My Journey to the Brotherhood

[MK1965]

Today I got a rejection letter from Aetna for my new cock. I'm submitting a Review Request it as I meet all of their stated parameters outlined in Aetna's Clinical policy Bulletin number: 0007

Andrew,
I am also covered by Aetna thru my employer and Aetna approved my implantat the end of August so I was implanted on 9/5.
I also looked at Aetna’s bulletin and it looks to me, your implant should be covered.
My defaults to different category as radical prostatectomy, Radical cystectomy, Surgery for colon Ca etc and implant is considered as restorative procedure caused by surgeries to remove Ca from above mentioned organs.
Just make sure your surgeon is using right ICD10 and CPT codes.
Good ICD10 code would be N52.02 which means ED of organic origin caused by veno-occlusive disorder.
CPT codes should be 54405 which means inserting of multi component penile prosthesis (cylinders, pump, reservoir)
I hope this might help.
MK

[williamb]

I am not sure if y'all are speaking directly to your insurance provider. I have had an implant and a replacement and I have never spoke directly to my provider nor will I in the future. The Dr has people that know the answers to give to justify the procedure whereas we do not , in most of our cases.
Just like installing the implant, let the experts handle the details.
Dave

[alibaba]

AMS help line is very helpful in getting on the phone with your insurer and you in a conference call and getting all the correct codes and agreement to get this done. Coloplast could learn a few things in respect to customer service.

[andrew1959nj]

Thanks MK1965,

My Urologist/surgeon used CPT code 54405 but the MS diagnosis needs to be validated by my Neurologist's diagnosis and 10 years of MRIs.

[Larry10625]

I am not sure if y'all are speaking directly to your insurance provider. I have had an implant and a replacement and I have never spoke directly to my provider nor will I in the future. The Dr has people that know the answers to give to justify the procedure whereas we do not , in most of our cases.
Just like installing the implant, let the experts handle the details.
Dave

A few other FT members had their doctors office handle dealing with the insurance companies with great success. Let them do it... they are good at it and you don't need the stress.

Larry