I spent 3 days one time, 1 day another trying to find a policy and was always told I had to buy it and wait for the policy to arrive to see what it covers. WTFIT? Do you buy a car w/o knowing if it is a Yugo or a Jag first? Dayum that Sheeit. Good luck.

[Tybeeman]

Get a copy of the policy and read it word for word. Call Blue Cross Bull Shit and have the rep point out the page and paragraph of your policy that states the denial, then dissect what it says. Some newer policies specifically deny implants for any reason. Others deny them for the purpose of breeding. If you have had a vasectomy you have that one licked already. It might be cheaper to buy insurance and pay premiums a year than pay for an implant but finding a policy is a bitch. I spent 3 days one time, 1 day another trying to find a policy and was always told I had to buy it and wait for the policy to arrive to see what it covers. WTFIT? Do you buy a car w/o knowing if it is a Yugo or a Jag first? Dayum that Sheeit. Good luck.

You can also repeal it to the state insurance commission. But the doctor has to make a good case that you have tried everything and it doe snot work

[Larry10625]

Get a copy of the policy and read it word for word. Call Blue Cross Bull Shit and have the rep point out the page and paragraph of your policy that states the denial, then dissect what it says. Some newer policies specifically deny implants for any reason. Others deny them for the purpose of breeding. If you have had a vasectomy you have that one licked already. It might be cheaper to buy insurance and pay premiums a year than pay for an implant but finding a policy is a bitch. I spent 3 days one time, 1 day another trying to find a policy and was always told I had to buy it and wait for the policy to arrive to see what it covers. WTFIT? Do you buy a car w/o knowing if it is a Yugo or a Jag first? Dayum that Sheeit. Good luck.

Appeal the decision but in the meantime get the doctor to write you a letter stating the medical reasons you NEED this surgery, otherwise your just another horney guy looking to make his dick bigger.

Larry

[David_R]

Your doctor needs to make a case for you.

Very true. Sometimes doctors and their contacts can make things happen (comparing implants to post-mastectomy breast reconstruction, for example). After all, they do want your business.

[sliphill]

Got scheduled by my urologist 2 weeks ago for an implant which I thought was odd since i hadn't got approval from BCBS. Was told today they would not cover any part of the surgery and I will have to pay 20 grand out of pocket. What's worse is the city I work for changed insurance carriers this year and the last one covered implants. I feel like I got kicked in the damn nuts. If I can't secure a loan or get the hospital to work with me I'm screwed. Anybody know of any back alley implant doctors?

That's odd, I have BCBS and they paid almost all of it. But then again, I'm 62, so maybe your age played into it. Not sure. Some doctors offer payment plans. But as others have said, your doctor will have to make the case that you need this procedure.

[radiodec]

Then again it may only look like Blue Cross Blue Shield. My insurance claims go through a BCBS claim route but are actually self-insurance by my employer. Recently they changed there exclusions to add penile implants specifically, that is after the covered my first in 2012, I now have had an implant failure but no insurance to cover the part of a replacement the manufacturers warranty doesn't.

Radiodec

[Jayham]

Thank you all for the suggestions. I've been busy today talking with my doctor, the hospital and insurance company. The implants are excluded in my policy so there is nothing that can be done about it. My doc set up a meeting with the implant rep to see if there are any finance type options to help me since that's the highest cost. I will pick up all the overtime I can get and my wife is going to get a part time job as well. It may take a few months or a year but I'm getting that damn implant!