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Anyone else experienced such insurance declines? Did you end up paying for it?
ViaSwiss wrote:If your insurance has an exclusion then they will not cover it.
If you do CX or LGX, then AMS has a financing program if your physician is signed up for it.
$18,000 is actually pretty good out of pocket. Here is a list of phsyycians and their out of pocket cost.
viewtopic.php?t=12950
Another option is to use Surgeo.com which adds "insurance" for any complications you could run into.
MK1965 wrote:Ask your insurance provider for detailed list of exclusions.
That is about 100+ pages to go through. You might find in one place that they cover implants for restoring functions lost due to illness and injury.
When you read further, they will exclude penile implants for sexual enhancement sex change and anything related to sexual pleasure.
If you have valid reason to proof that your implant will be for restoring function due to illnesses or injuries you might be approved for the procedure.
In your appeal, you have to use strong words an phrases to support your need to restore body function lost to illness or injury.
According to Aetna ( my Insurance) I mentioned that appeal was denied as policy exclusion, specifically the coverage of implant placement or replacement for the enhancement for sexual enhancement of any nature.
Strong words like “ vehemently disagree with the assertion” “ I am perplexed as to how Implant....”
Nicely written appeal letter might solve your problem if you have valid reasons like DM, HTN, prostate cancer etc.
MK
544kenmatt wrote:May I ask your age? If you are close to 65, you may want to wait for medicare to kick in.
deepanvee wrote:Unfortunately I dont have any medical reasons for this implant.
mike123 wrote:deepanvee wrote:Unfortunately I dont have any medical reasons for this implant.
Can you expand on that a bit further? You have ED, but no medical reason to explain it? Phycological ED? Or can you get a normal erection but are just looking for an enhancement?
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