Shot down by Insurance

[Breesfan]

I was scheduled to have implant surgery on the 25th of Sept, only to be denied by BCBS. I don't have $40k for Dr and hospital, so it appears my sex life is over at 51. ED caused by type 2 diabetes. Pills don't work, and i can't "do" injections. Anyone else in the same boat? Would appreciate ANY suggestions. Feeling pretty bad. May cost me my marriage.

[bloomingguy]

I'm sure that more experienced members will reply but I read here (FT) to tell insurance "you can't have sex". Anthem (Medicare) denied my request until I told them "I cannot have sex" (which is true), she said "hold on", came back and said it was fully covered. Again, more informed posters should comment quickly.

[bldoink]

I don't have any advice on dealing with your insurance. Some members have managed to win the battle with them. Hopefully some will chime in and help.

As to the injections, may I ask why you "can't do" them? I understand the implant is your preference but unless there is a medical reason injections aren't appropriate for you they should be considered as a secondary alternative if necessary. For most, once past the initial shock at the idea of sticking your dick, the pain isn't an issue.

[David_R]

Some urologists' offices will call the insurance company and fight on your behalf.

[alibaba]

Find out the reason for denial. For purposes to promote conception was the reason they used for me for a couple years. The insurance would give an automatic denial and the clerks who ran it at the doctors office would never contest it. I had a prostatectomy. A vasectomy is part of it. Conception was not going to happen. My wife's tubes were tied. Again not going to happen. If either you or your wife have had either, then battles on. Call the AMS help line and get them on a conference call with the insurance and you. They are very knowlegable and helpful with the correct codes. 1 damn fool and an incorrect code or even the older codes and there is an automatic denial. Find out if your denial was reviewed by a doctor or if it was made by a clerk looking at a screen at a call center. I had a long history of fighting to get an implant and did not give up. Don't you give up either. Do you have high blood pressure, kidney disease, heart disease, back surgery, accident or some contributing factor? If so use the contributing factor as your primary code and the e.d. as secondary caused by the primary. Sad we have to battle this stuff to learn how to deal with them. Hugs to your and your wife. d

[Breesfan]

I don't have any advice on dealing with your insurance. Some members have managed to win the battle with them. Hopefully some will chime in and help.

As to the injections, may I ask why you "can't do" them? I understand the implant is your preference but unless there is a medical reason injections aren't appropriate for you they should be considered as a secondary alternative if necessary. For most, once past the initial shock at the idea of sticking your dick, the pain isn't an issue.

Hello. Thanks for the reply. As for as the injections go, i just don't "think" i can do it. I can barely stick my finger to test my blood sugar! lol. Do you have "injection experience"? Am I making too much out of this? Thanks again.

[Happy Toy]

I had over 12 years experience with injections, it's no big deal. I would recommend the auto-inject setup for you. If you have any pain at all it's a pin prick if that. I used the auto-inject for about the first year then just started doing it manually when I started getting my Tri-mix and needles from Kaiser, there needles did not fit in the auto-inject device. The injections worked great for me for 11 years, then my ED worsened and had to take the "big" step to an implant, which I'm glad I did. Good luck with the injections .
Andy

[bldoink]

Yeah, I've been doing injections for a good while. The 1st self injection is the worst and it rapidly gets easier. As previously stated pain is usually at the pin prick level. The rare times it's worse it's still not at all bad. You can do it. My biggest issue is I don't like the wife watching me do it. I've told her she can watch if she does the injection as the naughty nurse. No participation, no watching. I don't know if she could actually pull off an injection as she has declined to try. I'm good with that. Meanwhile, good luck with you insurance struggles.

[Breesfan]

Find out the reason for denial. For purposes to promote conception was the reason they used for me for a couple years. The insurance would give an automatic denial and the clerks who ran it at the doctors office would never contest it. I had a prostatectomy. A vasectomy is part of it. Conception was not going to happen. My wife's tubes were tied. Again not going to happen. If either you or your wife have had either, then battles on. Call the AMS help line and get them on a conference call with the insurance and you. They are very knowlegable and helpful with the correct codes. 1 damn fool and an incorrect code or even the older codes and there is an automatic denial. Find out if your denial was reviewed by a doctor or if it was made by a clerk looking at a screen at a call center. I had a long history of fighting to get an implant and did not give up. Don't you give up either. Do you have high blood pressure, kidney disease, heart disease, back surgery, accident or some contributing factor? If so use the contributing factor as your primary code and the e.d. as secondary caused by the primary. Sad we have to battle this stuff to learn how to deal with them. Hugs to your and your wife. d

Thanks for the input. I will call the insurance co and find out why they turned me down.

[53@MVA]

UMR issue ; basically they denied the pre approved claim on the basis that some handbook that employee benefits /Hr has wording that the surgery is not covered. Something to do with sexual performance improvement. So now I have 64k hospital bill hangin plus my Dr and the Anesthesiologist @ 2.5k each. Fuck Em! BTW HR didn't have the handbook and said they will email it to me lol!