Another insurance question

[tobenormalagain]

I know this subject had probably been discussed ad nauseum, but can anyone recommend an insurance carrier that approved an IPP without having to stand on one leg, jumping through numerous hoops, and filing multiple appeals?

[Gt1956]

I know this subject had probably been discussed ad nauseum, but can anyone recommend an insurance carrier that approved an IPP without having to stand on one leg, jumping through numerous hoops, and filing multiple appeals?

You need to remember that insurance companies don't see their job is to throw money around. They all require paperwork to verify that your request matches the conditions of your policy.
I believe that the best way is to take your policy to the insurance people at your doctors office. Those are the people that deal with your insurance, not the doctor himself.

[tobenormalagain]

I have done this already! Other than forwarding a letter of medical necessity, the doctor’s office only provided diagnosis and CPT codes and instructed me to contact my insurance company!

[tobenormalagain]

I have done this already! Other than forwarding a letter of medical necessity, the doctor’s office only provided diagnosis and CPT codes and instructed me to contact my insurance company!

[oldbeek]

I browsed your earlier posts. What tests have you had to determine the cause? Do you have serious PD bend? or documented Veneous leaks? or an Prostatectomy with nerves removed? These thing will cause the insurance to cover you. Just organic ED, you are probably on your own if they have an exclusion clause.

[Gt1956]

I have done this already! Other than forwarding a letter of medical necessity, the doctor’s office only provided diagnosis and CPT codes and instructed me to contact my insurance company!

So what was the insurances reply??

[mikestap]

Tobe, you really don’t give us much to go on. If you have Medicare, you’re covered. If you get your insurance from your employer, this can get tricky. Insurers offer dozens of policies to their employer clients and these policies can have specific exclusions for penile implants. The details of these exclusions are deep inside the Summary Benefits Plan, often a 100+ page document that provides specifics on what’s not covered.

I can’t offer much help for a plan you go get yourself, but I hope this helps. Always get a written statement from your insurer that your plan covers the procedure.

[Gt1956]

Tobe, you really don’t give us much to go on. If you have Medicare, you’re covered. If you get your insurance from your employer, this can get tricky. Insurers offer dozens of policies to their employer clients and these policies can have specific exclusions for penile implants..........

I dug back thru his post history. As of last fall he said a couple of times that he is 55.

[SW0110]

The deciding issue is going through the insurance covered documents. My bcbs covered has one sentence. Implant is covered for Peyronies disease or biologically caused ed.

At open season I looked at geha to switch to. Nope their covered for implant was more ambiguous.

That one sentence is really important.

[tobenormalagain]

Tobe, you really don’t give us much to go on. If you have Medicare, you’re covered. If you get your insurance from your employer, this can get tricky. Insurers offer dozens of policies to their employer clients and these policies can have specific exclusions for penile implants..........

I dug back thru his post history. As of last fall he said a couple of times that he is 55.

Thank you all for your responses! Yes 55yo male with private insurance (Blue Cross/Blue Shield Regence). I am in very good health and have very mild PD due to Trimix injections. I expected that my implanting physician's office would go to bat for me and be proactive in dealing with my insurance company. They pretty just gave me the codes and told me to call myself.