Insurance will not cover implants

The final frontier. Deciding when, if and how.
needhelp
Posts: 202
Joined: Sun Jan 07, 2018 7:07 pm

Insurance will not cover implants

Postby needhelp » Wed Feb 06, 2019 7:14 pm

I was just informed that my insurance will not cover implants. I'm not sure what to do now. I know there's not much I can do, but I thought Id ask anyways
61 years old, single, Charlotte NC, Had a penile fracture. Implant scheduled for April 17. Dr Terlecki Winston-Salem, NC

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Larry10625
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Joined: Sat Apr 15, 2017 10:56 am
Location: Ontario, CANADA

Re: Insurance will not cover implants

Postby Larry10625 » Wed Feb 06, 2019 7:26 pm

needhelp wrote:I was just informed that my insurance will not cover implants. I'm not sure what to do now. I know there's not much I can do, but I thought Id ask anyways



Can you get insurance that will cover it and then cancel it after your implant?

Larry
51 years old, married 29 years. Implanted Mar 30/17 by Dr. Brock of London, Ont, CANADA. (AMS 700 LGX 18 + 2). Had implant removed Apr 29/17 due to Septic Shock. Liposuction By Dr. Gan and re-implant by Dr. Brock (AMS LGX 15 + 2) Dec 14/17.

needhelp
Posts: 202
Joined: Sun Jan 07, 2018 7:07 pm

Re: Insurance will not cover implants

Postby needhelp » Wed Feb 06, 2019 7:28 pm

I work for a corporation. Not sure how to go about that
61 years old, single, Charlotte NC, Had a penile fracture. Implant scheduled for April 17. Dr Terlecki Winston-Salem, NC

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Lunatech
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Joined: Wed Nov 28, 2018 2:07 pm
Location: Foothills of NC

Re: Insurance will not cover implants

Postby Lunatech » Wed Feb 06, 2019 7:37 pm

Have you spoke with the insurance company personally? My insurance doesn't cover them "unless medically necessary". Dr. has to do his part (paperwork) to fulfill that requirement. Worth checking into if you haven't already.
49 years old, Suffering from ED 10+ years, Implant surgery 2/28/19 AMS 700 LGX 18cm with 4cm RTE by Dr. Terlecki at WFBMC in Winston Salem NC

Lost Sheep
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Joined: Mon Jul 04, 2016 11:16 pm

Re: Insurance will not cover implants

Postby Lost Sheep » Wed Feb 06, 2019 7:58 pm

needhelp wrote:I was just informed that my insurance will not cover implants. I'm not sure what to do now. I know there's not much I can do, but I thought Id ask anyways

Larry10625 wrote:Can you get insurance that will cover it and then cancel it after your implant?Larry

needhelp wrote:I work for a corporation. Not sure how to go about that

"Medically necessary" and "for restoration of a lost or impaired bodily function" are "magic words" that clear away a lot of insurance company hurdles.

All insurance companies have an appeals process. Your Human Resources office should be able to help you with that (and you should not have to tell them the medical details just to get the paperwork).

Many insurance companies have a customer liaison function that can help you navigate through the bureaucracy. Your Human Resources office should be able to provide contact information and some amount of guidance.

Good luck. All I can think of right now.
Lost Sheep
Born 1948 AMS LGX 18+3 implant Nov 6, 2017 by Dr Tavis Shaw. Spent 14 months researching in effort to optimize outcome. After 30 yrs of progressive unrecognized ED I will do this RIGHT; no second chance with one's first.
Anchorage AK, USA

needhelp
Posts: 202
Joined: Sun Jan 07, 2018 7:07 pm

Re: Insurance will not cover implants

Postby needhelp » Wed Feb 06, 2019 8:05 pm

Thank you Lost Sheep
61 years old, single, Charlotte NC, Had a penile fracture. Implant scheduled for April 17. Dr Terlecki Winston-Salem, NC

needhelp
Posts: 202
Joined: Sun Jan 07, 2018 7:07 pm

Re: Insurance will not cover implants

Postby needhelp » Wed Feb 06, 2019 8:14 pm

Lunatech wrote:Have you spoke with the insurance company personally? My insurance doesn't cover them "unless medically necessary". Dr. has to do his part (paperwork) to fulfill that requirement. Worth checking into if you haven't already.


I called. They said it was an exclution in all the policies where I work. I asked them even if this was medically necessary? they said if it was in the exclution it was not covered. She said I could try to appeal it but she said in all her time she has never seen a case that was appealed won.
61 years old, single, Charlotte NC, Had a penile fracture. Implant scheduled for April 17. Dr Terlecki Winston-Salem, NC

Lost Sheep
Posts: 2123
Joined: Mon Jul 04, 2016 11:16 pm

Re: Insurance will not cover implants

Postby Lost Sheep » Wed Feb 06, 2019 9:01 pm

needhelp wrote:
Lunatech wrote:Have you spoke with the insurance company personally? My insurance doesn't cover them "unless medically necessary". Dr. has to do his part (paperwork) to fulfill that requirement. Worth checking into if you haven't already.


