Just a question ?? Any insight please ?!

[Ronn1708]

My implant has failed again. I am trying to work through the insurance maze. I called my insurance today and they said the CPT code 54410 (remove & replace implant) should include the C1813 inflatable implant. Each time I speak to someone at the insurance I get a different explanation and conflicting information. One told me the insurance would not pay for C1813 no matter what but C1813 is not an exclusion in the plan. Now the big question!!!! If I had an implant already when the company changed carriers (the previous carrier covered everything) is that a pre-existing condition under my new carrier??????? Just a question. I have not a clue what the answer is but does anyone have any insight ???
This broken thing is about to run me crazy. Depression is overtaking me All I can do is think about my problem of it being broken. All I can do is read here on this sight and google all these different questions. I mean 13K-20K may not be a lot of money to some by its like a million at my house address. All these different answers from the same insurance company.....I can't even keep my mind on my job when at work. Any suggestions??? HELP PLS

[Waynetho]

As I understand "Pre-existing conditions", that refers to being in existence before you were insured.

If your insurance is employer funded (the employer actually pays the claims THROUGH the insurance company who's the administrator), regardless of who they change to, the plans should have similar coverage unless the employer simply decided to stop covering implants prior to open-enrollment.

[Ronn1708]

Well the company changed insurance carriers. I work for the same company but they change insurance companies fairly often. The last insurance paid for the failure in 2017 & 2018 but now a different insurance company. I get answers from them but every call I make provides with with different and conflicting information

[Ronn1708]

I looked at a GoFundME but others that have put penile implant funds on there didn't show to have received any (ZERO) help.

[sonnyjim]

13-20k is not a small amount of money to me either, I can assure you. Half of the men on this forum must be rich to be able to afford to pay for this surgery and then revisions etc.

Because I am in the UK I paid nothing to have this done (NHS) and will pay nothing for future revisions. Obviously if anything were to go wrong, it would just take much longer for me to get it redone or whatever. I'm praying nothing goes wrong...

There seems to be a lot of people here who've had problems early on. Is that the norm? The more I read, the more I am actually waiting for something to break

I really feel for you mate, if I had to pay so much money to have this done I probably wouldn't of got it done for YEARS.

I hope you get this sorted out.

[MK1965]

Ron,
I am in the same boat. My insurance Aetna won’t cover my needed revision.
I also work for the same company and company did not change insurance carrier.
Aetna paid for my implant in 9/2018 but it is refusing to pay it now.
Apparently, it became excluded some time after initial implant.
I also heard same thing you did. Insurance will pay for implant removal but won’t pay for new device ( new implant).
And worsening mater, I am in pain for last 5-6 months, from time pandemic and lock down started.
To be honest, paying 13-20K for new implant is not affordable for me either.
Good luck Ron.
MK

[Old Guy]

If you have one OK by the insurance company get that person's name, email and position in the company. Hold them to it. When I had my implant insurance was pre-approved by the urology office. After my implant I got a bill for $14,000. WHAT? A call to the insurance company got that straightened out, thank goodness.
My thought is you have an implant now. It's broken. What if that was a knee or hip and the implant failed. Are they going to let you limp for the rest of your life? Or try the pain route, tell them it hurts so bad you'll need to be on pain drugs the rest of your life, and they'll have to pay for your prescriptions and doctor visits.
Good Luck.

[WhiteCane]

I hope I understood the question correctly… basically, if your insurance will pay for a remove/replace but not the device, I would try to get some sure fire evidence before you get the operation done that this was a device malfunction… Both devices have a lifetime warranty… from what I understand, it’s sort of this weird line as to if they will cover it or not but, for the most part they’re pretty cool about just saying it was their fault and getting you the new device… A couple problems that I could see before they even cut into you is that the company would say that it either wasn’t their fault or you would end up being responsible for it if your choice was to replace it with the other type of implant… I don’t know if this helps a lot but, I didn’t know if you had looked into the actual implant device is warranty program… because if they will do the remove/replace but won’t cover the implant, the implant is really the only charge you would have left in all of this besides your co-pay… Anyway, I hope this reaches you well! I’m sorry you’re going through all of this shit…

[sweaterfan]

I would go one step further than Old Guy's suggestion. Speak to a supervisor and explain that you are getting different answers then get them to send you written confirmation (email, fax) that the device is covered. Perhaps your HR department can assist. When my company switched to a different carrier they buggered things up so badly that HR had to assign a person specifically to interface with the carrier. Until they assigned that person it was hell dealing directly with the carrier. The next year my company changed carriers and everything settled down. There's no harm in asking HR for help.

[Ronn1708]

Well I work in a very small town and a very small company. I really don't want the local coffee shop talk to be about my implant...lol Gossip is small towns is crazy. I only have a local doctor for small stuff like sinus etc. I dont even have my other information from doctors a hundred miles away share any information with his office. My local doctor knows everything but it's not written in my file at his office. He knows how things are too!!! And HEPA don't mean crap around here. Trying to find the source of a leak is like finding a ring in the bottom of the ocean...impossible..