Is it possible to buy health insurance with the plan to do surgery?

[Asdefxx]

I'm not sure if this is realistic, but I thought I'd ask. I may be in the awkward position where I'll need to buy insurance in the private marketplace to cover me for the rest of the year.

I've been wanting an implant for a while, even saw a urologist for it already. So this gave me the idea of killing two birds and one stone and specifically choosing an insurer that is the most willing about approving implants, and then finally getting mine done.

Is this realistic though? Can I just choose whatever insurer I feel like and buy a plan off them? I'm in Pittsburgh, and I went on pennie.com and typed my zip code and it only gave me two options, Highmark and UPMC Health Plan. Surprised how cheap it was though, $300/month, I was expecting more given all the buzz about the skyrocketing healthcare costs.

[GoodWood]

You’d need to read the policy and its exclusions carefully.

Many insurance policies have exclusion causes that explicitly state that they don’t cover treatment for sexual dysfunction.

Eliminating preexisting condition clauses was a core component of the ACA (Obamacare) so you should be OK there.

So, contact both companies and ask for a copy of the plan including their exclusion clauses.

[edjohn]

And get the opinion of your favorite surgeon's office. When I asked about BCBS my surgeon's rep said state by state it isn't guaranteed but the federal employee plan should be good to go. They know.

[UpNorth]

I'm not sure if this is realistic, but I thought I'd ask. I may be in the awkward position where I'll need to buy insurance in the private marketplace to cover me for the rest of the year.

I've been wanting an implant for a while, even saw a urologist for it already. So this gave me the idea of killing two birds and one stone and specifically choosing an insurer that is the most willing about approving implants, and then finally getting mine done.

Is this realistic though? Can I just choose whatever insurer I feel like and buy a plan off them? I'm in Pittsburgh, and I went on pennie.com and typed my zip code and it only gave me two options, Highmark and UPMC Health Plan. Surprised how cheap it was though, $300/month, I was expecting more given all the buzz about the skyrocketing healthcare costs.

I’m just north of you and mine covered no questions asked.

We have since changed plans and I will try and find a copy of BCBS plan. I did look for it one other time without success so I will ask the wife to look around.

[Asdefxx]

I’m just north of you and mine covered no questions asked.

We have since changed plans and I will try and find a copy of BCBS plan. I did look for it one other time without success so I will ask the wife to look around.

Thanks, much appreciated! And sorry, I'm confused, was it Highmark that covered it no questions asked? Or was it a different company?

For anyone else who's having the same question as me, I found this research study, but keep in mind it's from 2019 and the sample sizes are low. According to the study, the best companies for penile implants are those below.

Medicare -- 87 approvals -- 0 denials -- 100% rate
Coventry -- 4 approvals -- 0 denials -- 100% rate
United Healthcare -- 14 approvals 6 denials -- 70% rate
Molina -- 19 approvals --10 denials -- 65% rate
Humana -- 10 approvals -- 6 denials -- 62% rate

[CarbonBurrito]

From my experience, it's not necessarily the insurance company. It actually comes down to what plan your company has picked. For instance, I have United Health Care. But to see if they will cover my IPP, I have to look at my employer's Summary of Benefits and Coverage (SBC). This document will tell you about the exact exclusions in your policy that your employer (or whoever) opted out of.

Hope this helps and good luck!