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And soon after getting the surgery? My concern is insurance denying my application due to pre existing medical issues.


It’s getting harder and harder to get this surgery approved. Wondering if anyone can direct me to a insurance company who covers IPP.

Not really the exact deal you are talking about, but I did buy my own health insurance and I will explain to you why it is best to just save up the money or take out a loan for the surgery.

I live in a low population state and insurance has run health care here for many years. The insurance companies don't have a lot to gain by providing insurance to this small of a group and state officials have had a lot of trouble getting companies to provide insurance. I think we were even one of the states that insurance companies divided up so we had no competition with who was providing insurance. I had the best BCBS Insurance policy I could buy. I had around a 1500 deductible and 3500 or 4000 max out of pocket. It cost north of 1200 a month the last year I bought it. It was a EPO policy (exclusive provider). That meet that mostly doctors that needed business and would accept the low reimbursement for services. It was basically a drug plan as the doctors did very little testing and would just provide medications to save BCBS money. It was the same plan as was on the health care marketplace (Obamacare). I do not know if you can purchase from your state's health care marketplace program. I made enough income the only reduction in insurance price for me was to use part of my tax deduction. That is the std or itemized deductions you have when you file your income tax. Just end up paying at tax time.

My local uro group doctors only do 2-3 implants a YEAR. None of them do repairs or replacements. A large number of men they implant end up having the device removed as the results are so poor. Way below the national average of above 90% satisfaction rate. So for me even though insurance did cover the surgery it only did so with doctors who were far below average in results. And the business office advise I would need to pay up front my deductible and max out of pocket and most likely a bit more as insurance would not cover all of the surgery. I guess reimbursement was so low that they needed to charge more to be able to stay in business. My local uro's business office wanted all the costs not covered by insurance paid up front before the surgery would be scheduled.

I did not feel good about letting my expensive insurance off the hook for the surgery, but I just could not have the surgery with the doctors the insurance would cover part of this. Part is the main factor as not only do you have to add in the cost of insurance but the other costs of deductibles, max out of pocket and the part insurance may not pay for. It took me 2 years to be able to pay out of pocket for mine. If I had it to do over, I would have gone with a Surgeo doctor that had insurance for a reoperation in the first year. That is only for a virgin (first implant) not for a replacement.

You need to go to your state's health care marketplace. See what companies and policies that are available to you in your state and see what they cost. See what the deductible's and max out of pocket are. And see if you qualify for reduced premiums not the use of you standard or itemized tax deduction. You can subtract the amount you are paying for your current health insurance through your work. Then decide if you can go to a doctor the Obamacare plan will send you to. I did use my insurance for my repair. I used a clause in my plan that said I could go out of area if I needed something that none of the covered doctors would do. Took 3 years to get this to go through. Tried to have Morey in TX do this and his office did not take single payer insurance. Tried Hakky after that with no results.

Only other way is to self-pay. To be able to self-pay for my first I cut my living expenses. Put up a broadcast TV antenna and stopped paying cable TV. I have a 25 dollar a month prepay flip phone. That may hurt you more than it did me as I do not text and use my computer for e-mail and web browsing. I pay a bit of money to another who has an internet account for web access. I watched my other expenses like reducing eating out or as a radio personality has said went on a beans and rice diet. If you have any debt, then according to that same radio guy start with the smallest amount of debt and pay as much extra as you can on it until you pay it off then put all of what you were paying on that loan on the next. Consider getting a second job. If you have any collectables sell them. If you have a very expensive car sell it and get a basic transportation car. You might look into a healthcare savings account (HSA).

Either way you go will be expensive.

newbie443 wrote:Not really the exact deal you are talking about, but I did buy my own health insurance and I will explain to you why it is best to just save up the money or take out a loan for the surgery.

I live in a low population state and insurance has run health care here for many years. The insurance companies don't have a lot to gain by providing insurance to this small of a group and state officials have had a lot of trouble getting companies to provide insurance. I think we were even one of the states that insurance companies divided up so we had no competition with who was providing insurance. I had the best BCBS Insurance policy I could buy. I had around a 1500 deductible and 3500 or 4000 max out of pocket. It cost north of 1200 a month the last year I bought it. It was a EPO policy (exclusive provider). That meet that mostly doctors that needed business and would accept the low reimbursement for services. It was basically a drug plan as the doctors did very little testing and would just provide medications to save BCBS money. It was the same plan as was on the health care marketplace (Obamacare). I do not know if you can purchase from your state's health care marketplace program. I made enough income the only reduction in insurance price for me was to use part of my tax deduction. That is the std or itemized deductions you have when you file your income tax. Just end up paying at tax time.

My local uro group doctors only do 2-3 implants a YEAR. None of them do repairs or replacements. A large number of men they implant end up having the device removed as the results are so poor. Way below the national average of above 90% satisfaction rate. So for me even though insurance did cover the surgery it only did so with doctors who were far below average in results. And the business office advise I would need to pay up front my deductible and max out of pocket and most likely a bit more as insurance would not cover all of the surgery. I guess reimbursement was so low that they needed to charge more to be able to stay in business. My local uro's business office wanted all the costs not covered by insurance paid up front before the surgery would be scheduled.

I did not feel good about letting my expensive insurance off the hook for the surgery, but I just could not have the surgery with the doctors the insurance would cover part of this. Part is the main factor as not only do you have to add in the cost of insurance but the other costs of deductibles, max out of pocket and the part insurance may not pay for. It took me 2 years to be able to pay out of pocket for mine. If I had it to do over, I would have gone with a Surgeo doctor that had insurance for a reoperation in the first year. That is only for a virgin (first implant) not for a replacement.

