Insurance denied revision

The final frontier. Deciding when, if and how.
MK1965
Posts: 625
Joined: Thu May 24, 2018 5:32 pm

Insurance denied revision

Postby MK1965 » Thu Aug 13, 2020 2:55 pm

Hi All,
Just learned that my insurance Aetna denied my revision which is scheduled for next week.
My doctor will call Aetna for peer to peer review.
I don’t have any idea why revision is not approved when same insurance paid for my initial implant in 2018.
Second question: How to delete messages from Private messages folder?
MK
IPP 9/5/18; TITAN OTR 18 +1cm RTE,Prostate Ca at 51 y/o; RARP 11/2/16, ED Post RP, Cialis, Viagra, VED,TRIMIX painful, BIMIX ineffective,lost 2+ inches of length after RP. Revision 12/2/20 by Dr Clavell, AMS 700 CX, L 21 R 21+1.5 RTE.

Meddman1
Posts: 47
Joined: Thu Mar 19, 2020 1:41 pm

Re: Insurance denied revision

Postby Meddman1 » Thu Aug 13, 2020 3:11 pm

That’s strange. Aetna paid for mine. It’s in the policy.
Implant March 2020. 64 years old. retired. Unable to get erect due to medication and diabetes. Received AMS 700 LGX , 5cm on right and 6cm left. 18x12 .Revision done in may 2020 because cylinder in right side fell out.

FixTDix
Posts: 85
Joined: Wed Jul 22, 2020 12:28 pm

Re: Insurance denied revision

Postby FixTDix » Thu Aug 13, 2020 3:34 pm

Keep fighting for it man. Anthem denied me originally for implant after they had approved my excision and grafting. Said they covered the dr but not the hospital. Went through hoops with them until the dr office talked to the right person. Don’t give up and keep fighting. Peer to peer should get you the approval you need
46 years old, 3 years diagnosed with peyronie’s, Xiaflex caused fracture (old uro), excision/grafting with Dr Faysal Yafi UCI 3/26/19, Implanted 8/11/20 Dr Yafi Coloplast Titan Zero degree 20cm + 1cm RTE

Waynetho
Posts: 1767
Joined: Wed Nov 27, 2019 11:22 pm
Location: Dallas, TX

Re: Insurance denied revision

Postby Waynetho » Thu Aug 13, 2020 3:57 pm

Meddman1 wrote:That’s strange. Aetna paid for mine. It’s in the policy.

Employer paid insurance policy is dictated by the employer. Since the employer actually pays the claims through the insurance carrier, the employer can decide what coverage they provide.
62yo, married 41 yrs. Urolift (x4) 8/12/19. AMS 700CX 15cm (no RTE) penoscrotal 10/28/19, Frisco, TX. PD 1995/ED 2011. Cialis helped but hinged. (1995)L:6/G:5.5+, (2019)Pre-op L:5/G:4.5, (2/2020)L:6.0/G:5.0

Lost Sheep
Posts: 6133
Joined: Mon Jul 04, 2016 11:16 pm

Re: Insurance denied revision

Postby Lost Sheep » Thu Aug 13, 2020 4:14 pm

Waynetho wrote:
Meddman1 wrote:That’s strange. Aetna paid for mine. It’s in the policy.

Employer paid insurance policy is dictated by the employer. Since the employer actually pays the claims through the insurance carrier, the employer can decide what coverage they provide.

It is my understanding that once the employer sets up or renews the policy (usually once a year), the terms of the policy (including what is covered and what is not) is determined by the contract and not able to be changed by the employer.

I hope I am not wrong about that.
Lost Sheep
AMS LGX 18+3 Nov 6, 2017
Prostate Cancer 2023
READ OLD THREADS-ask better questions -better understand answers
Be part of your medical team
Document pre-op size-photos and written records
Pre-op VED therapy helps. Post-op is another matter

Waynetho
Posts: 1767
Joined: Wed Nov 27, 2019 11:22 pm
Location: Dallas, TX

Re: Insurance denied revision

Postby Waynetho » Thu Aug 13, 2020 4:19 pm

Lost Sheep wrote:
Waynetho wrote:
Meddman1 wrote:That’s strange. Aetna paid for mine. It’s in the policy.

Employer paid insurance policy is dictated by the employer. Since the employer actually pays the claims through the insurance carrier, the employer can decide what coverage they provide.

It is my understanding that once the employer sets up or renews the policy (usually once a year), the terms of the policy (including what is covered and what is not) is determined by the contract and not able to be changed by the employer.

I hope I am not wrong about that.


