Insurance

[Magicmike]

I just got off the phone with my insurance company and they told me that my plan did not cover implant surgery. I can enroll in a new plan starting January 1st. Has anyone gone through this and how do I find a plan that covers the surgery.

[disapointed2]

depending on how a doctor writes the implant up his word is sometimes the defining authority. I would question your doctor if he has written up other implants. This is only a suggestion. I have had situations before over surgeries that were submitted to the insurance company a few times.
It may be worth your while to check with your doctor before calling the insurance company first. Just advice it does not hurt to put out there.
Good luck to you

[Gt1956]

I just got off the phone with my insurance company and they told me that my plan did not cover implant surgery. I can enroll in a new plan starting January 1st. Has anyone gone through this and how do I find a plan that covers the surgery.

Let the professionals do that. Don't muddy up the water so to speak. Your doctors office knows the correct words & codes to use. This is one area that you should definately stay out of.

[Magicmike]

Thanks I'll do that

[Lost Sheep]

I just got off the phone with my insurance company and they told me that my plan did not cover implant surgery. I can enroll in a new plan starting January 1st. Has anyone gone through this and how do I find a plan that covers the surgery.

There have been a few threads on the subject, how and why insurance companies deny coverage and how to get them to either allow exceptional coverage or use the proper coding that the DO cover.

Generally, surgery to recover a lost bodily function is covered unless a specific exclusion is specifically written into the policy. If an E.D. like condition caused blindness and an operation would restore sight, would they not cover that?

Search the threads. I wold but have no time right now. But they are there. Key words, "Insurance" "coverage" stuff like that.

[drjeeps]

I'm fighting this exact thing at the moment. My Dr. has submitted all the correct codes, but my company has decided they don't want to cover this. I am going after them for "Sexual Discrimination" based on them doing this for Gender Dysphoria (meaning a biological female wanting to become a man). Total crap.

I too am using the EEOC argument:

According to the Mayo Clinic, a Phalloplasty requires an implant-type of device for the non-biological male to achieve an erection. The fact that this plan covers this for Gender Dysphoria and not for a biological male is blatant gender discrimination towards me as a biological male.

Please note that EEOC Compliance Manual, Chapter 3: Employee Benefits states:
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.

Bottom line: if the option exists for both sexes, they should not be discriminating.

I foot-noted the heck out of my appeal and ensured I used known entities such as Mayo for my definitions.

I am also using my Pyronies and the associated issues and pain with that to push it as much as the ED.

I just sent my appeal via certified/registered mail today and the clock starts ticking tomorrow as they have 30 days in Colorado to respond.

I'll keep you posted, but hope for good news and I have sincerely appreciated the info here on the forum.

[SW0110]

My policy actually has one section on implants. It listed peyronies or other medical reason for ed as only options for implant approval.

Peyronies and venous leak were both my reasons. Double whammy so implant was my only option.

Good luck. I would get a copy of your insurance implant policy to your doc and let them do their stuff. Sometimes it is all about the medical record code.

[rdnkbiker]

i hope that works for you drjeeper my insurance gave conformation # whole bit the left me holding the bag which was very costly will pay on it from the grave lol wish i had thought of what your doing i live in colorado to would have known quicker maybe GOOD LUCK