You need to go to your state's health care marketplace. See what companies and policies that are available to you in your state and see what they cost. See what the deductible's and max out of pocket are. And see if you qualify for reduced premiums not the use of you standard or itemized tax deduction. You can subtract the amount you are paying for your current health insurance through your work. Then decide if you can go to a doctor the Obamacare plan will send you to. I did use my insurance for my repair. I used a clause in my plan that said I could go out of area if I needed something that none of the covered doctors would do. Took 3 years to get this to go through. Tried to have Morey in TX do this and his office did not take single payer insurance. Tried Hakky after that with no results.

Only other way is to self-pay. To be able to self-pay for my first I cut my living expenses. Put up a broadcast TV antenna and stopped paying cable TV. I have a 25 dollar a month prepay flip phone. That may hurt you more than it did me as I do not text and use my computer for e-mail and web browsing. I pay a bit of money to another who has an internet account for web access. I watched my other expenses like reducing eating out or as a radio personality has said went on a beans and rice diet. If you have any debt, then according to that same radio guy start with the smallest amount of debt and pay as much extra as you can on it until you pay it off then put all of what you were paying on that loan on the next. Consider getting a second job. If you have any collectables sell them. If you have a very expensive car sell it and get a basic transportation car. You might look into a healthcare savings account (HSA).

Either way you go will be expensive.

hey there thanks for the reply-

so let me ask, are you saying its that going with an independent insurance company they arent going to cover a implant with someone like Dr.Clavell

Pamen116 wrote:

hey there thanks for the reply-

so let me ask, are you saying its that going with an independent insurance company they arent going to cover a implant with someone like Dr.Clavell

Maybe or not. Insurance differs from state to state a bit due to each state responsible for it's own health care. Each state decides (or it's officials do) which companies can sell insurance in that state. Except if a multi state company has it's headquarters in another state. Then the home state is where insurance is purchased for all the company employees even the ones who work out of state.

This means you need to check your states insurance providers and the policies they sell. I did have an option to switch from BCBS to another company that offered out of network coverage. Thing was it was twice as expensive as my BCBS policy and had twice the deductibles and max out of pocket. Even with the lower cost BCBS I would most likely be at 1500 a month premium (18K a year) and 4k max out of pocket. So 22K for the part insurance would pay for with some extra for things my local uro charges for things not covered. This is for a virgin implant as the local doctors do not do repairs or replacements. That amount is the same as my out of pocket pay for the surgery with a really good doctor. So why not just go to a really good doctor if it will cost the same and I am restricted to low volume doctors that have poor outcomes. Now I had to buy insurance any way so the cost difference was a bit more. I think the office quoted 4-7K I would have to pay up front with insurance. My self pay was 20K more than that.

But states are different. And even if you live in TX you need to check to see what policies that he is network with. So check with insurance in your state and see how much it costs and what doctors are in network and if it has out of network coverage. Then add to cost of the policy and max out of pocket and see if it is worth it or not.

Another option would be to change jobs. The reason your policy has an exception is that it makes the policy affordable to companies shopping for insurance. So many will have the exception. Finding one that does not can be difficult. I would think that any federal gov job would have coverage and your best chance. Maybe even state gov job. Depending on location even a city gov job.

So you know what I have delt with in Kansas up to 3 years ago. Insurance open enrolment is in the fall for the next year so it has been a while for me since I went on Medicare. This gives you some information and questions to ask your states insurance. But in most cases from past posts it has been self pay to be able to go out of state. You just have to see what your state has.

Just an opinion. I suspect that an independent policy would be the least likely to cover an implant. I base this on the presumption that the independents are aiming their policies towards to dollar conscious consumers. Any coverage that they can not cover just allows them to shave a little off of the monthly premium. I know it sounds like a minor cost spread over lots of members. But insurance companies know very well that pennies do add up.
Of course, I'd really like to be wrong on this but this is my hunch.

Gt1956 wrote:Just an opinion. I suspect that an independent policy would be the least likely to cover an implant. I base this on the presumption that the independents are aiming their policies towards to dollar conscious consumers. Any coverage that they can not cover just allows them to shave a little off of the monthly premium. I know it sounds like a minor cost spread over lots of members. But insurance companies know very well that pennies do add up.
Of course, I'd really like to be wrong on this but this is my hunch.

I was referring to the states healthcare marketplace policies (Obamacare). These policies also have some reduced premium's depending on your income. That discount started around 50K. As it was a federal program all the policies did have coverage for implant surgery like Medicare does. The problem that was covered in the news when that all came about was it is very expensive as each policy covers everything. A man pays for women's services and women pay for men's services. The idea was to get everyone on this and reduce the cost. That and there is no exclusion for pre-existing medical conditions. When this came about premium's skyrocketed. Young healthy people did not buy it and the older sick people who could did. There were low cost plans at times but they had high deductible and max out of pocket. Or if you did not use your health care plan there were lower cost policies. If you bought the lower cost premium plan for implant surgery it would still end up in the same expensive cost due to the higher deductible and max out of pocket. The only difference was in how you paid. High premium and low deductible and max out of pocket or low premium and high deductible and max out of pocket. The attempt to make everyone purchase health insurance only lasted a couple of years. If you remember having to show proof of health insurance or getting a 2k penalty on you income tax. Insurance companies had to sell a policy to people no matter how sick they were. And insurance companies are in business to make money. The additional costs were passed on to people buying insurance. So self-employed or business owners with no employees other than themselves and maybe a spouse took a big hit.