Insurance coverage

The final frontier. Deciding when, if and how.
Happy Toy
Posts: 556
Joined: Fri May 11, 2018 9:30 am

Re: Insurance coverage

Postby Happy Toy » Mon Jun 04, 2018 12:03 pm

MK1965 wrote:I am 53 now. Had RP in November 2016. My recovery of erectile function did not go well. Already exhausted all non invasive options; PDE5 inhibitors Cialis and Viagra, VED pumps and for past 14 months injections TRIMIX and BIMIX. I feel it is time for implant. Heard, lots of insurance company denied insurance coverage for IPP. I have insurance thru my employer.(Aetna).
I would like to hear from recent implantees how did it go with their insurance. Was it approved at the first or after it was denied?
Any response and good advice is highly appreciated.

MK

I have Kaiser, will be implanted on the 26th. I checked on the co-pay, it will be $250 for the surgery. I know there will be some follow up costs, office visits for me are $20. So all and all not bad for a $30K surgery! Check with your financial department of Aetna, they should be able to tell what the cost will be. I would think a large company like that would cover it. Good luck with that and hope you have the surgery. From all of the feedback here on FT I'm sure I am doing the right thing.
Andy
Implanted 6/26/2018, Coloplast Titan 20cm, no RTE'S, infra pubic, Dr. Ree, Kaiser :o 8-) 75yrs., married 52 yrs. ED for over 20 yrs.

MK1965
Posts: 224
Joined: Thu May 24, 2018 5:32 pm

Re: Insurance coverage

Postby MK1965 » Mon Jun 04, 2018 1:20 pm

Thanks Andy,
If you feel you’re doing right thing then absolutely, you are doing right thing for yourself. I am of the opinion that every ED sufferer deserves the best, whatever his best it is ( implants, injections etc)
Wish you all the best for your procedure in near future.
MK
IPP 9/5/18; Coloplast TITAN OTR 18 cm 1cm RTE, Dr. Khera Baylor Houston,Prostate Ca at 51 y/o; RARP 11/2/16, ED Post RP, Cialis, Viagra, VED no usable erection, April 2017, TRIMIX painful, BIMIX tolerable but ineffective,lost 2+ inches of length after RP

DrNewman
Posts: 1
Joined: Thu May 31, 2018 3:29 pm

PRICE PEYRONIE TREATMENT

Postby DrNewman » Mon Jun 04, 2018 1:23 pm

How is Peyronie’s Disease Treated?

SURGERY - XIAFLEX - ANDROPEYRONIE

In a very few number of cases (about 13 out of 100), Peyronie's disease goes away without being treated. Many health care experts suggest treating the disease without surgery for the first 12 months after the disease is first noticed.
Men with small plaques, not much curving of the penis, no pain, and no problems with sex may not need to be treated. If you need to be treated, there are 3 choices.

1 Surgery for Peyronie's Disease : There are 3 basic ways to fix Peyronie's disease with surgery, but Surgery is not without risks and can include shortening of the penis (scar retraction) and a chance that the distortion will return. COST: $25,000 - $35,000
-making the side of the penis opposite the plaque shorter
-making the side of the penis that curves longer
-placing a prosthetic device inside the penis

2 Penile Injections ( XIAFLEX® ) COST: 8 vials $10,500
Injecting a drug right into the plaque brings higher doses of the drug to the problem than when a drug is taken by mouth. Plaque injection is often used for men with acute phase disease who aren't sure they want to have surgery. The skin is often numbed before the shot to reduce pain.
Injection of CCG into collagen-containing structures such as the corpora cavernosa of the penis may result in damage to those structures and possible injury such as corporal rupture. Treatment of Peyronie's disease with intralesional therapy: Injection of collagenase is contraindicated in the treatment of Peyronie’s plaques that involve the penile urethra due to potential risk to this structure and in patients with a history of hypersensitivity to collagenase used in any other therapeutic application or application method. Injection of collagenase into collagen-containing structures such as the corpora cavernosa of the penis may result in damage to those structures and possible injury such as corporal rupture (penile fracture).

