Dr. Karpman...Insurance Issues

[alibaba]

I have one of the best plans I can get. Once I meet $2900 deductible it usually pays 100% with no copays, meds covered. It is just the travel too docs are either out of network or like Dr. Eid, say your office visit and all pre surgical testing is not billable through insurance you pay that out of pocket. Out of network docs cost me $5980 deductible plus 20% of the total bill. On a 30 thousand $ bill that 20% is an additional $6k out of pocket. Paying docs over the last 10 years we went through our retirement savings of $410,000 plus the the med bills costs us 2 farms and 1 house. There is nothing else left. I cannot work 2 days in a row. I still get too exhausted from the toll everything else put on me. If I work 3 hours max, sit down and rest for 3-4 hours I can go day after day but that is the only way. it I try to force myself to put in a 5 hour day I am a shaking exhausted lump that ends up sleeping 12 to 14 hours straight to recover. The exhausted state is the only time that I do sleep non stop w/o getting up to pee several times though. That is why I am on dissability. when you go on disability at a young age your check is not crap. Mine is $435.50 a month. My wife gets the same plus an Additional $211 Social Security. Her check is small also because she had to retire due to health. I have 13 more years to go before I am eligable for Medicare which pays for new dicks and11 more years to get social security. man I hpe you don't have to go through all that shit to get a new dick.The system is fucked. It is like the screwed up law here that eye care is covered under age 16 or 65 and older only if you reside in a nursing home. What fuckwit makes those rules?
Be well. Good luck. Hope you can find a way. He in missouri it is a state law that it you have breast cancer , even one, the insurance has to pay for a new set of tits, BOTH! If you have dick issues.... tough shit. they aren't tits. I think that is a discriminatory law.

[gregorbehr]

I'm curious, did you ask your insurance company or did Karpman's office put in the request?
I'm in San Francisco and went outside of my insurance group to go to my surgeon at UCSF Medical Center. Between a recommendation from my primary physician and the doc's careful wording for the insurance request, we got out of network approval. 6 months later, I'm still waiting for the bill, but should only cost me my overnight in hospital co-pay of $750, instead of the nearly 50 grand that was billed to the insurance company.

[KMeister]

I don't trust any of the local doctors down here...

Nick, I understand your position; however, perhaps it wouldn't do any harm to check out the locals. It doesn't mean you have to make a commitment.

KM

[NickNickNick]

I'm curious, did you ask your insurance company or did Karpman's office put in the request?

I did both. Both of them told me my insurance would not cover the procedure. I'm still waiting on AMS to get back to me on the co pay assistance program. I'll post a new thread once they do.

[KMeister]

You wrote: "I did both. Both of them told me my insurance would not cover the procedure."

??? They won't cover the procedure at all or won't cover it with Dr. K? And again, would it hurt to take a look at one of the locals in your area who are covered under your insurance plan--if one exists?

KM

[alibaba]

Nickie, I hope you have had some luck. I spent this entire day till 5 pm on the phone with an insurance broker and conference calls with insurance companies trying to find a policy that covers did implants. This is my 3rd day at it. Broker is supposed to call again Friday to work on it more. Gal from United healthcare was a bitch. even the broker was ticked off what a bitch she was. Yeah, we talked about her snooty ass when she got off the conference call. Everyone else very nice but no coverage in either the gold plans or platinum plans. Platinum turned out not even avail in Mo. For $2015 a month you think this shit would be covered but I kept being told that penile prosthesis are considered elective like facelifts and boob jobs therefore not covered. To qualify for ACA payment rebating my income would have to go up an additional $13460 per year and I would lose medicaid and Ryan White so I would be stuck with 20% copays on everythign including meds plus the pay at the door copay. This is less coverage than I have now in an out of network setting. Best plan we could find is MUCH less coverage than I have now which blows big time. I can only hope every one of the assholes that write these rules suffer from dick failure at a very young age, their wife leaves them, their mistress' dump them and even the slut in the corner office flips them the bird. Be well. Good luck. Let us know if something works out. I really feel where you are at man. I swear it it weren't for pissing all over my balls i'd just take a pruner and lop the damn thing off since I can't seem to find a way that i'll be able to make that floppy ass thing useful any more. I really really hope you can overcome your issue to show that one man can be stronger than all the bullshit they throw through your door.

