Some Good Insurance News For a Change

[ElbowRoom]

It looks like HHS is working to end the practice of "pre-authorization" because of the kinds of inconsistency and agreeing to pay and then failing to do so that many have experienced on this forum.

Hopefully that will make things better for us all.

[Wooody]

I'm scheduled to have surgery with Dr. Hakky in October.

Anyway, just wanted to share that things might go my way on insurance and cost, which would be a big relief for me as I'm an average joe and not wealthy. Wish me luck!

Good luck with it!

As I've previously posted, I have Anthem BC in California, their lowest level, highest deductible EPO Bronze Plan and the policy specifically says they don't cover ED treatments including implants etc. My doctor told me at my initial consult, and Dr Clavell also told me, it wouldn't be covered. But my Dr said he would try and get it covered and he was able to get a pre-authorization and they wound up covering it with no issues or delays.

Sucks to hear how inconsistent the carriers are about this. Good luck to everyone seeking insurance coverage!

[duke_cicero]

Good luck man! I hope they cover for you. My insurance was a rollercoaster to say the least.
Summary is they (Cigna) pre authorized it then a week before denied coverage. I then to come up with the cash amount, which was 17k which included getting another credit card & maxing another out, bullshit. But I was doing this thing. Sexual health for me is top tier importance. I'm currently in the process of appealing & they supposedly have accepted the appeal but need a little more info from the hospital I had it done at.
Such a joke tho. The hospitals invoice for insurance company to pay is 77k so we'll see. I won't believe it until I see it but happy for you & I hope it's smooth. Insurance companies are obnoxious. Good luck brother

Cigna is a fucking disgrace.

Fr bro. They have been atrocious to deal with. I'm tryna be positive about it currently cuz it seems we finally, maybe, turned a corner. They say now they're willing to accept that the procedure even happened (despite initially approving & then denying it) but they need certain codes from the hospital now to prove it happened. This is proving to be challenging for the hospital because we self paid & apparently that changes things. My guess is that they're knowingly & legally ripping each other off at the expense of us for more profit but I digress.

Not fun to deal with especially because we're having to talk to a different Cigna "rep" each time. Whole things ridiculous & insurance companies are trash lol.

Sorry if I'm misunderstanding. Are you saying that you're trying to be reimbursed after the fact?

[Jgoody]

Np. Ya I'm pretty ADHD so writing comprehensively without editing & with little thought is a challenge sometimes.

But yes I'm trying to be reimbursed after self paying already. I had my surgery date set after pre approval & then the week before scheduled surgery they denied coverage abruptly. I didn't want to reschedule so I scrambled to come up with the funds & self paid. Hope that makes more sense

[UpNorth]

Good luck man! I hope they cover for you. My insurance was a rollercoaster to say the least.
Summary is they (Cigna) pre authorized it then a week before denied coverage. I then to come up with the cash amount, which was 17k which included getting another credit card & maxing another out, bullshit. But I was doing this thing. Sexual health for me is top tier importance. I'm currently in the process of appealing & they supposedly have accepted the appeal but need a little more info from the hospital I had it done at.
Such a joke tho. The hospitals invoice for insurance company to pay is 77k so we'll see. I won't believe it until I see it but happy for you & I hope it's smooth. Insurance companies are obnoxious. Good luck brother

Cigna is a fucking disgrace.

Fr bro. They have been atrocious to deal with. I'm tryna be positive about it currently cuz it seems we finally, maybe, turned a corner. They say now they're willing to accept that the procedure even happened (despite initially approving & then denying it) but they need certain codes from the hospital now to prove it happened. This is proving to be challenging for the hospital because we self paid & apparently that changes things. My guess is that they're knowingly & legally ripping each other off at the expense of us for more profit but I digress.

Not fun to deal with especially because we're having to talk to a different Cigna "rep" each time. Whole things ridiculous & insurance companies are trash lol.

Right. I panicked the whole time going for my surgery expecting some cancelation for some reason or another.

Our bc/bs plan was pretty good. I believe it was Anaheim. I had them for 25 years with no problem. Then when I’m off work my company switched to something else.

When we had Cigna for disability they were disastrous. I had to cast a spell on that MFr. when karma hits them I will feel no sympathy.

[Jgoody]

Cigna is a fucking disgrace.

Fr bro. They have been atrocious to deal with. I'm tryna be positive about it currently cuz it seems we finally, maybe, turned a corner. They say now they're willing to accept that the procedure even happened (despite initially approving & then denying it) but they need certain codes from the hospital now to prove it happened. This is proving to be challenging for the hospital because we self paid & apparently that changes things. My guess is that they're knowingly & legally ripping each other off at the expense of us for more profit but I digress.

Not fun to deal with especially because we're having to talk to a different Cigna "rep" each time. Whole things ridiculous & insurance companies are trash lol.

Right. I panicked the whole time going for my surgery expecting some cancelation for some reason or another.

Our bc/bs plan was pretty good. I believe it was Anaheim. I had them for 25 years with no problem. Then when I’m off work my company switched to something else.

When we had Cigna for disability they were disastrous. I had to cast a spell on that MFr. when karma hits them I will feel no sympathy.

100%
Haha

[edjohn]

Good luck, ElbowRoom! Please keep us posted on your journey with BCBS. If I can establish a home address in a neighboring state, I’ll qualify for BCBS of Texas through my employer. With my current address, I’m stuck with Aetna, which proved to be useless for any implant procedures.

Clavells office told me specifically that BCBS of Texas is no good. I currently have the foreign service aetna plan and it's completely out of the question with them.

[ElbowRoom]

Update: Hakky’s office forwarded my info as well as a HIPAA release to Coloplast. Apparently they will submit the pre-auth request (along with Hakky’s clinical notes and findings) to the insurer to try to get it covered.

Fingers crossed, I’d really prefer to have this done with insurance.

[dan_bionic]

Update: Hakky’s office forwarded my info as well as a HIPAA release to Coloplast. Apparently they will submit the pre-auth request (along with Hakky’s clinical notes and findings) to the insurer to try to get it covered.

Fingers crossed, I’d really prefer to have this done with insurance.

Good luck and hope, they'll cover it!

[GoodWood]

Best of luck with pre-approval.
I have BCBS Federal Employee Program and am in NY. After a couple years of the policy stating they don’t cover any treatment for ED, clearly stated on the exclusion page, the wording changed. Last year I noticed the wording now said they wouldn’t cover any treatment for ED except for surgical implantation of penile prosthesis for erectile dysfunction. Woohoo!!!

I had surgery in March and had my expected percentage copay. It went smoothly. My percentage ended up being around $6800. Not cheap, but considering I thought I had no coverage and would have to come up with $20,000-$30,000 it felt like a win.

One of the rarely stated benefits of a high volume implant surgeon is that the office staff know the different insurance plans and the correct codes to submit to have a smooth transaction.

Wishing you the best.