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Author Topic: How to make insurance companies to cover medications, VED, surgery for Peyronies  (Read 4851 times)

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Stabler67

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Okay

Because Mamma loves you all so much and because Mamma has pretty big Kahunnas herself...... this is what I have been doing today. (yes while I am at my job I am working to help you boys)

I called Dr Stephen Brandes office (he is one of the urologists on our list) and asked to speak with the person in charge of their precert/approval department for the Peyroines medications, VEDs etc...
Now like I said approvals for medication is what Mamma does for a living but I dont do it for Peyronies, so I went directly to the source. (a perk working in a Dr office)

Here is what I am told:

Coverage for all meds for Peyronies is difficult (you all know this) the reason in many cases is the way that your plans are structured. You need to know what kind of coverage that you have. This means work on your part. Call your insurance company (Member services # on back of the card)  and ask them what your coverage is for Peyroines. Have the names and doses of the medications and have the diagnosis code for the type of Peyronies that you have. Ask what your coverage is for penile surgery as well for the diagnosis of Peyronies to make sure that you have coverage for this.

If you dont know this code call your doctors office and get it, there are several different codes depending on the type/variation of Peyronies. The general diagnosis code is 607.85 but if you have a variation of the disease this code may be different.

Also ask them about coverage for VED machines. I was told that Medicare will not cover them at all and Blue Cross Blue Shield and United HealthCare are very hard to get a VED approved through, other insurance companies not so much a problem.

Here is the most important part.
When your doctors office goes to get the medications approved for you, they MUST use a diagnosis that you HAVE. they cant fabricate something in order to try and get you the medication. First and foremost that would be fraud on their part and second that would be giving you a health condition that you dont have, should you ever change insurance for some reason, you dont want to have any reason for them to deny a claim or deny you insurance. So make sure your doctors office are using proper protocol when getting your medications approved.

Dr Brandes office uses proper protocol and they will fight like mad to get the meds/VED/surgery approved appealing if needed and everything, make sure your doctors office follows these same guidlines for you.

Now, I was given a direct number to the person I spoke with, so if we have more questions or if there is something I did not cover that you all want to know on this subject, ask me and I can call and get us the answers.

Okay boys,  Mamma has to get back to work!!
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Smile boys, Mamma loves you!
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james1947

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Hi Stabler

Thanks for your effort and the input.
I am changing the topic title to:
"How to make insurance companies to cover medications, VED, surgery for Peyronies"
As it is not clear what the topic is about with the old name, "Please Read- This could help"
Maybe the topic should go to:
Open Questions or General Comments (that won't fit under any other topics) - PDS - Peyronies Society Forums

James
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Stabler67

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James please put it where it will best be seen. We now have a good first hand resource for our questions. I think we should utilize it.
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Smile boys, Mamma loves you!
Fav quote: Every decision you ever make in life NEVER effects JUST you.

james1947

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I am setting the topic sticky

James
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wonderbread1662

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Starting to sound like a broken record here but thanks again for this Stabler. I will bookmark this to make sure my specialist and I are on the right page to get me covered for as much as possible.
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