Is my IPP revision Medical Necessary?

[Friday121224]

Hey everyone,

I’ve been dealing with a tough situation for the past year. I had an IPP placed five years ago, and it broke down a year ago. Since then, I’ve been fighting with Blue Cross Blue Shield to get a revision covered, but they keep saying it’s not “medically necessary.”

I’ve been working two full-time jobs, putting in 80 hours a week, and saved up about $11,000. I’ve had to buy two vehicles and set up dental plans for my kids, so this has taken a back seat. I use a vacuum device regularly and don’t feel like I've lost size, but the stress is real.

Now, I’m at the point where I have a “peer-to-peer” review coming up where doctors from both sides will discuss the necessity of the replacement. I’ve got a great partner who’s been super supportive through all of this, but it’s been hard on both of us.

Here’s the kicker: Blue Cross covered my initial procedure, but when I switched jobs and got a new plan, I thought revisions would be covered too. Turns out, there’s an exclusion, and I’ve been denied three times.

So, I’m wondering—**is a revision considered medically necessary?** Any insights or advice would be really appreciated!

[ElbowRoom]

That’s crazy…like saying a heart valve is necessary, but it’s not necessary to replace the valve if it fails.

I hope this gets resolved positively, I also have BC/BS.

[John Dday]

Sounds like you have the answer to your problems. While saving your funds, develop new and exciting ways to develop your intimacy with your supportive partner. This can be a lot of fun in an otherwise difficult time, which in itself can magnify the possibilities.
Good Luck

[GoodWood]

Man, that is stressful. So sorry to hear that. Keep pushing. Ask your surgeon’s office to intervene as much as they can.

I have BCBS as well and ED treatment is excluded, except for surgical implantation of penile prosthesis. So there was an exclusion to the exclusion.

Each company’s plan is different but you are in a situation that defies common sense. Hopefully you will prevail.

[Friday121224]

Sounds like you have the answer to your problems. While saving your funds, develop new and exciting ways to develop your intimacy with your supportive partner. This can be a lot of fun in an otherwise difficult time, which in itself can magnify the possibilities.
Good Luck

Thanks John, it’s just I pay a lot a pay for nothing that is the thing. FYI it kinda hard to have real intimacy after a failure. Maybe impossible?

[sambalamba]

If yours was a CX and the silicone outer layer ruptured you'd have to have it immediately addressed. The underlying dacron is a perfect medium for tissue to grow and then a revision would be super difficult. Thankfully such a situation will not happen for the Titan.

[Rider1400]

Following as I’m going to see Dr Clavell this Monday the 12 for a possible revision due to my reservoir protruding and my tips poking my wife. Think I’m slightly undersized, and possibly some erosion. Not sure what’s the exact issue. Surely Clavell can shed some light on what’s the issue and if a revision is necessary.Will be interesting to see if it will be covered by my BCBS. I’m on same plan and a the same company I was 3-1/2 years ago when I got the implant. It causes me quite a bit of discomfort and the tips dig into my wife in any position other than straight up missionary. Will start a new post after Monday to report findings.