You are correct, I believe. It's called "Open Enrollment" and that locks in the policies for 12 months until the next OE rolls around at which time the entire shootin' match can change, including the insurance administrator (company like Aetna).
62yo, married 41 yrs. Urolift (x4) 8/12/19. AMS 700CX 15cm (no RTE) penoscrotal 10/28/19, Frisco, TX. PD 1995/ED 2011. Cialis helped but hinged. (1995)L:6/G:5.5+, (2019)Pre-op L:5/G:4.5, (2/2020)L:6.0/G:5.0

MK1965
Posts: 625
Joined: Thu May 24, 2018 5:32 pm

Re: Insurance denied revision

Postby MK1965 » Thu Aug 13, 2020 8:53 pm

As per Aetna bulletin on Erectile Dysfunction, penile implant and revisions are covered when you meet certain criteria. In my case, I had prostate cancer and Radical prostatectomy to remove prostate.
I did use all ( Viagra, Cialis, VED, TRIMIX, BIMIX) with no success at all.
My first implant was approved in less then 10 days.
Policy did not change but people who work for Aetna are non clinical and they don’t understand whole issues. Lady that I talked today was telling me that I have to exhaust all non invasive therapy before implant will be approved.
I tried to explain that when you get an implant and it becomes non functional, nothing Else will work But another implant.
I hope my doc will be able to talk to Aetna’s doc.
MK
IPP 9/5/18; TITAN OTR 18 +1cm RTE,Prostate Ca at 51 y/o; RARP 11/2/16, ED Post RP, Cialis, Viagra, VED,TRIMIX painful, BIMIX ineffective,lost 2+ inches of length after RP. Revision 12/2/20 by Dr Clavell, AMS 700 CX, L 21 R 21+1.5 RTE.

Agfa13
Posts: 1578
Joined: Thu Oct 31, 2019 6:03 pm
Location: Laurel, Maryland

Re: Insurance denied revision

Postby Agfa13 » Fri Aug 14, 2020 7:35 am

Noone addressed the delete message, so I will :lol:
Look at your message folder (private messages). ACROSS from the messages, to the right as your facing your computer screen, you will see check boxes. Place a checkmark on the ones you want to delete.
At the bottom of your message folder, it will ask you what you want to do with the messages:
Mark/unmark as important is the default (what comes up automatically selected). Click arrow next to it for the other option, which is:
Delete marked

Then hit the 'Go' button after you have marked the messages.

As for the insurance, good luck on that. My Orto Dr. said my knee was shot! I paid my out of pocket for this year...get the damn knee fixed and over with...
Ag, 58, Maryland
Document with BEFORE/after pics
AMS cx 24cm, Titan malleable, Titan Legacy on 3/2/20 (20cm/bilat 2cm RTE/ 75 cc)
Face pic on pg. 22: names and faces; dick pics on pg 7/41: Dick of day
Smaller dick, but can fuck without fail :lol: :D

Biker60
Posts: 362
Joined: Sat Aug 03, 2019 12:06 am
Location: Philadelphia Pa

Re: Insurance denied revision

Postby Biker60 » Fri Aug 14, 2020 10:02 am

Aetna requires 5 codes for coverage of implants with employer plans. I lost 3 appeals because hospital coded wrong. I had coverage letter from Aetna from a different urologist. After loosing 3 appeals and blaming the hospital they wrote off their 87k bill and charged me $317. The Dr did plication so they did cover 5k of that and the Dr portion they covered 3k of the 5k he charged. I told them they screwed up. Provided all proper codes for coverage. Also told them I was not paying the $3k. The procedure with my plan should have costed me $500 total. My main reason for surgery was Peyronies. The xiaflex injections cost more then implants. With a 97 degree bend , xiaflex is just a torture with zero benefit. Since having the implant. I can no longer feel plaque, can have penetrative sex. I am straight and all is well. Til the unit fails. I cycle daily and have gotten most length back. But titan really increases girth. I had 4 appeals and stopped after 3 when hospital bill was written off. Dr bill, I will wait for a settlement. But if you need this done, borrow from 401k, savings etc. It will be like 24k our of pocket or up to 30k. Negotiate with provider. Worst part for me, I did not need prior authorization. So the surgery was almost instant problems. Insurance wise. Ams has a rep that will help writing a letter to employer sponsored plans.

MK1965
Posts: 625
Joined: Thu May 24, 2018 5:32 pm

Re: Insurance denied revision

Postby MK1965 » Mon Aug 17, 2020 9:50 pm

As of this evening, Aetna still did not approve my revision.
Surgery was scheduled for 8.19 and this evening my surgeon told me that my surgery needs to be rescheduled.
I blame his office staff for sending wrong diagnosis.
I am not much optimistic his staff will ever get me approved.
Will give them week or two and if it is not approved, it will be time to look for new implant surgeon.
I am so proud Hustonian and I don’t want to go out of HOUSTON to have it done.
With my first implant, I had no problems to get it approved.
It wS quick and easy approval.
Let’s wait and see.
MK
IPP 9/5/18; TITAN OTR 18 +1cm RTE,Prostate Ca at 51 y/o; RARP 11/2/16, ED Post RP, Cialis, Viagra, VED,TRIMIX painful, BIMIX ineffective,lost 2+ inches of length after RP. Revision 12/2/20 by Dr Clavell, AMS 700 CX, L 21 R 21+1.5 RTE.


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