“I am currently uninsured or my insurance has denied my appeal.”
Before committing to paying for the procedure yourself, investigate your options for insurance coverage. Even if you have looked in the past and have decided against purchasing coverage, there are more options now than ever before. Many plans are financially subsidized if you meet specific income criteria.
If you have insurance, but your plan does not cover the procedure, you may be interested in looking into alternative plans offered by your employer, policies available through the Affordable Care Act (ACA) exchanges/marketplace, or policies purchased directly from various insurance companies. You may need to wait for an open enrollment period; these usually occur in October/November or when your plan year ends.
When looking at plans, you will need to evaluate the possible out-of-pocket costs in combination with the monthly premium costs. An insurance broker can help you fully evaluate your coverage options. Remember, switching policies usually require a full year commitment, but you can always switch back to your original coverage the following year.
For the plan(s) you are considering, you will need to contact the insurance company directly and ask whether or not there is coverage or a benefit exclusion for the procedure. Information on coverage for sexual dysfunction is not usually in the summaries provided. You will need a representative of the insurance company to look up this information on your behalf.
If you are paying for the procedure yourself, the first thing to be aware of is that your choice of physician and facility can dramatically affect your costs. For example, Ambulatory Surgery Centers (ASCs) usually have lower costs than Hospital Outpatient departments. Each provider or facility sets their own price for a procedure. When they set this price, it is assumed that most patients will be covered by insurance, and pay only a fraction of the rates negotiated by their plans (which are often considerably lower than the “list” price). Therefore, these prices can be quite high.
If you are financing the procedure yourself, do not hesitate to check all of your options. Most facilities and physicians have financial assistance programs or policies, but the lower the initial amount, the more affordable the end result is likely to be. Keep in mind that you will receive a bill for (at minimum) the surgeons cost as well as the facility cost.
In many cases you will have to ask specifically before you will receive information regarding assistance programs. Do not be afraid to advocate for your needs.
Many assistance programs will require you to provide financial data to determine your level of need. Ask if the provider and facility offer self-pay discounts or prompt pay discounts. Coloplast does not have an assistance program at this time.