DMV docs & Cigna

[bcant43]

I have severe PD. Full treatment of Xiaflex did not work; in fact PD got worse (almost 90 degrees upwards). Went to see Dr Taj earlier this year, but implant was rejected by United. Now have new insurance, Cigna, thanks to wife's new job. Dr Taj's office is going to submit for approval but said Cigna rejected 90+%.
Anyone had any luck with Cigna in the DMV? If so what doctor? Curious if its just Dr Taj. Would love to have him do it; but at wits end in dealing with this. Can't afford the private pay option.
TIA!

[GoodWood]

Request a copy of your policy. Pay special attention to the exclusions page(s). It’s not uncommon to see an exclusion for treatment of erectile dysfunction, but sometimes the exceptions will allow for it.

For example, my policy had an exclusion for the treatment of sexual dysfunction EXCEPT for the surgical implantation of penile prosthesis for erectile dysfunction. So in my case there was an exception to their exception.


You have to read through the be fine print.

And if they reject with that surgeon, look at was urology surgeons are in network with that policy and have a consultation with them as well.

Best of luck to you.

[ElbowRoom]

All policies are different, but I had Cigna through my wife's company last year and they flat out denied it, there's an exclusion for my policy for any procedure related to sexual dysfunction.

Last open enrollment, I switch back to my employer's Blue Cross/Blue Shield plan. It has an exclusion that reads:

* Any treatment for sexual dysfunction (except male organic erectile dysfunction)

So they have an exclusion to their exclusion for physiologic ED! The ended up approving the IPP. I'm still holding my breath waiting for them to reverse course, but so far so good.

Cigna is pretty bad at covering things, IMO. I think that's why my wife's employer offered it as a benefit for free with no premium to the employees.

[ElbowRoom]

For example, my policy had an exclusion for the treatment of sexual dysfunction EXCEPT for the surgical implantation of penile prosthesis for erectile dysfunction.

BC/BS plan? That reads very much like my exclusion.

[GoodWood]

For example, my policy had an exclusion for the treatment of sexual dysfunction EXCEPT for the surgical implantation of penile prosthesis for erectile dysfunction.

BC/BS plan? That reads very much like my exclusion.

Yes, BCBS, although I’m sure there are many versions of BCBS plans.

[Boatdrinks]

I have Cigna and hate it… BUT after initial denial, I was able to get approved. In mine it stated that because my ED was from my prostate cancer and RP, that was acceptable. So glad as the “billed total” was over 150 grand… of course the actual was more like 65.