Yet Another Journal: Revision scheduled

[GoodWood]

Your husband sounds amazing. It’s great to have such a supportive partner in life. I’m glad you have your surgery scheduled and will be back in the saddle in 2026.

I’m happy to return the favor with a show and tell if you want to check out the classic pump. You helped me as I was getting ready to take the leap.

[NYCGay]

NYCGay-
Wishing you all the best and a speedy recovery.

Thank you! I appreciate it.

NYCGay-
I'm sure you don't need me to tell you that Dr. Eid will take good care of you.

Indeed. That’s why I’m going back to him, even though I can’t find out whether or to what degree it will be covered by my insurance.

[NYCGay]

I’m happy to return the favor with a show and tell if you want to check out the classic pump. You helped me as I was getting ready to take the leap.

Thank you, GoodWood! I will DM you.

[ElbowRoom]

Indeed. That’s why I’m going back to him, even though I can’t find out whether or to what degree it will be covered by my insurance.

I would think if the insurance covered the initial surgery, that they’d cover a revision. After all, if the revision isn’t done you’d be left completely impotent and with ongoing atrophy. That sounds to me like the very definition of “medically necessary”.

[NYCGay]

I would think if the insurance covered the initial surgery, that they’d cover a revision. After all, if the revision isn’t done you’d be left completely impotent and with ongoing atrophy. That sounds to me like the very definition of “medically necessary”.

Your reasoning is correct; your logic is solid. But unfortunately, that isn’t exactly the situation I’m in. The insurance I have now is not the one I had in 2021 when I got my implant. Back then, I had Aetna BlueCross BlueShield through my employer. That plan covered ED treatment, including implants.

Now I’m on my husband’s insurance with Cigna. This plan explicitly excludes any treatment for ED.

But, and here comes the ambiguity, the plan explicitly includes repairs and replacements of internal prostheses.

After doing some research online, it seems that the explicit exclusion doesn’t necessarily override the explicit inclusion. So Cigna may cover the replacement, even though they would not have covered a virgin implant.

I don’t expect my insurance to pay for anything that is not covered. My gripe with Cigna is just that they refuse to provide me with a definite determination beforehand.

But I’ll stop whining about my insurance (at least for now). I consider myself fortunate that I can afford to pay for the procedure out-of-pocket, and that I have a husband who tells me to go for it.

[cbinspok]

Good luck NYC
We’re rooting for you!

[ElbowRoom]

I would think if the insurance covered the initial surgery, that they’d cover a revision. After all, if the revision isn’t done you’d be left completely impotent and with ongoing atrophy. That sounds to me like the very definition of “medically necessary”.

Your reasoning is correct; your logic is solid. But unfortunately, that isn’t exactly the situation I’m in. The insurance I have now is not the one I had in 2021 when I got my implant. Back then, I had Aetna BlueCross BlueShield through my employer. That plan covered ED treatment, including implants.

Now I’m on my husband’s insurance with Cigna. This plan explicitly excludes any treatment for ED.

But, and here comes the ambiguity, the plan explicitly includes repairs and replacements of internal prostheses.

After doing some research online, it seems that the explicit exclusion doesn’t necessarily override the explicit inclusion. So Cigna may cover the replacement, even though they would not have covered a virgin implant.

I don’t expect my insurance to pay for anything that is not covered. My gripe with Cigna is just that they refuse to provide me with a definite determination beforehand.

But I’ll stop whining about my insurance (at least for now). I consider myself fortunate that I can afford to pay for the procedure out-of-pocket, and that I have a husband who tells me to go for it.

I had Cigna bedore I switched to BC/BS for my surgery. Cigna was a PITA to deal with and definitely didn’t cover it under my policy.

Fingers crossed for you, it’s a tough situation.