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Hi, I’ve been going through urologists at UCSD, but mediCal doesn’t cover implants so I had to switch to my employers insurance which is with Sharp Healthcare. I’m now finding out that UCSD is not in network, so the surgeon I wanted wont be able to do my surgery…Does anyone know if there is even a good surgeon with Sharp?

My last doppler was also incorrectly done so it showed negative for venous leak. I was about to have it redone, but I’m afraid Sharp might get it wrong again. Then Ill be stuck in this process all over again for months.

I’m only 25 so my life has been on halt. Im tired of jumping through this snail-paced medical machine. I’m stuck with whatever surgeon they give me, and if they fuck up (reduced size, infection, and so on) I’m finished and will become a buddhist monk. Please let me know if there is a surgeon in the Sharp system.

I would highly recommend doing everything in your power to get a high volume well reviewed surgeon regardless of cost...

It's worth traveling for to get the right surgeon, as well. I live in Idaho and traveled to Silicon Valley to get Dr. Edward Karpman, after interviewing several different surgeons. It was 12 hours by car, but worth it to me.

I don't know your insurance at all, but if they also handle surgeons in other geographies it might be worth it to expand your search.

Best wishes for a great outcome.

Quincy

Insurance companies aren’t always evil. Neither are doctors.

Talk to doctor’s financial people first. Level with them. Tell them you’d like to use them, you’ve got an insurance network issue. How much would they bill the insurance carrier to do you.

Then talk to the insurance carrier. Try asking them who within network has the experience & reputation of your chosen surgeon. How much were they going to pay this in network guy?

It might or might not happen but it’s worth investigating. Your insurance carrier might allow you to go outside their network while paying your doctor the equivalent of what they pay in network. Your doctor might accept their payment against a bill of what he charges the insurance carriers in his network, and pass along a copay to you.

Reality is doctors like to think patients appreciate their work. In the big scheme of things insurance carriers are concerned about risk and exposure and paying for a surgeon a patient is happy with gives them better odds of a happy outcome.

goose1235 wrote:Hi, I’ve been going through urologists at UCSD, but mediCal doesn’t cover implants so I had to switch to my employers insurance which is with Sharp Healthcare. I’m now finding out that UCSD is not in network, so the surgeon I wanted wont be able to do my surgery…Does anyone know if there is even a good surgeon with Sharp?

My last doppler was also incorrectly done so it showed negative for venous leak. I was about to have it redone, but I’m afraid Sharp might get it wrong again. Then Ill be stuck in this process all over again for months.

I’m only 25 so my life has been on halt. Im tired of jumping through this snail-paced medical machine. I’m stuck with whatever surgeon they give me, and if they fuck up (reduced size, infection, and so on) I’m finished and will become a buddhist monk. Please let me know if there is a surgeon in the Sharp system.

If everything fails for me, my plan B is also to become a buddhist monk. Best of luck man.

returntocenter wrote:

goose1235 wrote:Hi, I’ve been going through urologists at UCSD, but mediCal doesn’t cover implants so I had to switch to my employers insurance which is with Sharp Healthcare. I’m now finding out that UCSD is not in network, so the surgeon I wanted wont be able to do my surgery…Does anyone know if there is even a good surgeon with Sharp?

My last doppler was also incorrectly done so it showed negative for venous leak. I was about to have it redone, but I’m afraid Sharp might get it wrong again. Then Ill be stuck in this process all over again for months.

I’m only 25 so my life has been on halt. Im tired of jumping through this snail-paced medical machine. I’m stuck with whatever surgeon they give me, and if they fuck up (reduced size, infection, and so on) I’m finished and will become a buddhist monk. Please let me know if there is a surgeon in the Sharp system.

If everything fails for me, my plan B is also to become a buddhist monk. Best of luck man.

Did you get on hmo medi-cal plan like Caloptima? I had caloptima before kaiser. UCI medical was part of it....

But if i were you, and NOOOO other option then I'd still get it done at Sharp... bro, at your age, this implant as bad as I've had it, is still worth it

Hillywilly wrote:I would highly recommend doing everything in your power to get a high volume well reviewed surgeon regardless of cost...

Agreed. An implant with Dr. Clavell (to just name 1 reputable high volume surgeon) will set you back not much more more than an economy car. At your age, i’d take the bus/subway/uber and enjoy a proper sex life.

goose1235 wrote:Hi, I’ve been going through urologists at UCSD, but mediCal doesn’t cover implants so I had to switch to my employers insurance which is with Sharp Healthcare. I’m now finding out that UCSD is not in network, so the surgeon I wanted wont be able to do my surgery…Does anyone know if there is even a good surgeon with Sharp?

My last doppler was also incorrectly done so it showed negative for venous leak. I was about to have it redone, but I’m afraid Sharp might get it wrong again. Then Ill be stuck in this process all over again for months.

I’m only 25 so my life has been on halt. Im tired of jumping through this snail-paced medical machine. I’m stuck with whatever surgeon they give me, and if they fuck up (reduced size, infection, and so on) I’m finished and will become a buddhist monk. Please let me know if there is a surgeon in the Sharp system.

*************
Your employer might have more than one plan available for 2024 and this is the time of year you can switch plans for 2024 (open enrollment). You might want to check and see what will be offered in 2024 andalso ask that UCSD be added as a provider to your Insurance Network. Many times for special situations you can force the insurance carrier to treat an out of network provider as a network provider and get benefits paid by insurance.
Good Luck

I would not go with anyone at Sharp - they don't have any high volume implanters!! At your age, you really need someone with a lot of implant experience to get you the best result, don't gamble.

Txagq8 wrote:Insurance companies aren’t always evil. Neither are doctors.

Talk to doctor’s financial people first. Level with them. Tell them you’d like to use them, you’ve got an insurance network issue. How much would they bill the insurance carrier to do you.

Then talk to the insurance carrier. Try asking them who within network has the experience & reputation of your chosen surgeon. How much were they going to pay this in network guy?

It might or might not happen but it’s worth investigating. Your insurance carrier might allow you to go outside their network while paying your doctor the equivalent of what they pay in network. Your doctor might accept their payment against a bill of what he charges the insurance carriers in his network, and pass along a copay to you.

Reality is doctors like to think patients appreciate their work. In the big scheme of things insurance carriers are concerned about risk and exposure and paying for a surgeon a patient is happy with gives them better odds of a happy outcome.

So I just ask and hopefully I get approved. If I tell my insurance that I dont trust the surgeons because they don’t do high volume I might be able to find a way for UCSD to perform the surgery instead. Another option Ive been considering is getting a private loan