Has any one use a bad faith claim to compel insurance to pay?

[andrew1959nj]

I have been treated unsuccessfully for severe ED for 9 years. My Doctor and I have exhausted every non-surgical treatment and he now says that a Penile Implant is my only option left to regain a sex life. Aetna is my insurance company and the denied the pre-authorization and my appeal with a general response. Has anyone successfully filed a bad faith claim and won? My policy covers penile implants and has published criteria that I meet completely and in no uncertain terms. Any advice would be welcome!

[MK1965]

Andrew,
Sign into your Aetna account and go to benefits and coverage, click on Find clinical policies bulletins and it will open all policies in alphabetical order, then click on E and find Erectile dysfunction CPB 0007, click on this bulletin and you will all kind of staff that is covered or not covered by your insurance. It seems to me that you exhausted all your non invasive and less invasive options so looks like it should be category that you fit in.
I included page from my Aetna coverage CPB 0007.
I hope you will find something useful for your fight with your insurer.
Good luck and be persistent.
MK

[Larry10625]

Andrew,
Sign into your Aetna account and go to benefits and coverage, click on Find clinical policies bulletins and it will open all policies in alphabetical order, then click on E and find Erectile dysfunction CPB 0007, click on this bulletin and you will all kind of staff that is covered or not covered by your insurance. It seems to me that you exhausted all your non invasive and less invasive options so looks like it should be category that you fit in.
I included page from my Aetna coverage CPB 0007.
I hope you will find something useful for your fight with your insurer.
Good luck and be persistent.
MK

How do they know that you don't have a 25 year old girlfriend that wants a baby and you need to reproduce... IVF is too unpredictable... that would be discriminatory... wouldn't it?

Larry

[andrew1959nj]

Thanks MK.

I used CPB 0007 in my review request. Aetna's response was "Denied Services: After review, it has been determined that the proposed service(s) would not be eligible under the member's insurance plan, assuming all of the clinical information remains unchanged." I can answer affirmatively on all 7 criteria.

I'm seeking a legal representation at this time.

[andrew1959nj]

Larry10625, given that I had a vasectomy 25 years ago and my partner had a hysterectomy a few years back, our love child would be a current day "immaculate conception"! Besides, I'm old, not crazy! LOL

[Larry10625]

Larry10625, given that I had a vasectomy 25 years ago and my partner had a hysterectomy a few years back, our love child would be a current day "immaculate conception"! Besides, I'm old, not crazy! LOL

I'm just waiting for someone to come along and be able to use that and sue their insurance company for discrimination.. You were the first one I tried it on... yea, it doesn't sound like it would be very practical for you. lol

Larry