Insurance denied - can I appeal?

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chipc

My insurance, Blue Cross of TN, just denied coverage for my mid-June scheduled implant by Dr Milam at Vanderbilt. The denial letter simply states, "Based on your health benefit plan, this service is not covered." Yet, the implant was approved in Dec 2012 to be done by a local Chattanooga urologist, but after many delays in scheduling the implant surgery, I grew suspicious that the Chattanooga urologist had never performed an implant so I switched to Dr. Milam after joining this forum.

Question: Blue Cross does have an appeal process. Any thoughts on reasons to appeal? Thanks in advance for your help... Chip

DO

 Yes appeal! there should be a number on the back of yout care for member services, take notes from the 1st aproval,with names and any codes and tell them you never had the 1st operation. They should be able to have it in their notes from the last approval, too!

LWillisjr

Yes insurance is all based on the procedure codes. Once you get the codes used by the first doctory call Dr. Milam's office and get this information to them as well.
Developed peyronies 2007 - 70 degree dorsal curve
Traction/MEDs/Injections/Surgery 2008 16 years Peyronies free now
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chipc

Well, I appealed & Blue Cross of TN denied, stating that my policy doesn't cover sex problems. So, I went back to Dr. Milam & rec'd a quote of $20K for surgery in an outpatient center. I may start a new thread asking for negotiating tips. Thanks for the input.... Chip

jackp

Chipc
Without a diagnosis of peyronies or penile injury most insurance will not cover an implant just because of ED.

Talk to Peggy Shuster RN at Vanderbilt and see if she has any suggestions. Also on the AMS web site there is a link for insurance help.

Yes you can appeal. With insurance the way it is today most men get denied the first time.

Good Luck

Jackp
http://jackp-penileimplant.blogspot.com