28 year old, moderate to severe ED for 8 years now

[Lasthope20]

Hey yall so I’m 28 years old, first experienced ED around 20 years old. Has gradually gotten worse over the years, I haven’t gotten morning erections for about 6-7 years now, soft upon waking up. I take Tadalafil every other day or so 20mg split into two, so 10mg, it helps but I haven’t had a super strong erection in years, maybe like 70-80%, enough to have sex but not be too confident in the firmness after a little bit during sex. About a month ago I went through a solid two weeks of not being able to get hard enough for sex and couldn’t get hard masturbating. It has somewhat gotten better. I’ve been to Dr Clavell’s office before, they injected me with trimix, I got firm but unable to get a hard erection at all, they came in and did the ultrasound and said I didn’t have a venous leak.

I’m looking into getting insurance with Blue Cross Blue Shield of Texas, however all the plans I’ve seen have sexual dysfunction in the limitations or exclusions. I know Clavell’s office accepts BCBS, however how do they get the insurance to cover the penile implant if sexual dysfunction is on the limitations and exclusions list for all these plans I’ve seen??? Thank you in advance for the replies.

[Kodixx]

Lasthope20, I am really sorry to hear about your situation. Have you tried VED ? If so, does it get you past the 70-80% erection you described ?

As far as insurance, you might want to be aware of what's available from the Affordable Care Act. ACA insurance plans generally cover implants when proven medically necessary. If you have access to insurance thru an employer or spouse, you wouldn't qualify. If you make $50-$70K/yr, it is subsidized to be reasonably "affordable". Otherwise it can be expensive since there's no employer contribution.

- Chuck

https://www.google.com/search?q=does+the+Affordable+Care+Act+cover+internal+penile+prosthetic+procedure&oq=does+the+Affordable+Care+Act+cover+internal+penile+prosthetic+procedure&gs_lcrp=EgZjaHJvbWUyBggAEEUYOdIBCTIyODIxajBqMagCALACAA&sourceid=chrome&ie=UTF-8

I’m looking into getting insurance with Blue Cross Blue Shield of Texas, however all the plans I’ve seen have sexual dysfunction in the limitations or exclusions. I know Clavell’s office accepts BCBS, however how do they get the insurance to cover the penile implant if sexual dysfunction is on the limitations and exclusions list for all these plans I’ve seen??? Thank you in advance for the replies.

[Lasthope20]

Yes so my employer offers blue cross blue shield for insurance coverage, I was planning to use it starting next year. However the two plans they offer with blue cross blue shield have sexual dysfunction on the limitations and exclusions list, and I checked other non employer plans through BCBS and sexual dysfunction was on all limitations exclusions list. So I’m just confused, if I get insurance through my employer, will I be able to get the implant eventually if deemed medically necessary?

[alans4570]

You should call the insurance company for answers. They are the only ones who can clarify your questions. Years ago I had healthcare insurance that would not cover anything to do with feet. I don't know how they can do that but they get away with it. If you or your employer pay for healthcare coverage it should be covered period.

[HikerMan]

Hey yall so I’m 28 years old, first experienced ED around 20 years old. Has gradually gotten worse over the years, I haven’t gotten morning erections for about 6-7 years now, soft upon waking up. I take Tadalafil every other day or so 20mg split into two, so 10mg, it helps but I haven’t had a super strong erection in years, maybe like 70-80%, enough to have sex but not be too confident in the firmness after a little bit during sex. About a month ago I went through a solid two weeks of not being able to get hard enough for sex and couldn’t get hard masturbating. It has somewhat gotten better. I’ve been to Dr Clavell’s office before, they injected me with trimix, I got firm but unable to get a hard erection at all, they came in and did the ultrasound and said I didn’t have a venous leak.

I’m looking into getting insurance with Blue Cross Blue Shield of Texas, however all the plans I’ve seen have sexual dysfunction in the limitations or exclusions. I know Clavell’s office accepts BCBS, however how do they get the insurance to cover the penile implant if sexual dysfunction is on the limitations and exclusions list for all these plans I’ve seen??? Thank you in advance for the replies.

I had almost 100% coverage with Blue Cross/Blue shield, but I also went thru a prostatectomy beforehand.

Call Blue Shield and talk to one of their reps.
You should be covered.

Good luck.

[GoodWood]

What insurance do you have now? Many plans have a specified period of time where they don’t cover preexisting conditions.

If Dr Clavell is going to be your surgeon his office staff will be able to tell you a lot about which plans they have success with and which they don’t.

Representatives from the insurance company will be able to give you information as well. Ask for a copy of the policy and look at the exclusions page.

I was covered by BCBS (although a different policy than the one you will have) and the exclusions page said they don’t cover treatment for erectile dysfunction, EXCEPT for surgical implantation of penile implant for erectile dysfunction. So there was an exception to their exception.

I still had to pay a co-insurance portion that could have gone as high at $7500 (my annual cap). In my case I ended up paying just under $6000.