Insurance will not cover implants

The final frontier. Deciding when, if and how.
needhelp
Posts: 202
Joined: Sun Jan 07, 2018 7:07 pm

Re: Insurance will not cover implants

Postby needhelp » Wed Feb 27, 2019 11:22 pm

PeteTx wrote:Virtually all large corporations pay their own claims and use insurance companies to process the claims and send them the bill. For me, my company uses Aetna and specifically added gender dysphoria coverage but not sexual dysfunction coverage. Gender dysphoria and sexual dysfunction are additional coverages a business must add to Aetna"s plan. Essentially my company paid for a benefit/treatment/procedure for females but not for males. Breast implants post mastectomy are required coverage by federal law. ED meds were covered under a separate pharmacy policy.

Coverage to provide an implant to reassign sex from female to male was heralded corporate wide. But corporate decided not to add the extra coverage for sexual dysfunction. So Aetna categorically denied implants, pumps, injections, corrective surgery, etc. for ED, Peyronie’s, or for prostatectomy.
Blatant sex discrimination.

such bull shit...your right.... blatant sex discrimination!... I wish I was retired lawyer and had some time on my hands. Id love to fight these corporations
61 years old, single, Charlotte NC, Had a penile fracture. Implant scheduled for April 17. Dr Terlecki Winston-Salem, NC

MUNKY_BUTTR
Posts: 40
Joined: Mon Sep 22, 2014 10:09 am

Re: Insurance will not cover implants

Postby MUNKY_BUTTR » Thu Feb 28, 2019 1:29 am

PeteTx wrote:Virtually all large corporations pay their own claims and use insurance companies to process the claims and send them the bill. For me, my company uses Aetna and specifically added gender dysphoria coverage but not sexual dysfunction coverage. Gender dysphoria and sexual dysfunction are additional coverages a business must add to Aetna"s plan. Essentially my company paid for a benefit/treatment/procedure for females but not for males. Breast implants post mastectomy are required coverage by federal law. ED meds were covered under a separate pharmacy policy.

Coverage to provide an implant to reassign sex from female to male was heralded corporate wide. But corporate decided not to add the extra coverage for sexual dysfunction. So Aetna categorically denied implants, pumps, injections, corrective surgery, etc. for ED, Peyronie’s, or for prostatectomy.
Blatant sex discrimination.


PeteTx-you were able to send one letter to your benefits department citing EEOC's Compliance Manual regarding Employee benefits, and your company completely changed their SPD? It sounds like it happened fairly quickly if you were only just denied in Dec. I'm impressed! Good on you! I think it's worth a shot for myself and needhelp. My company is verbatim with yours regarding gender dysphoria. Did you just send an email? Or physical letter, ceritified, return-receipt?
38 years old, single in Washington, D.C. Implanted 11/20/2014 by Dr. Kramer with an AMS CX 21cm with 1cm tips.

ocitgo
Posts: 376
Joined: Wed Jan 01, 2014 8:48 pm
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Re: Insurance will not cover implants

Postby ocitgo » Thu Feb 28, 2019 2:23 am

Medicare cover mine 100%
ocitgo (Bob F), Bremerton, WA
Implanted 11/13/2017 AMS 700LGX 15 cm, 3 cm rear tip

needhelp
Posts: 202
Joined: Sun Jan 07, 2018 7:07 pm

Re: Insurance will not cover implants

Postby needhelp » Thu Feb 28, 2019 9:06 am

MUNKY_BUTTR wrote:
PeteTx wrote:Virtually all large corporations pay their own claims and use insurance companies to process the claims and send them the bill. For me, my company uses Aetna and specifically added gender dysphoria coverage but not sexual dysfunction coverage. Gender dysphoria and sexual dysfunction are additional coverages a business must add to Aetna"s plan. Essentially my company paid for a benefit/treatment/procedure for females but not for males. Breast implants post mastectomy are required coverage by federal law. ED meds were covered under a separate pharmacy policy.

Coverage to provide an implant to reassign sex from female to male was heralded corporate wide. But corporate decided not to add the extra coverage for sexual dysfunction. So Aetna categorically denied implants, pumps, injections, corrective surgery, etc. for ED, Peyronie’s, or for prostatectomy.
Blatant sex discrimination.


PeteTx-you were able to send one letter to your benefits department citing EEOC's Compliance Manual regarding Employee benefits, and your company completely changed their SPD? It sounds like it happened fairly quickly if you were only just denied in Dec. I'm impressed! Good on you! I think it's worth a shot for myself and needhelp. My company is verbatim with yours regarding gender dysphoria. Did you just send an email? Or physical letter, ceritified, return-receipt?


Just sent the letter...AMS is following up with there team .....
61 years old, single, Charlotte NC, Had a penile fracture. Implant scheduled for April 17. Dr Terlecki Winston-Salem, NC

MUNKY_BUTTR
Posts: 40
Joined: Mon Sep 22, 2014 10:09 am

Re: Insurance will not cover implants

Postby MUNKY_BUTTR » Thu Feb 28, 2019 2:06 pm

needhelp wrote:Just sent the letter...AMS is following up with there team .....


Glad to hear! It's worth a shot-what can it hurt? Keep us posted!
38 years old, single in Washington, D.C. Implanted 11/20/2014 by Dr. Kramer with an AMS CX 21cm with 1cm tips.

needhelp
Posts: 202
Joined: Sun Jan 07, 2018 7:07 pm

Re: Insurance will not cover implants

Postby needhelp » Fri Mar 01, 2019 4:54 pm

MUNKY_BUTTR wrote:
needhelp wrote:Just sent the letter...AMS is following up with there team .....


Glad to hear! It's worth a shot-what can it hurt? Keep us posted!


Will do munky-butter ....... cant hurt..
61 years old, single, Charlotte NC, Had a penile fracture. Implant scheduled for April 17. Dr Terlecki Winston-Salem, NC

PeteTx
Posts: 7
Joined: Mon Mar 16, 2015 9:03 pm

Re: Insurance will not cover implants

Postby PeteTx » Tue Mar 05, 2019 12:24 am

I'm sorry I haven't responded sooner. My back went out again. Vicodin and Flexeril keep me knocked out. If I can be of any help just let me know. I have several regulations I can send your way. Just PM me.

Pete
59 yo, diabetes, Peyronie's, and phimosis. Implanted with AMS CX700 and circumcised on the 3/23/15 by Dr. Robert Cornell in Houston, TX. Revision scheduled for 3/12/19 by Dr. Bryan Kansas in Austin, TX.


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