Dr. Karpman...Insurance Issues

[NickNickNick]

Hey fellas,
So here's the story...I live in Southern California and I have an HMO insurance through my work with Aetna. I want to have my implant surgery with Dr. Edward Karpman because he is the best implant doctor on the West Coast. Here's the problem...although Aetna does cover this type of surgery they only cover it if it's done by a doctor within my local medical group and since Dr. Karpman's office is 5 hours away my insurance will not be able to cover it. I don't trust any of the local doctors down here and am willing to pay out of pocket if I have too. But before I do that, I was wondering has anyone on the board shopped around for a 2nd health insurance plan just to cover the surgery? I feel like purchasing a 2nd insurance plan would make more financial sense than spending over $20,000 out of pocket.
Also if anyone had an implant surgery with Dr. Karpman, what insurance provider did you have that was able to cover the surgery costs?

[dradamas]

Nick,
Where I work there is an open enrollment period annually, where you can change it. I have had the same plan for years with Anthem Blue Cross and am very pleased with it. The lion's share of the surgery was covered, so far so good anyway... I would look into that if you haven't already. Yes Karpman may well be the best but surely there is someone good there is SoCAl perhaps at UCI. I would consider that too.

[NickNickNick]

Thanks man,
I'm pretty hesitant about low volume doctors especially considering the problems people on here have posted. I'm not even sure if I trust my own urologist lol.

I might check out Anthem to see what they can do. Also..Karpman's secretary just told me that AMS has a new co-pay assist program that's pretty good and will help cover some of the surgery costs as well as 0% interest. I went ahead and called them and I'm in the approval process right now. If it turns out to be pretty legit I'll post about it.

Here's the link...
http://americanmedicalsystems.comwww.am ... 212014.pdf

[ED2013]

I took out a personal loan to cover my implant by Dr Karpman. It was well worth it to me. I am delighted with the results. I'd rather be in debt a while, than take the risk of a possible bad outcome by a lesser experienced surgeon.

[alibaba]

Interesting you brought up the second insurance. I have been considering that form myself and also my wife. She has been turned down by many doctors because we cannot find one that will take her insurance. Thanks for the co-pay link also! Good luck getting through this. A quitter never wins.

[alibaba]

Well crap. Just found out the program is not available to Missourians. I wonder what republican redneck nutjob made that law here.

[NickNickNick]

I took out a personal loan to cover my implant by Dr Karpman. It was well worth it to me. I am delighted with the results. I'd rather be in debt a while, than take the risk of a possible bad outcome by a lesser experienced surgeon.

Ed
Did you ever consider purchasing another insurance plan to cover your surgery? Or did you have no choice but to take out a loan?

And I agree... I too would rather go in to debt lol

[NickNickNick]

alibaba

Ah that sucks man. Sorry your state won't accept the co-pay assistance and that your wife is having insurance problems. I hope you guys find a solution. Keep me posted on what happens with your insurance please.

[alibaba]

I'll let you know. I hope you can get things worked out but my hope factor for myself is now in negative territory. I feel like I am getting close to that suicidal point again. An "insurance specialist" is supposed to call me this week sometime. I spent 2 hours yesterday in the agent's office and another 3 this afternoon. Every single step in the process to get this done has been met with a slap in the face. I doubt the insurance specialist will be able to assist either.Being told i should have started the implant process a long time ago is another slap in the face when I have basically been told to go screw myself by 17 doctors in 25 months, Only 3 of which I actually got to see and they told me the surgery Dr. Eid ( and I know others also do) cannot be done. Dr. Eid says he does it on a regular basis. I went through the interview process with AMS. As soon as the gal entered my zipcode it turned into reading me a script that I am not eligible because copay assistance is not legal in the state of Missouri. Then she proceeds to tell me when i move out of the state of Missouri or if Missouri changes their laws I can reapply. Goodbye. A quick disconnect like that again is another slap in the face. Still no repy from anyone other than Perito and Eids secretary. Eid is nolonger sounding promising either. If you have questions you better find a way to call early in the day because quitting time is 4:00 at his office and you are told so and goodbye. (slap) Geuss we are too laid back for set quitting times when asking questions in Missouri where copays are a no no. i was told besides airfare, presurgery testing will not be covered by insurance and I would have to arrive 3 days before and stay 3 days after so to expect to spend 7 days in a Newyork motel at approximately $485 a night. She tells me if you want to do it out of state "you have to pay the price". If I want to keep costs down I should consider a local lesser experienced doctor. I've already tried that route for 25 months. $45 taxi fares back and forth on arrival date, doctors visit date, testing, surgery day, checkup day,and then back to the airport sounds like it will eat up another 5-600 $ quite easily. $285 for a 30 minute phone consult some time in mid January. Only after that will they check with the insurance. Consult fee will not be billed to insurance either. No idea how far out surgery would be if it was scheduled. I was only told "his time is booked". I don't know if it is booked till February or booked to September. "If I am in a rush, I should have started the process earlier. I liked what he told me in the email about getting this done but at this point I again feel it is never ever going to happen. Not a chance. Clearly the only way you can do this is be rich, have a good income and borrowing ability, be old with medicare or be a veteran. Other than that the chance it will happen is zero. zilch, nada. I should have followed up on instinct in 2009 and given up instead for letting myself be convinced to keep on living. Good part about today its the ammunition is only a few feet away. Maybe i should set up my life insurance to buy a lot of guys dick implants so when i go to hell and they ask what I did with my life I can tell them I paid for a lot of dick. Home equity loan was maxed out on prior hospital bills so there is zero room for more there and 15 more years to go till it is paid off again. what is the use of putting this off till mid year every year so the deductible is met to assure the doctor is paid when you cannot get it done? I am starting to wonder why I spend so much time even caring it the doctors get paid? I have spent hundreds of days when I was too sick to fight talking to insurance companies going over bills for an hour a day till I ran out of voice to make sure the doctors got paid every penny. Now it seems that is a waste too.

[NickNickNick]

Alibaba

That sounds like hell! Really feel for you man. It is so frustrating what we have to go through to cure a problem that is so crucial for enjoying a great life. All these idiot doctors and insurance companies can go fuck themselves. Nobody understands what you and I and all the rest of the Franktalk dudes are going through.

I know it’s easier said than done but you need to get this surgery done. You NEED this. I told myself that I don’t care if I have to sell the car, deliver pizzas on the side, rent a room out or even rent the house out and get small apartment. One way or another, I’m going get that surgery done. I will not let this defeat me. There is hope...

PS. Have you considered modifying your current insurance plan to a higher plan? When I called my insurance the rep on the phone told me that upgrading to a PPO insurance plan would most likely be able to cover the surgery cost. Since I have to wait till open enrollment at my work (June 2015) this is not a viable option for me.