Will Medicare pay for an implant upgrade?

[brasscar]

I had a malleable implant 12 years ago. At the time the reliability of the inflatables wasn't quite there. Now I'd like to upgrade to an inflatable. I'm on Medicare. Will Medicare pay for the upgrade even if the old one isn't broken? If it was broken, would they pay for replacement with an inflatable or insist on an even swap?

[dg_moore]

I think you should check with your urologist - they know all of the ins and outs of Medicare and insurance, and they also know how to code procedures so insurance will cover them. Unless you're a medical professional you probably won't have much luck getting specific information about most anything from Medicare directly.

Good luck!
Dave

[gregorbehr]

Might also want to say to the doc, that the current one has never been very comfortable and it just seems to be getting worse... gives them a reason to use towards fighting medicare for a new one.
Just a thought.

[brasscar]

My guess is you're probably right and in fact, it's the truth. Knowing Medicare, patient satisfaction with function is somewhere near the bottom of their list.

John

[ValPinto]

I went to Kramer in Baltimore- I'd decided on him as far as revising/fixing my implant as was prepared to pay. Turned out he wrote a letter to my insurance and got it all covered! Very happy w/ the result in all regards. I felt Kramer and Perito were the best in the world, I thought Perito had a few legal issues that scared me, otherwise both great.

[dg_moore]

I went to Kramer in Baltimore- I'd decided on him as far as revising/fixing my implant as was prepared to pay. Turned out he wrote a letter to my insurance and got it all covered! Very happy w/ the result in all regards. I felt Kramer and Perito were the best in the world, I thought Perito had a few legal issues that scared me, otherwise both great.

Kramer did mine also (before I was on Medicare) - I would recommend him to anybody. And, as luck would have it, his office is only about 30 minutes from where I live.

[brasscar]

Thanks Guys

[SR68GTO]

To ValPinto,

You said you went to Kramer for revising or fixing your implant. Can you share what was the issue with your implant? Was Kramer to do a repair? What type did you have and what did you get?

Thanks.

[ValPinto]

Sure- happy to share. My initial Uro put in an implant that was way too short. It didn't to up to the tip of my penis, it stopped way too low. I can tell you he pushed the envelope to put in the largest implant he could, and now it does go all the way to the tip of my penis. He was upfront with me- told me all he could make the tips go all the way up to the end of my penis. The conversation we had was interesting, told me it doesn't matter whether the doc does 1 per year or millions, or the patient tells him the penis used to be 20 inches or 1 inch, he or any other doc cannot change what the penis size is no matter how much patients complain and plead to him that their penis got shrunken. Basically he told me he'd just make the implant go to the correct part of my penis- which was what I needed. Now it does go out to the tip, not much more I could ask for I guess.