Big disappointment

[Badspartan]

ED for over 10 years diabetes heart disease 62yrs
Implant was last resort Dr didn’t suggest I try the vacuum system
Pills quit working and shots just didn’t do it. BCBS said no today
That’s really a huge disappointment when you’ve prepared yourself to take the big step and have the implant surgery

[SteveSW]

Badspartan, You didn't provide the details of the type of plan you are on, or the reasons given by BCBS for denial, but any decision by the provider can be appealed, and you should do so. However, Medicaid absolutely will not pay for implants, if that should be how you are covered. Barring that, appeal it! Often you can be irritating enough for them to cave in and approve. Good luck, Steve.

[Badspartan]

It’s an employer plan from work. They rejected saying our plan covers nothing for sexual dysfunction for any reason. (For surgery). Will cover pills and shots

[Cajun Jeff]

Badsoartin, I completely understand your disappointment. I had BCBS employer plan. They said exactly the same thing to me. We applied still denied.

To this day I am still doing injections.

God luck

[DougAnd]

Well brother I feel for you. But in three years medicare will pay 80 percent and you can find a free supplement that will cover the other 20 percent. I waited totally impotent for more than 2 years. It's a long dry haul but keep the faith. We are all cheering for you.

[Badspartan]

Thanks for the words of encouragement. It’s so many health issues to hit in the last few years,there seemed hope for this For some fun. Something to give hope. That seems over and just don’t know what to do about it. Total depression has set it

[newbie443]

I buy my own insurance and have a BCBS Gold plan. It is compliant. It has coverage for an implant if caused by injury as from diabetes. First thing I would do is read my policy to make sure there is no coverage for injury or disease. Could be your doctors office submitted the request incorrectly. If that is not the case open enrollment is near and you could check into purchasing a policy with coverage. You would have to wait until after the first of the year. And a new round of deductibles would apply. That may even be what your current insurance is doing and not going to approve the surgery this late in the year. I have had that trouble with BCBS not approving coverages for certain things late in the year. Another option would be self pay. From what I have seen costs seem to be 24k and up. If that is an option it might be something to check into. While you are deciding you might give the VED a try. Not only to see if you can have some fun but to help retain size. Stretching with the VED or other means have been shown in studies to help with this.

My BCBS has my policy online. I log on to Blue Access and on the right side I click on Contract/Certificate. Below is from the Comprehensive Program section. Under sub section E. Special Situations.



3. Penile Prosthesis for Physiological Impotence Benefits are provided for a penile prosthesis required for physiological (not psychological) impotence, subject to advance approval by the Company only in the following situations: trauma, radical pelvic surgery, diabetes, Peyronie's Disease, vascular or neurological diseases when individual situation warrants coverage in the Company's opinion. To request advance approval, a written report prepared by Your Doctor must be submitted to the Company. The Company has the right to request and obtain medical information it considers needed to determine whether benefits should be approved or not. Benefits are not provided for services of sleep laboratories for nocturnal penile tumescence testing.

I hope this helps in some way. Just a few options if you want to keep on trying to get this part of your life back. Take care.

[DougAnd]

Wow. If you have the same coverage I would send that clause to them with a letter telling them that you have turned the matter over to an attorney and if you do not get approval within 30 days you will sue for mental damages in excess of 2 million dollars. LOL That should get their attention and their approval.

[Larry10625]

It’s an employer plan from work. They rejected saying our plan covers nothing for sexual dysfunction for any reason. (For surgery). Will cover pills and shots

If they cover pills and shots then they DO cover things for sexual dysfunction. What about reproduction... starting/continuing a family??

[Badspartan]

Larry, they will only pay for pills and caverject. Will not cover surgery for any reason. No family planning. Vasectomy 30 yrs ago. Wouldn’t even cover VED. So I’m starting over, ordering cialis for daily and a new trimix formula. Also order a VED for rehab just a few years away from Medicare so hopefully it will still be covered then. Thanks