I haven't been on the site since my implant in 3/2015. My employer at the time bought coverage for ED so my implant was covered.
Forrward to last fall and a different employer (large corporation). Developed a leak somewhere and I need a replacement. Finally saw my urologist in December. He submitted a predetermination request. Insurance denied because my employer plan had a specific exclusion for any sexual dysfunction. Out of pocket was $18K.
My issue/solution was with my employer not the insurance company.
Now my new employer has a very active inclusion program and a very vocal LGBTQ social group within the corporation. Gender dysphoria is completely covered. A penile implant for gender reassignment is covered but not for Peyronie's, venous leakage, or even prostatectomies! Bottom line is a lady transitioning to a man can get an implant but not for a guy staying a guy even after cancer.
So, in January, I brought the sex discrimination to the attention of the corporate ethics, legal, and benefits departments. I cited several govt regulations but specifically:https://www.eeoc.gov/policy/docs/benefits.html#B.%20Health%20Insurance%20Benefits%20(T7)
EEOC Compliance Manual
Chapter 3: Employee Benefits
Title VII /EPA Issues
II. Discrimination Based on Sex, Race, Color, National Origin, or Religion
B. Health Insurance Benefits
Like retirement benefits, health insurance benefits must be provided without regard to the race, color, sex, national origin, or religion of the insured. An employer must non-discriminatorily provide to all similarly situated employees the same opportunity to enroll in any health plans it offers. An employer must also ensure that the terms of its health benefits are non-discriminatory. In evaluating charges that an employer has discriminated in the terms of health benefits it offers, the following principles apply:
The employer cannot provide different coverage to men and women where the risk insured against is mutually contractible - that is, where the underlying condition affects, or the treatment/test is available to, both men and women.
Where both men and women are, or could be, affected by the same condition or helped by the same treatment, the employer will be liable for sex discrimination if it provides different coverage to employees of each gender on the basis of gender.
The benefits department jumped right on it. It took several weeks to implement backdated coverage for organic/physiological sexual dysfunction to 1/1/19 to avoid fines and penalties. I believe it was not intentional. They thought they were denying "cosmetic enhancement" not a legitimate medical need.
I didn't have to file an official complaint, but if I did, they are prohibited from any form of retaliation. Retaliation would result in fines, penalties, and/or monetary compensation to you.
Also, you have between 180 to 300 days to file an offucial complaint. If you're past the window have your doctor obtain another denial to restart the period to file.
I hope this helps.
BTW: My surgery is scheduled for 3/12/19.
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.