Any long term daily users? 10 year plus reliability possible?

[ElbowRoom]

Cardinal, did BCBS cover the original implant, but not a revision? If so that’s pretty evil.

[CardinalCopia]

I do not recall which provider I was with when I got my original implant, I don't believe it was BCBS. Whoever I was with, it was a much better policy, and the implant was 100% covered.

[lasthope2.0]

Cardinal, did BCBS cover the original implant, but not a revision? If so that’s pretty evil.

If employer sponsored BCBS plan excludes ED treatments, implants and revisions won’t be covered. This exclusion is set by the employer’s benefit design, not by BCBS. BCBS only acts as the plan administrator. Employers can choose a cheaper benefit package that includes these exclusions to lower costs in any given year, or they can select a plan without them and enable coverage.

[CardinalCopia]

Cardinal, did BCBS cover the original implant, but not a revision? If so that’s pretty evil.

If employer sponsored BCBS plan excludes ED treatments, implants and revisions won’t be covered. This exclusion is set by the employer’s benefit design, not by BCBS. BCBS only acts as the plan administrator. Employers can choose a cheaper benefit package that includes these exclusions to lower costs in any given year, or they can select a plan without them and enable coverage.

This is correct.

[ElbowRoom]

Cardinal, did BCBS cover the original implant, but not a revision? If so that’s pretty evil.

If employer sponsored BCBS plan excludes ED treatments, implants and revisions won’t be covered. This exclusion is set by the employer’s benefit design, not by BCBS. BCBS only acts as the plan administrator. Employers can choose a cheaper benefit package that includes these exclusions to lower costs in any given year, or they can select a plan without them and enable coverage.

I understand all of that. My question was whether the plan in question covered the original implant but not the revision. I have BCBS and my plan covered the implant, but I'd be very bummed if the same plan wouldn't cover a revision in the event of a failure.

[lasthope2.0]

Cardinal, did BCBS cover the original implant, but not a revision? If so that’s pretty evil.

If employer sponsored BCBS plan excludes ED treatments, implants and revisions won’t be covered. This exclusion is set by the employer’s benefit design, not by BCBS. BCBS only acts as the plan administrator. Employers can choose a cheaper benefit package that includes these exclusions to lower costs in any given year, or they can select a plan without them and enable coverage.

I understand all of that. My question was whether the plan in question covered the original implant but not the revision. I have BCBS and my plan covered the implant, but I'd be very bummed if the same plan wouldn't cover a revision in the event of a failure.

If it's the same plan design that covered the 1st implant and it doesn't have the sexual dysfunction plan exclusion criteria, denial for revision is highly unlikely. I heard this directly from my surgery scheduler. The only place where it can cause problems is if diagnosis codes don't justify clear medical necessity.

Did you require any prior authorization, ElbowRoom?