New to this site - Ed is like hell on earth to me. - need implant, have questions

[oldbeek]

Dr Hakey in the Atlanta area is very good. His out of pocket cost, no insurance, is around $18,000. Cheaper than a sub compact car and much more enjoyable.

[Time2Change]

There are literally thousands of versions of just Blue Cross/Blue Shield plans. Thousands. Each with extremely different and specific inclusions and exclusions. Plan provisions vary by employer menu of services agreed to be covered, etc. If you're thinking of buying a plan, solo, on the open market, then I think you've got to bang the phone and internet and very specifically ask the questions - what, specifically, is or is not covered.

I'm sorry for what you're going through. It's obviously horrible.

You need to do your homework and really get up to speed on the relevant medical/billing coding in order to ask the right questions of insurers. CPT Codes:

CPT 54405 (Insertion of multi-component, inflatable penile prosthesis, including placement of pump, cylinders and reservoir) is the most common billing code you will encounter with implantation. Ask with specificity when you call or email plans for details.

ICD 10 Codes - these are diagnostic codes which describe the underlying reason for surgeries. Different insurance plans will require different ICD 10 codes to get you covered for an allowable surgery.

No one can tell you the prerequisites, because each plan is going to be different. Again - thousands of plans with thousands of unique requirements for either inclusion or exclusion of your claim.

Typically? You may see a plan want a documented failure of oral therapies (Viagra etc) and then a documented failure of injectables (Trimix etc) for x period of time, with whatever incremental dosing titrations having failed over y amount of time period, etc etc etc.

You have a lot of homework to do. But it's workable. Most of this is easily searchable online. Where it's not...swallow your embarrassment and start dialing.

Doctor or facility? - there's plenty. But I would strongly advise you to not go to the first surgeon because they're either geographically convenient or because their price is cheaper. I won't eat "Discount Sushi". Same concept here, only with much more devastating, dire consequences if you seek out implantation based largely on a favorably cheaper price. This is not the way to go about this. My serious advice is - find the best surgeon you can, and find a way to make it happen with that surgeon. Nothing but regrets and dark days for you later if you compromise on the skill of the guy with the knife in his hand.

I'm a healthcare exec and very familiar with some of your obstacles you're worried about here - please feel free to message me privately if I can be of any help. Chin up, man. Seriously. I know shit looks bleak now, but there is a way forward.

I just want to emphasize how excellent this information from stephen54 is.

It was a months-long battle with my insurance company to get them to cover my operation. And it finally came down to a coding problem.