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Out of state coverage/Revisions/Paying out of pocket

Posted: Fri Mar 15, 2024 8:32 pm
by Maybebroken28
I was wondering about the cost to install an implant out of state. I live in Massachusetts and I think if I were to get an implant I would want to go to Dr. Clavell in Houston Texas since he is one of the best in the world. Has anyone gone out of state like this? Would insurance cover me? What financing plans are there? Also are revisions always covered by insurance since they are medically necessary?

Re: Out of state coverage/Revisions/Paying out of pocket

Posted: Fri Mar 15, 2024 8:40 pm
by NuclearMedicineGuy
Flew from the east coast to see Clavell. Insurance from my employer was a major insurance company (Blue cross) - was a participant in my network so I didn’t have to pay out of network prices. Only had to worry about my yearly deductible and my out of pocket max. Ended up paying around 1900 towards the surgery and the rest was paid by insurance. It’s doable and Clavell’s team is amazing at getting authorization and talking through the provider charges and can connect you with the hospital to discuss their costs too.

Re: Out of state coverage/Revisions/Paying out of pocket

Posted: Fri Mar 15, 2024 9:36 pm
by Maybebroken28
NuclearMedicineGuy wrote:Flew from the east coast to see Clavell. Insurance from my employer was a major insurance company (Blue cross) - was a participant in my network so I didn’t have to pay out of network prices. Only had to worry about my yearly deductible and my out of pocket max. Ended up paying around 1900 towards the surgery and the rest was paid by insurance. It’s doable and Clavell’s team is amazing at getting authorization and talking through the provider charges and can connect you with the hospital to discuss their costs too.


Wow that’s awesome!! I have heard really good things about blue cross, I have Unicare which is a state indemnity plan because I am a government employee. They said they cover it if it’s medically necessary and I did talk to someone of Clavell’s team today and she said it’s common for people to travel for the surgery and have their insurance cover. My ED started recently and I’m 99% sure it’s a physical thing and I have only met with one urologist so far but I plan on getting a Doppler soon. That’s awesome to hear you got the surgery done by Clavell and his team! You just had it done a few weeks back? I hope you get some good use out of your implant soon!

Re: Out of state coverage/Revisions/Paying out of pocket

Posted: Sat Mar 16, 2024 9:55 am
by NuclearMedicineGuy
Maybebroken28 wrote:
NuclearMedicineGuy wrote:Flew from the east coast to see Clavell. Insurance from my employer was a major insurance company (Blue cross) - was a participant in my network so I didn’t have to pay out of network prices. Only had to worry about my yearly deductible and my out of pocket max. Ended up paying around 1900 towards the surgery and the rest was paid by insurance. It’s doable and Clavell’s team is amazing at getting authorization and talking through the provider charges and can connect you with the hospital to discuss their costs too.


Wow that’s awesome!! I have heard really good things about blue cross, I have Unicare which is a state indemnity plan because I am a government employee. They said they cover it if it’s medically necessary and I did talk to someone of Clavell’s team today and she said it’s common for people to travel for the surgery and have their insurance cover. My ED started recently and I’m 99% sure it’s a physical thing and I have only met with one urologist so far but I plan on getting a Doppler soon. That’s awesome to hear you got the surgery done by Clavell and his team! You just had it done a few weeks back? I hope you get some good use out of your implant soon!




Sent you a PM - happy to chat