[KMeister]

Nickie, I hope you have had some luck. I spent this entire day till 5 pm on the phone with an insurance broker and conference calls with insurance companies trying to find a policy that covers did implants. This is my 3rd day at it. Broker is supposed to call again Friday to work on it more. Gal from United healthcare was a bitch. even the broker was ticked off what a bitch she was. Yeah, we talked about her snooty ass when she got off the conference call. Everyone else very nice but no coverage in either the gold plans or platinum plans. Platinum turned out not even avail in Mo. For $2015 a month you think this shit would be covered but I kept being told that penile prosthesis are considered elective like facelifts and boob jobs therefore not covered. To qualify for ACA payment rebating my income would have to go up an additional $13460 per year and I would lose medicaid and Ryan White so I would be stuck with 20% copays on everythign including meds plus the pay at the door copay. This is less coverage than I have now in an out of network setting. Best plan we could find is MUCH less coverage than I have now which blows big time. I can only hope every one of the assholes that write these rules suffer from dick failure at a very young age, their wife leaves them, their mistress' dump them and even the slut in the corner office flips them the bird. Be well. Good luck. Let us know if something works out. I really feel where you are at man. I swear it it weren't for pissing all over my balls i'd just take a pruner and lop the damn thing off since I can't seem to find a way that i'll be able to make that floppy ass thing useful any more. I really really hope you can overcome your issue to show that one man can be stronger than all the bullshit they throw through your door.

Sounds like you're having a tough go of it, Ali. With no insurance you may have to come up with the cash. And from what I've read, the doctors, surgery centers and so forth want the money up front. I'm not sure what to suggest. Perhaps one of our brothers here can recommend someplace not too expensive.

But Nickie's not in the same boat as you. He opened this thread with this declaration:

"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."

Who wouldn't want to fly to another state to have the procedure performed by one of the top implanters in the country? But few of us can afford that luxury. I still don't understand why someone who has coverage won't as least check out what's available through his insurance network. I'll say it for the third time: It wouldn't hurt to take a look.

KM

[NickNickNick]

Nickie, I hope you have had some luck. I spent this entire day till 5 pm on the phone with an insurance broker and conference calls with insurance companies trying to find a policy that covers did implants. This is my 3rd day at it. Broker is supposed to call again Friday to work on it more. Gal from United healthcare was a bitch. even the broker was ticked off what a bitch she was. Yeah, we talked about her snooty ass when she got off the conference call. Everyone else very nice but no coverage in either the gold plans or platinum plans. Platinum turned out not even avail in Mo. For $2015 a month you think this shit would be covered but I kept being told that penile prosthesis are considered elective like facelifts and boob jobs therefore not covered. To qualify for ACA payment rebating my income would have to go up an additional $13460 per year and I would lose medicaid and Ryan White so I would be stuck with 20% copays on everythign including meds plus the pay at the door copay. This is less coverage than I have now in an out of network setting. Best plan we could find is MUCH less coverage than I have now which blows big time. I can only hope every one of the assholes that write these rules suffer from dick failure at a very young age, their wife leaves them, their mistress' dump them and even the slut in the corner office flips them the bird. Be well. Good luck. Let us know if something works out. I really feel where you are at man. I swear it it weren't for pissing all over my balls i'd just take a pruner and lop the damn thing off since I can't seem to find a way that i'll be able to make that floppy ass thing useful any more. I really really hope you can overcome your issue to show that one man can be stronger than all the bullshit they throw through your door.

Ali,
So I called AMS and set the approval process in motion. I specified that I wanted to go with Karpman... After 10 days I get a letter denying me coverage for two reasons:
1) "Your out of pocket amount must total at least $500 from your providers.
2) "According to benefits investigation results of insurance, patient is covered at 100% for physician and facility services. He must meet medical criteria for coverage"
Confused because my insurance and Karpmans office told me I wouldn't be covered if I go through them, I called AMS up and they told me that the letter is correct and that I'm 100% covered to have the surgery done at his office. Excited, but skeptical, I ended up calling my insurance, I'm placed on a 3-way call with them and AMS, and long story short... it turns out AMS was wrong all along. Since he's not within my medical network my insurance, I will not be covered. duh...idiots!

