Anyone have experience with dealing with AETNA OAMC POS plan. My plan is pretty good. I had the original surgery with Dr. Kramer in 2019 under AETNA and it was approved and surgery completed successfully.
6 years later and my implant has failed, and now they are saying the revision is not approved. I am jumping through a lot of hoops. I need to resubmit my medical records (which they already have from the original surgery!) and they already approved the initial visit with Dr. Kramer who concluded I need a replacement done (I would like to have Dr. Kramer redo the surgery).
ARGH. any thought from others please post here or DM me.
Having issues with AETNA approving Revision with POS Plan
Having issues with AETNA approving Revision with POS Plan
Last edited by krh9999 on Wed May 28, 2025 8:43 pm, edited 1 time in total.
52 yo Gay Male. LA/Palm Springs CA. Had Dr. Elist penile/ball implants in 2009. Had it all removed about a year later (don't do it!!!). Silicone injected into scrotum. ED for about 15 years. Was about 8", now 6.5-7" due to venous leak.
Re: Having issues with AETNA approving Revision with PPO Plan
Aetna PPO here. They didn't approve even the initial surgery.
Re: Having issues with AETNA approving Revision with PPO Plan
LastHope wrote:Aetna PPO here. They didn't approve even the initial surgery.
Absolutely ridiculous. They will do transgender surgery but no penile implant! Nothing wrong with being transgender, but seriously, not having erections or having a broken implant being and still be denied as not medically necessary is criminal.
How did you take care of it?
52 yo Gay Male. LA/Palm Springs CA. Had Dr. Elist penile/ball implants in 2009. Had it all removed about a year later (don't do it!!!). Silicone injected into scrotum. ED for about 15 years. Was about 8", now 6.5-7" due to venous leak.
Re: Having issues with AETNA approving Revision with PPO Plan
krh9999 wrote:LastHope wrote:Aetna PPO here. They didn't approve even the initial surgery.
Absolutely ridiculous. They will do transgender surgery but no penile implant! Nothing wrong with being transgender, but seriously, not having erections or having a broken implant being and still be denied as not medically necessary is criminal.
How did you take care of it?
I agree 100%. It's strange that they cover therapies that are lifesaving but care least about quality of life! I ended up paying cash.
Re: Having issues with AETNA approving Revision with POS Plan
I have an Aetna ppo plan H5521-419 through medicare . I had no issues getting my revision done about 2.5 months ago.
I am a licensed independant insurance agent who write medacare plan in 10 States..
I am a licensed independant insurance agent who write medacare plan in 10 States..
Re: Having issues with AETNA approving Revision with POS Plan
superb_h wrote:I have an Aetna ppo plan H5521-419 through medicare . I had no issues getting my revision done about 2.5 months ago.
I am a licensed independant insurance agent who write medacare plan in 10 States..
Mine was Aetna commercial and not Medicare.
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