Denied !

I still strongly suspect / expect that the problem with the insurance company is that there is not yet a problem that they cover, so they can't check off a required box on the form. I was told that after they processed my surgery claim, and the surgeon THEN diagnosed the ED at a later date as being a direct result of the surgery, it would be at least possible.

My (big national) insurance does not cover any ed med at all unless the ed is caused by a medical condition that they cover. Just getting old and falling apart is not enough. I asked about pre-surgery coverage, and they said no, not covered, period, for anyone under my company's plan.

And yes, Trimix works out to be more economical, but getting the first one approved was a real challenge. Took several weeks of phone calls and a very dedicated pharmacist.

Okay, I should say this...my insurance doesn't cover Trimix either, but it is still MUCH cheaper than the other options.

Jitters,

You are absolutely correct in your comments about the employer - you get as much coverage as what they buy with your money. Just like any other insurance - car, home, life, but in those cases you control the choice directly.

I have seen many cases of people leaving very good jobs to step down in quality or pay to get better insurance. That was the reason for a big number of departures at one of my previous employers, who decided to save money by dramatically reducing coverage. That event forced me to get outside whole life and cancer coverage when I reviewed all the changes, which has turned out to be things I could not buy today.

DonaldJ, I had surgery with Menon and ended up with serious ED. I had a complete veil nerve sparing procedure but even that's a crap shoot. I'm told I have a "great chance at regaining full functionality". Doesn't thrill me now that I'm almost 7 weeks post surgery and doing the rehab. Everyone on this forum has been a huge help in "talking me down from the ledge" and I've got my head in the game much more than it had been. They all concur that the rehab if you end up like me is anywhere from 1 to 2 years.

One thing I can tell you is that my insurance company won't pay for more than 4 pills per month. I've got an appeal going but am not hopeful. Menon's staff suggested getting 4 20mg pills and quartering them or cutting them in half. Their recommendation initially was 5mg daily Cialis which is what you'll leave the hospital with after you get the cath out. I had to refill the Cialis and cost at CVS was $172 for 30 5mg tabs. My AAA discount brought it down to about $130 or so but still. So for the second month I'm paying for this and might look for an alternative but Menon's office was clear in their advice of steering clear of the overseas stuff as they can't guarantee what's in it. And don't expect him to go to India to get anything for you or even call you back after surgery.

Menon's office then suggested Sildenafil, generic Viagra and a daily dose of 20mg. This was significantly cheaper at about $40 for 30 tabs. I ordered a 90 day supply for $109. However, I then discovered that it's not "like Cialis" in that it doesn't promote blood flow "all day" as Cialis does. I'm a little out of my area here but my primary care physician looked at it and said it's half life is 3 to 4 hours compared to Cialis which is about 17 or more.

They also prescribed bimix injections for me at Menon's office. That cost me $190 for the first prescription that's supposed to be approx a 6 month supply. However, for some reason they cut the strength in half of what they issued me as the test dose when my cath came out. I'm currently at 25 units and going up to 30 my next injection as I have not gotten the desired results yet. If this was the same strength as the test dose I'd be going to 15 units and hence would last longer due to the strength of the dose.

Long story short, don't expect insurance to pay what the doctor recommends. I'm still going to push the appeal through my insurance company but I'm not hopeful. My recommendation to you is that if you get the test injection and it's 5 units and doesn't give you a full erection then make sure you don't let them get you the half strength dose. You'll just go up in smaller increments to find your correct dose and ideally the prescription will last longer.

Also, if you're not local to Menon make sure you have a good local doctor to follow-up with. You'll never speak with Menon after the surgery. The nurse there was great at getting back to me but the last week it's been radio silent with no returned emails or calls and I'm now looking for a good local urologist to handle the rehab program. The last thing any of us need after this life changing surgery is any extra stress.

Best wishes for successful surgical outcome and I hope you're in the percentage that has no ED and continence issues after surgery.