Surgery costs/options

[cwilli]

My doctor has recommended an implant and the procedure  was submitted to my insurance company...they turned me down.  Anyone have suggestions?  I'm assuming this is a 20K or more operation.  I kook forward to any and all comments.  I am pretty much non-functional because of the degree of curve.  

[james1947]

cwilli

As I know the only way to get approval for implant is for ED.
Maybe the reason they turned you down is because it was submited for Peyronies.
The doctor office should submit the implant surgery as the only way to correct your ED.

James

[Norm]

This is a tough situation. Your doctor should have enough experience to know how to write it up to get it covered for insurance. Visit with your doc.Tell him/her your problem. They will know how to write it, either for ED or for Peyronies Disease. My doc wrote it for Peyronies Disease, as I was 80 degrees and non functional. If your doc cannot or will not put in the effort, then see another. The surgeon, himself, may be the route to go. Best of luck to you. What part of the country are you in?
Norm

[cwilli]

Quote deleted by moderator - James
Please read the forum rules regarding quotes

Portland Or.  Dr Hedges,  OHSU.  The Dr has allot of experience and has performed numerous surgeries.  I went in for several visits and had my wife go back with me on the final pre-surgery visit.  I requested a formal estimate for the procedure and something submitted to the insurance company...glad i did because they turned down all the costs.  I would have been out the entire expense.  When I questioned the DR, he responded the implants are rarely paid for.  But, he did say the Medicare will pay for it...I can't wait that long!  The DR, has composed a new request letter and re-submitted it to insurance.  I await another decision.

[hope4all]

cwilli, did they deny it under "Not medically necessary"? This is the broadest denial and the easiest to overturn with doctor's help.

If they deny it further you should write a complaint to the state insurance commissioner.  Also if you purchased your insurance plan from the state exchange, the US Dept of Health and Human Services should know about it too.  Make sure you copy the insurance company in your correspondence.  The State usually has online grievance processes in place. If that doesn't help try calling your US House of representative constituent services.

Do not give up fighting the insurance company. If you have a federal health insurance plan known as a FEHB plan it may be an excluded condition entirely. You should complain to OPM and your congressional representatives.

Good luck.