Insurance and the "rock star" docs.

[eisenhower]

Question for you guys who have had your implant surgeries performed by one of the high volume experts like Dr. Kramer. If you're on a work-sponsored health insurance plan, how are you treated when you want to go outside the system and have a surgery performed by someone maybe clear across the country like Dr. Kramer, for instance? Are you covered, or do you have to go out of pocket for the whole thing?

Thanks,
eisenhower

[dg_moore]

There's no simple answer for this. Every group plan has its own rules and policies, so you'll have to check with your plan administrator to find out how your particular plan deals with this. Dr. Kramer did my implant, and my group plan (United Healthcare) covered about 95% of the cost.

[eisenhower]

Can I assume you were seeing a Uro under your workplace plan, and then when it came time to get an implant, you decided to go to Kramer? How did you approach this with your Uro? Was it awkward or difficult?

Thanks,
eisenhower

[KMeister]

Question for you guys who have had your implant surgeries performed by one of the high volume experts like Dr. Kramer. If you're on a work-sponsored health insurance plan, how are you treated when you want to go outside the system and have a surgery performed by someone maybe clear across the country like Dr. Kramer, for instance? Are you covered, or do you have to go out of pocket for the whole thing?

Thanks,
eisenhower

My work-related health insurance paid for a good 90% of my implant surgeries (had to have three in four years) because I stayed "in network" (i.e. doctor in town). Had i gone "out of network" the percentage picked up by my insurance would have been far less; I think about 50%.

I agree with DG Moore: You have to check with your group plan to see what they cover and how. You're paying premiums for your health insurance so you're a consumer and have every right to ask. Many billing clerks at a doctor's office will call your insurance provider and make the inquiry for you.

KMeister

[RelievedofED1]

It is different for every insurer and for every product that that insurer has depending on which product your employer picked. Some of the high volume docs have worked with insurers so many times that even though they are a distance away they will have signed conttracts to be in network. And then they may not be covered at all. Your member services number on your insurance card should be able to help with that info. I still haven't heard what my insurance paid but was told Dr Kramer was in network even though I am 300 miles away.

[dg_moore]

Can I assume you were seeing a Uro under your workplace plan, and then when it came time to get an implant, you decided to go to Kramer? How did you approach this with your Uro? Was it awkward or difficult?

Thanks,
eisenhower

I didn't have a urologist at the time since I had no urological issues. I had a vasectomy many years ago, but to my knowledge that urologist doesn't do implant surgery. The implant suggestion came from my internist, who is an old friend and said "it's just plumbing - why not get it fixed?" after pills quit working and injections failed. He referred me to U of MD Medical Center, where I met Dr. Kramer.

[eisenhower]

Thanks, all. Very helpful.

eisenhower

[firstcav46]

My answer may not be relevant. I went out of state to a high volume surgeon because I had Medicare with state insurance as supplemental backup. It did not cost me anything.