Trying to get my insurance provide to cover Penile Doppler Ultrasound

So I have BlueCross BlueShield TN and have had no problems with them despite having numerous health issues.

Recently though, I had a Penile Doppler Ultrasound after failing to respond to ED medication. My ED is considered endocrine related now, I am not sure what it would have been considered at the time. We were doing it to rule out a venous leak.

Anyways, I see today that they have deemed it a non-covered service and are billing over $1,000.

I looked it up and apparently coverage ranges wildly across the BlueCross system. For example, Massachusetts will cover it. Texas will cover it if it is deemed non-psychogenic. I am a bit confused about how Tennessee defines it though.

https://www.tn.gov/content/dam/tn/finance/fa-benefits/documents/blue_handbook_2021.pdf

” Surgery or treatment for, or related to, psychogenic sexual dysfunction or transformation other than psychological treatment or counseling.”

https://www.bcbst.com/providers/manuals/BCT_PAM.pdf

“Services or supplies to treat sexual dysfunction, regardless of cause, including but not limited to erectile dysfunction, delayed ejaculation, anorgasmia and decreased libido.

Under the first book, I should qualify. Under the second, I would not qualify. Although I must say is it even fair to unilaterally deny services if deemed to be medically necessary?

I plan on appealing but I am wondering how exactly I need to wage my argument to best effect.

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So I have BlueCross BlueShield TN and have had no problems with them despite having numerous health issues. Recently though, I had a Penile Doppler Ultrasound after failing to respond to ED medication. My ED is considered endocrine related now, I am not sure what it would have been considered at the time. We were doing it to rule out a venous leak. ​ Anyways, I see today that they have deemed it a non-covered service and are billing over $1,000. I looked it up and apparently coverage ranges wildly across the BlueCross system. For example, Massachusetts will cover it. Texas will cover it if it is deemed non-psychogenic. I am a bit confused about how Tennessee defines it though. ​ https://www.tn.gov/content/dam/tn/finance/fa-benefits/documents/blue_handbook_2021.pdf ” Surgery or treatment for, or related to, psychogenic sexual dysfunction or transformation other than psychological treatment or counseling.” https://www.bcbst.com/providers/manuals/BCT_PAM.pdf “Services or supplies to treat sexual dysfunction, regardless of cause, including but not limited to erectile dysfunction, delayed ejaculation, anorgasmia and decreased libido. ​ Under the first book, I should qualify. Under the second, I would not qualify. Although I must say is it even fair to unilaterally deny services if deemed to be medically necessary? I plan on appealing but I am wondering how exactly I need to wage my argument to best effect.
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