I called. They said it was an exclution in all the policies where I work. I asked them even if this was medically necessary? they said if it was in the exclution it was not covered. She said I could try to appeal it but she said in all her time she has never seen a case that was appealed won.

Every state government has an office whose mandate is to protect the public, even down to individuals subject to abusive health insurance policies. Different names, same functions.
Office of the Insurance Commissioner
Department of Insurance
Division of Insurance.
etc.

I hate to send anyone into a morass of regulations, but getting a copy of your insurance policy, with the exclusion and (after reading it first) taking it to a lawyer who specializes in getting (forcing) insurance companies to honor their policies might be worth the couple hundred dollars a consultation might cost.

"all the policies" smacks of something foul. Blanket denial of expensive requests/demands/claims is a tactic of unethical companies (not just insurance companies, either). So, also, is employees telling potential appellants (falsely) that "no one ever wins an appeal".

I will not suggest you contact your insurance company (higher up than you have reached so far) with an adversarial attitude, but a firm attitude might convince whoever you talk to that you will not be discouraged from exhausting all avenues to get them to honor their policy. With the Affordable Care Act, a lot of insurance policies were required to include what they previously were able to escape by listing them in their "exclusions". Press them. Politely but firmly. Good luck.
Lost Sheep
Born 1948 AMS LGX 18+3 implant Nov 6, 2017 by Dr Tavis Shaw. Spent 14 months researching in effort to optimize outcome. After 30 yrs of progressive unrecognized ED I will do this RIGHT; no second chance with one's first.
Anchorage AK, USA

needhelp
Posts: 202
Joined: Sun Jan 07, 2018 7:07 pm

Re: Insurance will not cover implants

Postby needhelp » Wed Feb 06, 2019 10:06 pm

Lost Sheep wrote:
needhelp wrote:
Lunatech wrote:Have you spoke with the insurance company personally? My insurance doesn't cover them "unless medically necessary". Dr. has to do his part (paperwork) to fulfill that requirement. Worth checking into if you haven't already.


I called. They said it was an exclution in all the policies where I work. I asked them even if this was medically necessary? they said if it was in the exclution it was not covered. She said I could try to appeal it but she said in all her time she has never seen a case that was appealed won.

Every state government has an office whose mandate is to protect the public, even down to individuals subject to abusive health insurance policies. Different names, same functions.
Office of the Insurance Commissioner
Department of Insurance
Division of Insurance.
etc.

I hate to send anyone into a morass of regulations, but getting a copy of your insurance policy, with the exclusion and (after reading it first) taking it to a lawyer who specializes in getting (forcing) insurance companies to honor their policies might be worth the couple hundred dollars a consultation might cost.

"all the policies" smacks of something foul. Blanket denial of expensive requests/demands/claims is a tactic of unethical companies (not just insurance companies, either). So, also, is employees telling potential appellants (falsely) that "no one ever wins an appeal".

I will not suggest you contact your insurance company (higher up than you have reached so far) with an adversarial attitude, but a firm attitude might convince whoever you talk to that you will not be discouraged from exhausting all avenues to get them to honor their policy. With the Affordable Care Act, a lot of insurance policies were required to include what they previously were able to escape by listing them in their "exclusions". Press them. Politely but firmly. Good luck.


I cant thank you enough for all your support. I will have more questions for you as I move forward.
61 years old, single, Charlotte NC, Had a penile fracture. Implant scheduled for April 17. Dr Terlecki Winston-Salem, NC

David_R
Posts: 1694
Joined: Mon Nov 02, 2015 1:03 pm
Location: Northeast Maryland

Re: Insurance will not cover implants

Postby David_R » Wed Feb 06, 2019 10:11 pm

Sometimes questions can be asked about whether or not breast reconstruction after a mastectomy is covered. This is not required for medical reasons, and it certainly has nothing to do with being healthier or living longer. It is strictly about improving the woman's quality of life. In other words, if they cover breast reconstruction after a mastectomy, then they should cover penile implants as well. (Sometimes the urologist's staff can go to bat for you with the insurance company.)
Last edited by David_R on Thu Feb 07, 2019 12:56 pm, edited 1 time in total.
Age 69. Prostatectomy in 2000. My urologist (for over 20 years) has been Dr. Marc Siegelbaum of Chesapeake Urology, in the Baltimore suburb of Towson. I have LGX, and after regular inflating I regained my original length. (My wife and I love it!)


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