Insurance will not cover implants

The final frontier. Deciding when, if and how.

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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: 391
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, leak, 3 cm rear tip
Implanted 06/17/2019 AMS 700LGX 18 cm, 1.5 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: 9
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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drjeeps
Posts: 16
Joined: Tue May 14, 2019 11:27 am

Re: Insurance will not cover implants

Postby drjeeps » Thu Jul 25, 2019 12:29 am

Sadly, I'm going through this IDENTICAL issue with my company. I had found the EEOC info and then saw this post. I've used this language and just filed my appeal via Cigna. Additionally, I'm filing a grievance with my HR department based on gender discrimination in the morning.

What a ridiculous pile of nonsense....I'll let you know how it turns out.

Robert51
Posts: 430
Joined: Thu Dec 28, 2017 10:39 pm

Re: Insurance will not cover implants

Postby Robert51 » Thu Jul 25, 2019 7:20 am

needhelp wrote:It just gets worse. I called again my insurance company and again they said no if its an exclusion. I even asked them all these issue were a repercussion from the original surgery that my insurance paid for. They said its in the policy/exclusion that says " for what ever reason", ....wtf..... and to make maters worse I had asked my old gf who was the one that I had the fracture with , if she could help me with a ride picking me up from the hospital because I have no one that I could ask ...... she text me back and said she's met some one...so she said no.... this has been so depressing. I guess you could say I'm struggling right now. Not sure I can even afford the surgery. Dr gave me a price but said he dose not know the full amount because he's not sure how much he has to do with the peyronies.... I was scared as it was but now I've got all this other stuff hitting me ....




Did you check cost overseas say philippines. Thailand. Korea. Should be 1/2
66 years old married 14 years on my 3rd wife /////// had a major operation at 51 hernia below belly bottom ed got really bad after that .. Tried pills not much and side affects.. trying alprostadil without a lot of success but only 3rd time

Robert51
Posts: 430
Joined: Thu Dec 28, 2017 10:39 pm

Re: Insurance will not cover implants

Postby Robert51 » Thu Jul 25, 2019 7:24 am

Lost Sheep wrote:
needhelp wrote:My surgeon is out of the country till 2/19...I'll check back with him then. Im visiting another surgeon 3/19. Supose to very good to. His discount for pay out of pocket is alot more. Just prepairing myself incase I have to go that route.
Im going to send in an appeal regarding the exclusion ….to more people. I'll have to explain my situation again. I just feel uncomfortable explaining my situation. I'm trying to keep it as priviate as possible.

I felt that way for many years (even after I figured out that I had E.D., which itself took a while). I finally mentioned it to my primary care physician and we tried Sildenafil Citrate (Viagra) and it worked, for a while. I got more comfortable discussing the situation with him and even with some of his nurses present (THAT was a hurdle!).

Eventually, I discussed my needs with non-medical personnel with the V.A. system in trying to arrange authorization, travel, lodging, etc.



I finally told my va doc she said your service connected go to a urologist and bill it to foreign medical program so i will test the waters

I got used to explaining my situation. I am glad I did. A travel specialist, knowing my situation, clued me in to a Urological Surgeon who just got stationed at Elmendorf Air Force Base Hospital and he was GOOD. If I had not been so open about my situation, that networking would not have happened.
66 years old married 14 years on my 3rd wife /////// had a major operation at 51 hernia below belly bottom ed got really bad after that .. Tried pills not much and side affects.. trying alprostadil without a lot of success but only 3rd time


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