Some Good Insurance News For a Change

[ElbowRoom]

Congrats! A heads up for ya cause i'd like you to have a smooth transition regarding insurance. I had my implant done well over 2 years ago. BCBS gave the go ahead and to date and after quite a few appeals they haven't paid the dr. My case has been sitting in the hands of the Dept of Labor for some time now. My Surgeons office has been great. They haven't asked me for a dime and have been so helpful in helping me. I'm on the hook for $45,000. I've heard many other stories such as mine. Approved then not paid. I'm hopeful that mine will be settled. It's been one long nightmare. GL to ya.

Thanks for the information. BC/BS is really a conglomeration of different insurers so it makes things...inconsistent. I have BC/BS of Georgia, and I know BC/BS of NC, TX, FL, etc might have wildly different experiences.

I asked about being approved and then the insurer not paying, and Dr. Hakky's office said they see that happen in about 20% of cases with BC/BS. So it's a bit of a roll of the dice, but in the end I think it would work out, and I think it will for you too if you're persistent.

One thing that Dr. Hakky's office suggested is that in addition to the approved pre-cert, call the insurers member services number and ask them if it's a covered procedure under your plan. Then get an a reference number for the call. That way in addition to the pre-certification by the insurer, you also have a verbal confirmation with a reference number you can fall back on.

In my case, BC/BS said in the call that "coverage is based on medical necessity, pre-certification is required, your doctor will have to submit a pre-cert request." So that sounds like if they approve the pre-cert they have agreed the procedure is medically necessary and the procedure is covered.

I'll let you know what happens!

[ElbowRoom]

I want to let guys know that I have Cigna, and they covered my implant.

It was a fight to get it approved, but it did happen. And they were a little slow paying for it. I remember opening a bill from the hospital and nearly passing out when I saw it was for over 50k.

But, a couple of phone calls straightened that out.

You must have a different Cigna plan than we had. There was an outright exclusion in our policy for any treatments or procedures related to sexual dysfunction.

[Jgoody]

Good luck man! I hope they cover for you. My insurance was a rollercoaster to say the least.
Summary is they (Cigna) pre authorized it then a week before denied coverage. I then to come up with the cash amount, which was 17k which included getting another credit card & maxing another out, bullshit. But I was doing this thing. Sexual health for me is top tier importance. I'm currently in the process of appealing & they supposedly have accepted the appeal but need a little more info from the hospital I had it done at.
Such a joke tho. The hospitals invoice for insurance company to pay is 77k so we'll see. I won't believe it until I see it but happy for you & I hope it's smooth. Insurance companies are obnoxious. Good luck brother

[HikerMan]

I'm scheduled to have surgery with Dr. Hakky in October. I have had Cigna insurance through my wife's work (because her plan has no premiums!), and it has a hard exclusion on IPP surgeries, so I was planning to pay out of pocket, over $22k.

To try to avoid that hit, we left the wife on Cigna and I switched to my employer's BC/BS plan. I got my new insurance card yesterday and called their member services line to confirm it's a covered benefit. The response is "it's based on medical necessity, and pre-certification is required, your doctor will have to submit a pre-cert request."

So it seems it's covered if medically necessary. I called Dr. Hakky's insurance specialist and she's going to try to get the pre-cert authorized on August 4. BC/BS will only issue the authorization within a month of the procedure typically. We'll see what happens, we might have to move up my surgery to September.

I'm sure Dr. Hakky can make a good case this is medically necessary, as other treatments have failed and my systolic flow numbers are terrible as confirmed by Doppler.

Anyway, just wanted to share that things might go my way on insurance and cost, which would be a big relief for me as I'm an average joe and not wealthy. Wish me luck!

Yes, BC/BS had me covered almost 100%

[ElbowRoom]

Good luck man! I hope they cover for you. My insurance was a rollercoaster to say the least.
Summary is they (Cigna) pre authorized it then a week before denied coverage. I then to come up with the cash amount, which was 17k which included getting another credit card & maxing another out, bullshit. But I was doing this thing. Sexual health for me is top tier importance. I'm currently in the process of appealing & they supposedly have accepted the appeal but need a little more info from the hospital I had it done at.
Such a joke tho. The hospitals invoice for insurance company to pay is 77k so we'll see. I won't believe it until I see it but happy for you & I hope it's smooth. Insurance companies are obnoxious. Good luck brother

Ugh, that's my fear is the authorization then then it being yanked away, seems to happen sometimes. I hate that you went through this, that's more stress and drama than anybody needs.

[ElbowRoom]

Yes, BC/BS had me covered almost 100%

That's great to hear...fingers crossed!

[Jgoody]

Good luck man! I hope they cover for you. My insurance was a rollercoaster to say the least.
Summary is they (Cigna) pre authorized it then a week before denied coverage. I then to come up with the cash amount, which was 17k which included getting another credit card & maxing another out, bullshit. But I was doing this thing. Sexual health for me is top tier importance. I'm currently in the process of appealing & they supposedly have accepted the appeal but need a little more info from the hospital I had it done at.
Such a joke tho. The hospitals invoice for insurance company to pay is 77k so we'll see. I won't believe it until I see it but happy for you & I hope it's smooth. Insurance companies are obnoxious. Good luck brother

Ugh, that's my fear is the authorization then then it being yanked away, seems to happen sometimes. I hate that you went through this, that's more stress and drama than anybody needs.

Thanks man & yeah it was stressful. Luckily it seems like they have accepted the appeal as of now. Whole thing was annoying because it was originally accepted after being deemed "medically necessary" then being told anything erectile dysfunction is not covered & now after self paying & appeal they're saying it's potentially covered with certain codes. Dealing with customer service who barely speak English is obnoxious. Hopefully it pays off.

Hopefully your prior authorization holds up & if for any reason it doesn't, don't give up. If there's hope for me & my shitty coverage, there's hope for anyone. Good luck again!