Virginia BCBS rejection of IPP

[leesburg2013]

Went to see Dr. Kramer on 4/15/2014. He was awesome, appointment lasted maybe 45 minutes at most seeing nurse and him. He agreed immediately for implant, measured size for Titan and scheduled implant surgery for May 7th at 7am in Baltimore. Talk about fast go around. Bad news was BCBS of Va refused to pay - just great. Was going to ask about payment plan but have not done so so far. $18,000 - $20,000 a lot out of own pocket.

[tryfied]

Sorry to hear that.

How are things going anyway now that it has been three weeks since surgery? I will have a penile implant in a few months by Dr. Kramer too. Can't wait to get fixed. Can I ask how old you are?

[billylee]

Indeed bad news. I have heard of another individual who had BCBS reject and negotiated for cash. Your estimate is probably in the ballpark. Fortunately for my friend his companies insurance changed and he is scheduled for IPP this month. I have secondary BCBS to MC so when I found out MC would pay got a little personal enjoyment to know BCBS had to follow suit. Ashamed that we have the "some do, some do not" in payments, but unfortunately I would not be surprised if MC stops soon. I feel fortunate with the huge coverage I got. Good luck.
b

[stringerbell]

I had my Coloplast implant done by Dr. Kramer about 2 months ago, everything was smooth and easy. I have Medicare which paid 80%, and apparently agreed to pay part of the remainder, I got a bill for about $1100. I feel this was pretty reasonable, Kramer actually tried to get it waived and fought to write it off but couldn't- but it was a nice enough gesture. I was inflating and deflating by 3 weeks, overall pretty easy. Interestingly he's changing over and putting in mostly AMS implants now? Not sure what to make of that.

[billylee]

S,
Curious if before surgery you were informed that you might have some payment? It is my understanding that you must be informed. I believe my big reduction mentioned could have been because I was not informed. My theory is they knew it but did not know if I knew it. I felt at first, as you, that it was worth some pay on my part, BUT not necessary then I migt as well benefit from the rule. If you do not have suppliment, then there could be another twist. You might question it. I do not think this to be a Texas law. Worth checking.
B

[leesburg2013]

so you used Medicare -was that in Va. I am about to start Medicare and wonder if I can apply through them. Not sure. Anyway was excited about surgery and Kramer promised me he'd keep it same size and thickness which was awesome to here.

[billylee]

L.
It was not in VA, TX, but I feel coverage per MC could be same in both states. MC paid fine for me and because they did their part, then suppliment followed in their part. b

[ED2013]

I too had to pay out of pocket. Had to take a personal loan out to do it. Price was around your quote. I would do it again in a heartbeat.

[ronbstewart]

For what it's worth I'm military retired (AF). Had my duel implant (AMS 700 & AMS 800) done in a military hospital (WPAFB-OH) I have Tricare for life and MC, they covered total cost of everything, in fact money/cost was never brought up or discussed with me..

[billylee]

I was concerned about IF insurance would pay and inquired making it known that I could not pay for the surgery. Lady in surgeon's office could not guarantee pay, but when I showed doubt to going through with surgery unless it was known, she assured me that hospital would notify me IF they thought that they would not get reimbursed. I talked with someone I knew who worked in office of small hospital where I had worked and she assured me that I would know if I was not going to be covered. As I understand my friend's explanation, IF I anticipate that insurance is covering and no one tells me different then I do not have to pay a bill not explained to me pre-op.

One point that may have may have been significant in the coverage of my surgery was that it was pre-recommended by my regular urology clinic. The NP I see at clinic, there with her father who is also uro surgeon, knew I had tried meds, VED, etc and was actually the one who suggested the PI and showed me a sample device, AMS. She is very easy to talk with (not to mention being very attractive), suggested that I talk with her father, which I did. He perhaps had the skill but not the numbers that I wanted, plus worked out of a local hospital (rural) where I preferred not to have surgery). Fortunately the clinic seemed good with the referral of surgeon that my research found (thanks partially to FT). An individual research and desire for surgery may not be enough, referral from urologist for surgery may be a must....revealing "the last resort" for ED correction.

Once approved by MC then I believe your supplement must follow for their part. One thing for sure, the cost figures really change. My $41K tab was certainly not near that in final payment. The $17-20 cash settlement is probably a common satisfaction, maybe even less for some of the lesser known surgeons.

b