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I've been perusing this forum for some time and find all the comments very helpful. After years of contemplating it, I finally decided earlier this year to go for an implant. I met with the surgeon in May and scheduled it for 7/22/21. All summer I've been a nervous wreck, it seemed like the date would never come. Then, yesterday I found out that my insurance company, Cigna, is refusing to cover it all, even if it is proven to be medically necessary. It's simply not an included benefit in the plan. What a let down! HR rep at my company is looking into whether anything can be done but I'm not holding my breath. Hospital told me the self-pay cost for the surgery would be 40 Grand and that's not including the anesthesiologist! I know the going rate is $16 - 25K so I canceled the surgery and am shopping around. Does anyone have experience going the self-pay route? Where did you go and what was the cost? I'm in Columbus, OH but willing to travel.

Anthem denied my operation 3x this year stating it was not medically necessary, my doc had to have 2 peer-to-peers with them before they approved.

If the plan has an exclusion, AMS will work with your HR to try to get you a one off. Michelle can help: Richelle.OReilly@bsci.com

If none of those options work, Dr. Tatem's self pay is $17,000 in Indianapolis. Dr Hakky is around $17,000 in Atlanta.

I did self pay in NYC with Dr EID for 32k. If the cost is affordable I would not choose anyone else. If you have to go with a more affordable option, I hear great things about Dr Hakky in Atlanta. He should be under 20k.

ViaSwiss wrote:Anthem denied my operation 3x this year stating it was not medically necessary, my doc had to have 2 peer-to-peers with them before they approved.

If the plan has an exclusion, AMS will work with your HR to try to get you a one off. Michelle can help: Richelle.OReilly@bsci.com

If none of those options work, Dr. Tatem's self pay is $17,000 in Indianapolis. Dr Hakky is around $17,000 in Atlanta.

And then you have the embarassment of your HR department, and possibly your whole work, knowing about your problem that your dick doesn't work. I dealt with that myself at my work. Nobody has said anything, but I just get the feeling now a lot of people know.

Too bad you're not requesting a sex change. If you wanted to cut your penis off they would pay for everything and send you a get well card

trevbalser wrote:I've been perusing this forum for some time and find all the comments very helpful. After years of contemplating it, I finally decided earlier this year to go for an implant. I met with the surgeon in May and scheduled it for 7/22/21. All summer I've been a nervous wreck, it seemed like the date would never come. Then, yesterday I found out that my insurance company, Cigna, is refusing to cover it all, even if it is proven to be medically necessary. It's simply not an included benefit in the plan. What a let down! HR rep at my company is looking into whether anything can be done but I'm not holding my breath. Hospital told me the self-pay cost for the surgery would be 40 Grand and that's not including the anesthesiologist! I know the going rate is $16 - 25K so I canceled the surgery and am shopping around. Does anyone have experience going the self-pay route? Where did you go and what was the cost? I'm in Columbus, OH but willing to travel.

Hi Trevbalser,
I work for the HR department for a big company. The HR representative in charged of Benefits can help you to get it approval, Also, it is illegal to disclose employees' medical condition. If for any reasons somebody in HR discloses your claim with anybody, you can sue the company and the HR employee gets fired.
Also, if you read several Bionic guys here. They have to resubmit their claim several times before it gets approval.
Don't give up on your first knock out.
Your doctor can appeal your claim or your HR/ Benefits department can push it through.
Good luck man. We are in this battle together.
Hector

Thanks for all the comments. Will keep you posted. Haven't heard back from HR yet. For now, I'm researching out-of-state surgeons with reasonable self-pay costs. Have a feeling I may end up going that route. I may also reach out to AMS to see what advice they have.