3 ANDROPEYRONIE® COST: $200
Treatment of Peyronie's disease with penile traction therapy (ANDROPEYRONIE). Penile traction therapy (PTT) is used to avoid penis shortening after prostate surgery, which can be used as penile rehab. it would be an effective and safe method Without expensive risky surgery or injections. Andromedical, a urology laboratory which has been investigating medical, non-invasive treatments to Peyronie’s disease, micropenis, post radical prostatectomy penile rehab and erectile dysfunction for 20 years. Andropeyronie is a simple, effective and non-invasive treatment of the correction of penile curvature. Andropeyronie reduces the curvature of the penis + 50%. Andropeyronie increases the length of the penis and also the girth.

David_R
Posts: 1800
Joined: Mon Nov 02, 2015 1:03 pm
Location: Northeast Maryland

Re: Insurance coverage

Postby David_R » Mon Jun 04, 2018 3:43 pm

MK1965 wrote:If my insurance does not cover implant

I understand that some doctors' office staff will call your insurance on your behalf to argue for you. If the insurance company covers breast reconstruction surgery after a mastectomy -- something that is not life-threatening but which is needed to improve life -- they will argue that the same should be the case for men and penile implants -- something that is not life-threatening but which is needed to improve life.
Age 69. Prostatectomy in 2000. My urologist (for over 20 yrs) has been Dr. Marc Siegelbaum of Chesapeake Urology in Baltimore, and Chief of Uro. at Univ. of Md. St. Joseph Medical Center. I have LGX, and have regained my original length. Nice n hard!

Randy461
Posts: 1
Joined: Sat Apr 14, 2018 3:52 pm

Re: Insurance coverage

Postby Randy461 » Tue Sep 10, 2019 10:11 pm

Currently 2 years post RP, spared nerves on one side but not the other. I am starting to look into an implant. Use tri mix as well as bi mix with so so results.
I have employer provided Aetna Choice POS II insurance. I made 1 call to them with 3 dx codes including Peyrones as well as post RP ED. Was told they don’t cover the procedure.
Do any of you that had an Aetna paid procedure know the dx codes that were submitted for approval? Also for those still in the work force, how long out of work for the procedure? My job is somewhat physical so I would that would impact return to work time.
Any information is greatly appreciated.

MK1965
Posts: 224
Joined: Thu May 24, 2018 5:32 pm

Re: Insurance coverage

Postby MK1965 » Wed Sep 11, 2019 8:16 am

Randy461 wrote:Currently 2 years post RP, spared nerves on one side but not the other. I am starting to look into an implant. Use tri mix as well as bi mix with so so results.
I have employer provided Aetna Choice POS II insurance. I made 1 call to them with 3 dx codes including Peyrones as well as post RP ED. Was told they don’t cover the procedure.
Do any of you that had an Aetna paid procedure know the dx codes that were submitted for approval? Also for those still in the work force, how long out of work for the procedure? My job is somewhat physical so I would that would impact return to work time.
Any information is greatly appreciated.


Randy,
I have same insurance as you, Aetna Choice POS II thru my employer.
My implant last year was mostly paid by insurance with my out of pocket $1450.
Since you had RP, for prostate Ca removal, this is valid reason and qualifies you for coverage unless your employer strictly stipulated that.
We have one member here who is fighting against sex discrimination with his insurance company which denied coverage or his implant regardless of ED after prostatectomy.

Here are my ICD10 codes that were submitted to insurance:

N52.02 Corporo-venous occlusive erectile dysfunction
N52.31 Erectile dysfunction following RP

And CPT code for surgery:

54405 - Insertion of multi components penile prosthesis including placement of pump, cylinders and reservoir.

I hope this might help you and you can compare your doc codes against my codes.
Good luck,
MK
IPP 9/5/18; Coloplast TITAN OTR 18 cm 1cm RTE, Dr. Khera Baylor Houston,Prostate Ca at 51 y/o; RARP 11/2/16, ED Post RP, Cialis, Viagra, VED no usable erection, April 2017, TRIMIX painful, BIMIX tolerable but ineffective,lost 2+ inches of length after RP


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