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Prostate Cancer
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Posted 2/12/2013 1:31 AM (GMT 0)
Been going back and forth with insurance for 15 months over claims for ED rehab. Got word that my second appeal was denied. No surprise but disgusted nonetheless with the principal of the whole thing.

They pay for a procedure that creates a problem where non previously existed then leave you on your own. Had to pay every penny out of pocket each step for pills, Muse, and injections. Docs had me try every option before finally putting trimix on the table.
<vent off>

On the positive side, things are finally turning around. After about 3 months of trimix some natural stirrings started. Not sure if injections helped or if I just had to wait 18 months for a natural response. Either way, I'm more than gratified to get a response the last couple times without pills or shots.

You may have to pay your own way, but ED may finally yield if you persist.
smilewinkgrin
Posted 2/12/2013 2:38 AM (GMT 0)
very unfair system to say the least. but glad you are getting some natural results, that's always a good sign of things to come.

david
Posted 2/12/2013 2:44 AM (GMT 0)
That doesnt sound like much of an insurance policy. Thought Treating ED was just as important as the cancer especially emotionally.
Posted 2/12/2013 3:18 AM (GMT 0)
Is Explorer's experience (lack of insurance coverage for ED therapy) the norm or the exception?
Posted 2/12/2013 3:37 AM (GMT 0)
the norm, most health insurances won't pay for ED drugs, or very limited, regardless of the reason
Posted 2/12/2013 4:37 AM (GMT 0)
My insurance refused to pay until a very resourceful and determined pharmacist "reminded" them that the ED was totally caused by my surgery (I had no issues before that), but even then the coverage is limited, due to the type of policy my company subscribes to (targeted to younger employees, who can't have ED, right?). My pump was paid only because I was malicious about getting copies of every conversation "on the record", and could cite chapter and verse back with their letters in copy as support.

If you get anything paid for, you are doing well.

Posted 2/12/2013 12:20 PM (GMT 0)
The only ED thing covered by my insurance post OP would have been a VED for "rehab" purposes but with a $500 deductible they were not really covering any part of it.  Even Trimix which is for guys like us is not covered but at least it is affordable compared to ED oral drugs. You have to wonder why there are generic versions of Viagra and Cialis legally available in in Europe and India for around $1 a dose and here it more like $25 smhair devil
Posted 2/12/2013 1:22 PM (GMT 0)
Fortunately, it looks like my insurance company covers ED drugs. I can get 24 tablets of Viagra/Cialis for a $50 copay. I can do that every 3 months. (Seems that Levitra is not covered.)

(If I need one of the lower doses, I can ask my doc for a higher dose Rx and cut the tablets in half, perhaps.)

-Gedman
Posted 2/12/2013 1:57 PM (GMT 0)
Gedman.

Splitting the pills works. Before my PC I was using 25mg of Viagra for several years. I got the 100mg for the same price as the 25mg and using a pill splitter got 4 doses for the price of 1.

Terry

Posted 2/12/2013 1:59 PM (GMT 0)
Several have said that while battling PCa you are your own best advocate. In the case of ED, I found I was my only advocate in the system. Not a doc, PA, pharmacist, insurance patient liaison, etc. did a thing without me prodding them. A couple were rather unprofessional and came close to violating privacy laws. On appeal, I found a couple persons to carry the message up the chain, but they were neutral otherwise. In the end it didn't make any difference.

With employer provided insurance covering primary treatment but refusing coverage for treatment induced ED, I'm reminded of a quote from Quintus Arrius in the movie Ben Hur. "We keep you alive to serve this ship"

QOL is clearly up to me. I'm walking away from the aggravation of messing with insurance on this issue. It will improve my outlook and that alone may improve my recovery.

Explorer
Posted 2/12/2013 3:27 PM (GMT 0)
Terry,

The so-called generics you find offshore are in violation of US patent laws and Customs rules. That is why we do not discuss that here (covered under the rule about discussion of illegal activity).

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