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Got a call from Dr. McCammon's office yesterday - calling to schedule my surgery! I asked about the insurance issue and she said that at this point they had determined that the implant surgery was not excluded from the policy (but that doesn't mean it's approved). Apparently they need to schedule it in order to submit for insurance approval - which will likely not happen since my policy says that nothing is covered related to "sexual dysfunction" - if not approved I understand that's when the doc or someone from his office can/will send a letter explaining why it should be covered and then if necessary, there can/will be a peer-to-peer conversation between the doc and someone at the insurance company. Assuming all of that fails, I become a self-pay patient. YIKES! Last year's surgery (aborted mid-surgery) was self-pay and was a package deal at $20,000 - I was committed to that. This time I am scheduled for a 4-hour slot and maybe an overnight stay if doc finds that he needs to do any grafting so all bets are off as to what this would cost me. Lady with whom I spoke yesterday couldn't give me any numbers other than $40,000 to $50,000 - I CANNOT commit to that. I asked about working out any self-pay deals and she said that would be between me and the hospital. . . .anyone have any experience in wheeling and dealing on that front? So anyway, I'm on the books for August 29 - the process has started. . . we'll see how it goes from here. . . will keep you all informed as usual.

Rick

Wow - you have to commit to the plan or else they won't tell you if they'll pay for it. Sounds like the web sites where you can't find out how much something costs until after you've bought it.

I hope you or your doc get some answers soon. Good luck!

Dave

I can always cancel if it's determined that insurance won't cover and I can't work out a self pay price/plan that I can live with.

Thanks for the update Rick.

Please don't forget to find out if the insurance company covers mastectomies, and if they do, they should include implants as well. Neither are life-threatening, but both effect a person's quality of life quite a bit.

Got some encouraging news today- I had called the hospital's estimate line to find out how much my implant surgery might cost (without insurance coverage) - with the procedure codes I gave them, estimate is $31-$42K - no that's not the good news. . . . I asked about any possibility of discount or negotiations based on being a self-pay patient and she referred me to the financial assistance office - I called them and explained and was told there is a 30% discount for self-pay patients and possibly even more based on my financial status. So moving forward - surgery scheduled for 8/18. . . here we go again. . . hopefully better outcome this time. Funny that it will be almost exactly one year from the first attempt. . . not sure if that's a good sign or not.
Rick

rglassva wrote:Got some encouraging news today- I had called the hospital's estimate line to find out how much my implant surgery might cost (without insurance coverage) - with the procedure codes I gave them, estimate is $31-$42K - no that's not the good news. . . . I asked about any possibility of discount or negotiations based on being a self-pay patient and she referred me to the financial assistance office - I called them and explained and was told there is a 30% discount for self-pay patients and possibly even more based on my financial status. So moving forward - surgery scheduled for 8/18. . . here we go again. . . hopefully better outcome this time. Funny that it will be almost exactly one year from the first attempt. . . not sure if that's a good sign or not.
Rick

Fingers crossed for you, Rick - I hope it all works out!
Dave