I won battle with insurance

[MK1965]

I finally won bottle with my insurance provider.
After 3 denials to Dr office, and after my 1 st appeal was denied, I decided to go with Second Level Appeal and it was received at Insurance on October 12,
On November 10, I got letter from insurance where it states that proposed procedure CPT code 54410 ( Removal and replacement of all components of a multi component inflatable penile prosthesis at the same operative session) is APPROVED after Re- evaluation Review by Clinical Claim Review Staff.
Given 6 months for procedure to be done by 5.2.21.
Already got scheduled on December 2 with Dr Clavell in Houston TX.
Looking forward to better results then what I got with my first implant.
MK

[sweaterfan]

Awesome, MK! I'm seriously thinking of using the same surgeon for my first implant. Please keep us posted.

[Gt1956]

I'm happy for you. If I remember the story correctly. I couldn't understand what their issue was? Either way, I bet you'll sleep alot better now. Turn this into a job. Get it done & all healed up. Just like your future sex life depends on it. Oh wait, just get it done pronto.
You are a role model to some of the guys here for your determination & just plain won't give up attitude. Congrats!

[newbie443]

Congratulations. Way to hang in there.

[SW0110]

Absolutely fantastic. That is the code my doc used. Removal and replace. He sent first request in that said just installation. Chatted with him and said. You got to take the one out first.

He also gets paid more.

[Gt1956]

Absolutely fantastic. That is the code my doc used. Removal and replace. He sent first request in that said just installation. Chatted with him and said. You got to take the one out first.

He also gets paid more.

Isn't that strange that he made that mistake? I was under the impression that many surgeons claim more work than was done. Whether by accident or purpose, who knows.
I used to chat with my pharmacist. He said that every once & a while. Insurance companies would audit his records to verify that he billed correctly. He claimed that a different pharmacy had like $85K usd's sucked backwards.from him. He was always very careful in his billing & codes.
I figured that similar things happened to doctors.

[MK1965]

Just want to thank you all dear FT friends.
It was hard and 3 months long fight with insurance bureaucrats but I was so determined in this battle to go all the way.
Failure was never an option in my life, and that was my motivating strength in this battle.
I had lots of support here delivered by many of you, had support from my wife and daughters for which I am very thankful.
Now, finally looking for my revision and hopping for better results then with my first implant.
MK

[hopeful_future]

I finally won bottle with my insurance provider.
After 3 denials to Dr office, and after my 1 st appeal was denied, I decided to go with Second Level Appeal and it was received at Insurance on October 12,
On November 10, I got letter from insurance where it states that proposed procedure CPT code 54410 ( Removal and replacement of all components of a multi component inflatable penile prosthesis at the same operative session) is APPROVED after Re- evaluation Review by Clinical Claim Review Staff.
Given 6 months for procedure to be done by 5.2.21.
Already got scheduled on December 2 with Dr Clavell in Houston TX.
Looking forward to better results then what I got with my first implant.
MK

Congrats...but keep ALL the documentation, make sure you scan a copy of the approval, and prepare for a potential additional fight. I went through the same thing, months of fighting with them, reading 100+ pages of insurance documents and citing specific lines out of the policy to prove I was covered. Then after the procedure, both the surgeon and the hospital charged me $30k, since the insurance rejected my claim. Took another 2 months of fighting, even with the letter showing approval...But eventually got it taken care of.

I had to call Cigna back every week, and every week they said "Oh yeah, definitely, your approval is right here, we should have it ironed out within a week..." Our insurance industry is gross.

[ViaSwiss]

Dr Clavell is an A+ surgeon. Who did your first one?

Why was insurance originally denying coverage?

Happy you got this figured out.

[truckrglenn]

Just want to thank you all dear FT friends.
It was hard and 3 months long fight with insurance bureaucrats but I was so determined in this battle to go all the way.

Was this Pun said on purpose? Lol