Anyways...after I sorted everything out I will be eligible for the AMS co-pay assistance since Karpman isn't covered. They're giving me 2 options (still waiting on paper work for specifics).... 1) $2,500 grant or 2) Zero interest for 24 months. Not much help either way but it's better than nothing. If I decide to have my surgery with him I might take the grant option. I'll keep you posted...

But I really feel for you Ali. Especially since you have such a high insurance plan. I wish there was some way we could all help but I hope your broker works something out on Friday. I don't want to sound like a baby but it's really not fair what were going through. I know blind people, deaf people, mute people all have it rough but I put our situation up there with them. Like them, this is life changing. The only thing that separates us from them and that gives me hope is that there is a cure to our problem. We just need to freaking get there already!
Hang in there brotha.

[NickNickNick]

Nickie, I hope you have had some luck. I spent this entire day till 5 pm on the phone with an insurance broker and conference calls with insurance companies trying to find a policy that covers did implants. This is my 3rd day at it. Broker is supposed to call again Friday to work on it more. Gal from United healthcare was a bitch. even the broker was ticked off what a bitch she was. Yeah, we talked about her snooty ass when she got off the conference call. Everyone else very nice but no coverage in either the gold plans or platinum plans. Platinum turned out not even avail in Mo. For $2015 a month you think this shit would be covered but I kept being told that penile prosthesis are considered elective like facelifts and boob jobs therefore not covered. To qualify for ACA payment rebating my income would have to go up an additional $13460 per year and I would lose medicaid and Ryan White so I would be stuck with 20% copays on everythign including meds plus the pay at the door copay. This is less coverage than I have now in an out of network setting. Best plan we could find is MUCH less coverage than I have now which blows big time. I can only hope every one of the assholes that write these rules suffer from dick failure at a very young age, their wife leaves them, their mistress' dump them and even the slut in the corner office flips them the bird. Be well. Good luck. Let us know if something works out. I really feel where you are at man. I swear it it weren't for pissing all over my balls i'd just take a pruner and lop the damn thing off since I can't seem to find a way that i'll be able to make that floppy ass thing useful any more. I really really hope you can overcome your issue to show that one man can be stronger than all the bullshit they throw through your door.

Sounds like you're having a tough go of it, Ali. With no insurance you may have to come up with the cash. And from what I've read, the doctors, surgery centers and so forth want the money up front. I'm not sure what to suggest. Perhaps one of our brothers here can recommend someplace not too expensive.

But Nickie's not in the same boat as you. He opened this thread with this declaration:

"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."

Who wouldn't want to fly to another state to have the procedure performed by one of the top implanters in the country? But few of us can afford that luxury. I still don't understand why someone who has coverage won't as least check out what's available through his insurance network. I'll say it for the third time: It wouldn't hurt to take a look.

KM

Hi KM,
I forgot to mention I'm keeping both options on the table for now. I have an appointment with my own Urologist on the 15th and we're going to talk about the implant surgery. Like you said, it doesn't hurt to take a look. But the reason I'm so skeptical is because of how much bad stuff I've read about low volume doctors both on FT and on the web. Higher infection rates, botched surgeries, shorter penis lengths, floppy head issues, longer recovery time...some of this scares the shit out of me. I've heard nothing but good about Karpman.

But I will see what my uro says after I have my appointment. But either way I'm in a tough position...Pay 20k but have the complete reassurance that one of the best implant doctors in the country is going to do my surgery. Or pay nothing, and take my chances with one of the local surgeons in my medical network. God why can't this be easy hahaha

[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.

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

I looked into it, but couldn't find anything. Another one of the reasons I chose Dr. Karpman was because of a quick recovery time. I have a very physical job, and there was no telling how long I wouldn't be able to work if I had it done by someone else. On top of that, my own uro I was seeing before Dr Karpman tried to talk me out of an implant. He said I would lose size for sure. I found Dr Karpman here on Franktalk, scheduled a consultation and was very impressed with him. He said I wouldn't lose any size, I'd be cycling the implant in a week, and having sex a few weeks later. He was correct. I would recommend anybody seriously contemplating an implant to see him.