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Just my 2 cents, but this is not a negative experience with Kramer.
Rather, just a negative experience.
From what I have read, and mind you, I may have missed something, but there seems to be a disconnect somewhere, and Kramer is not an end-all for surgery/implants.
You were diligent in taking notes and names, but somewhere, someone dropped the ball, and Chesapeake Urology can only proceed IF insurance goes through (unless you are paying yourself). By what you wrote, the clinic is just proceeding according to what they were told. Someone at the insurance gave them the wrong info.
You yourself said somewhere at the insurance company someone said something that was on your insurance info, and that another place said it was not coming up on their end?

There is no rhyme or reason when fighting with an insurance company. His staff is probably doing as much as possible. Now days people are working from home with limited resourses. Do you know for a fact that the girls were even in the physical office. I had mine done at a large teaching hospital and call returns were ????? questionable. But, this is life as we know it. I am a type A person and expect perfection out of everyone. I hear type A in your explanation. Have to learn to chill. P.S. I am not in the Eid, Kramer cheering squad. Lots of excellent doctors out there doing implants.

I think you can place about 80% of the blame on insurance companies. I work in the medical field, and it's such a shit show. They will approve everything and deny it last minute, or even after the fact leaving you with a huge bill of which the burden is on you to prove it's not valid. They love to pull that crap, and it's an endless cycle of paperwork and calls, too many middle men many of whom don't even understand their own processes. I will say Danielle sometimes is a bit less than available with communication, or at least not timely responses, which doesn't help the situation, but most of what happened to you is really on poor customer service and processes within the insurance company.
These implants are an expensive undertaking and it's not in the insurance company's interest to let you go through with getting one. You're just set up to fail before you even start, and that's the way they want it. They want you to give up. Just keep thorough records of names, times you spoke to people since they will conveniently have no record of your calls 3/4 of the time. Sorry to sound so cynical, but I've dealt with this crap for 20 years and it never gets better.

I don't know how valid this story might be. I was told once while trying to get approval for a surgery for my wife. The insurance companies "plan" on expenses to happen at a predictable pace. Too many requests in too short of time span will get some of them denied. Part of it is hoping than you might go away. But part of it is to shift that cost into the next month or quarter. Whatever time frame they use for budgeting. That is part of the reason that stuff gets approved on appeal. It has moved into the next budget time frame. In our case, sure enough. It was approved a few weeks later.

My issues were not with Dr K or his staff, but with his formet affiliate University of Maryland Medical Center. In my case, the good Dr K always responded in minutes. His staff was within a few days, and the UMD staff almost never. I was told by his staff that they knew my insurance and I was covered so nothing to worry about. Had the surgery and was denied. Only support I got from the UMD team after that was a request for payment. Dr K did assist by advising who to contact at UMD but they would not respond. I eventually had to shell out full payment while I worked out insurance issues. They eventually paid and then the fun started with trying to get my payment refunded. Eventually they did process a refund. I can see why Dr K moved his affiliation away from UMD.

On a related note, as part of this I was billed by UMD for a proceedure that they cancelled do to OR availability. That could not be covered. They kept billing and began collection action. When I finally got to someone at UMD, they advised the only thing they could do was for me to pay, then they would refund. They advised they would process the refund first and trust me to pay. So I paid and never got that refund and never heard from them again.

Thanks guys for the replies.
my points:
1. Insurance companies are for profit. No reason for them to pay such large amounts, if there is a possibility to avoid them. That is why every medical provider has a specialist who is aware of this and does it on daily basis. It is not like a patient who tries to connect to a customer service once in a lifetime.
2. Diagnosis submitted to insurance (Erectile dysfunction due to arterial insufficiency, malignant neoplasm of prostate, induration penis plastica.) clearly showing ED, and I am not sure why prostate is mentioned. This was initially approved. My question here, as a provided, if it then denied, wouldn't you argue this denial? Because I didn't want to go through this process without being sure it will be approved, On May 22nd I emailed Danielle, attaching a copy of the exclusions in my policy to check if this procedure would be approved, as I was having (Plan B, employer insurance) only before July 1st. She replied that she spoke to insurance and they confirmed that code (54405) is approved. Leslie also confirmed the same. So, who put me in this and now is considering my follow up requests overwhelming?
3. Despite several reminders to get the confirmation for the rescheduled procedure, I was sent for tests without this.
4. Working from home is an advantage, especially with this type of work. You can email a patient or call insurance why laying on the couch. For me, I used to spend 12 hours from time I wake up, go work and get back home with traffic,while working 8 hours. Now, while working from home, I work 10 hours a day, and still I have more free time.

I am considering finding an implant surgeon within DC area or nearby states. Who are the best ones?

In the DC area? Dr Kramer

Vinny21 wrote:In the DC area? Dr Kramer

No luck to schedule with Kramer, so far. Looking for other alternatives.
Thank you.