Insurance Help

[Anthony]

Im sure this comes up a lot. Well my insurance co denied me due to not being reconstruction. I am looking at other options for insurance. Being I am on the Federal Employee program (Not military, no Tri-Care) I went to OPM and found "Blue Cross and Blue Shield Service Benefit FEP". Under exceptions it lists "Services, drugs, or supplies related to sexual dysfunction or sexual inadequacy (except for surgical placement of penile prostheses
to treat erectile dysfunction and gender reassignment surgeries specifically listed as covered)."
That Second part in parenthesis is important. It appears to partially pay for the surgery but the word "AND" is confusing as it could mean both conditions are covered OR both conditions must be met in order to qualify. Im not enrolled in this plan yet so I can't call them to ask.. GEHA I know doesn't cover as is the case with UMR which I currently have.
Has any Federal Employee had this done using BCBS while not on Medicare and actively employed??

Thanks!

[Lost Sheep]

Im sure this comes up a lot. Well my insurance co denied me due to not being reconstruction. I am looking at other options for insurance. Being I am on the Federal Employee program (Not military, no Tri-Care) I went to OPM and found "Blue Cross and Blue Shield Service Benefit FEP". Under exceptions it lists "Services, drugs, or supplies related to sexual dysfunction or sexual inadequacy (except for surgical placement of penile prostheses
to treat erectile dysfunction and gender reassignment surgeries specifically listed as covered)."
That Second part in parenthesis is important. It appears to partially pay for the surgery but the word "AND" is confusing as it could mean both conditions are covered OR both conditions must be met in order to qualify. Im not enrolled in this plan yet so I can't call them to ask.. GEHA I know doesn't cover as is the case with UMR which I currently have.
Has any Federal Employee had this done using BCBS while not on Medicare and actively employed??

Thanks!

(except for surgical placement of penile prostheses
to treat erectile dysfunction and gender reassignment surgeries specifically listed as covered)

It appears to me that the grammatical defect renders the the phrase self-contradictory. (One cannot have erectile dysfunction if one is having gender reassignment. MtF will not have a penis and FtM automatically requires a constructed penis.) Therefore, I infer that the sentence is meant to qualify either need as covered. But that needs clarification.

The earlier part of the quote you posted suggests that the insurance will not cover erectile medications, devices, diagnostics etc, but will cover implants. But such implants would have to be "specifically listed as covered". I suppose the covered list is elsewhere in the policy and likely enumerates things like injuries, amputations, specific diseases (including, it seems, listed sexual dysphoria, but not all erectile dysfunction, but only those listed specifically as covered).

Probably would cover Peyronie's Disease, but not venous leakage. Arterial inadequacy from diabetes might not be covered but the arterial inadequacy from injury might be.

I would press on the "I can't call them to ask..." point. Someone, somewhere in their marketing department has GOT to be interested in talking to potential clients.

Edited to add: Every state government in the USA has a commission that regulates insurance companies. Perhaps they might have contact information for someone in the company who could help you.

[SW0110]

Bcbs fed insurance took care of almost all of mine. I was out about 900. Insurance was billed almost 70,000. I will see what revision to an lgx will be this week.

I know it ed was covered due to peyronies or other medical condition.