Insurance Coverage.

[Gacleader1]

Like many here, I was very concerned about insurance coverage. For others with the same concern, I have a couple of comments / suggestions.

First, ask the price up front. I was shocked at how much lower the price was when done by the high volume surgeon I chose, than it would have been locally. That is not why I chose my surgeon, I chose him because of his reputation, but his price for the total package was about half of many others.

Second, something that occurred to me at almost the last minute, after I had already taken out an equity line of credit on my house, was the possibility of getting a second insurance policy through my wife's employer. It turned out that they do consider this to be an approved procedure. Sure, it was expensive, to the tune of $800.00 per month, plus my co-pay of $6350.00, but when you totaled everything up, it was far less expensive than paying for the surgery myself. The $800.00 per month works out to about $600.00, since it is taken out pre-tax, so my total out of pocket, not counting the hotel for my wife and I for a week (You may stay less) was $13,500 (January 2017 prices)

This gave me the piece of mind in knowing that not only was I covered for much of the surgery cost, but most of what I did owe could be spread out over the course of the year in insurance premiums. I also set my mind at ease regarding all of the what-ifs in the event of a complication.

On the negative side; you will have to wait for the enrollment period, and no one at an insurance company wants to give you a direct answer about coverage until you are a member. I tried for about 3 months to get an answer from the company who insures people where she works. I never did get an answer, until finally she asked her boss to call. Her boss called and inquired about a surgery for "her husband" and was told it would be covered. We were reluctant to share this personal information, but finally decided it was worth it. It is too soon after the surgery to see the E.O.B.s from the insurance company, but we have been told it was covered. Also, since coverage was confirmed, neither the hospital or the doctor asked for any money up front; they are waiting for the E.O.B.s. By the time all of that has settled, two months will have passed, and I can put it on my credit card. When that comes do, then and only then will I use my equity line of credit.

Do your research. You do not have to pay $60,000 for this surgery, but even if you do decide to pay cash, call the more experienced surgeons you read about here. I was very pleasantly shocked that not only did I receive a surgery that was top notch, but the cost was lower than I ever expected.

By the way, after the first time my wife and I try out the device, and are happy with it, I am going to send a card to her boss, thanking her for the best sex I have had in 3 years:)

[OttoHS]

There are two basic issues regarding insurance coverage. The first issue is whether a policy covers or excludes penile implants. The second is what you need to get approval for an implant if they are covered by the policy. Insofar as the first question is concerned, if you already are covered by a policy, you should be able to get an answer by calling customer service at the insurer. If you are in the market for a policy, an insurance broker should be able to get information about coverage for you before you buy a policy. If you have a policy, then you need to find out what you need to get approval. I had had a radical prostatectomy. My impression is that if implants are covered by a policy, approval is easy to get if a period of time has elapsed since the RP. The policy I had at the time of the RP required a two year wait. I had to change insurers 16 months later and my new policy only required a one year wait. Your surgeon's staff should be able to help you with the approval process. Dr Kramer's staff was very helpful to me when I was going through the approval process.

[rdnkbiker]

my insurance would not cover mine...when the doc first sent them the request it was approved and so was the hospital had a conformation # the whole thing about 2weeks later sent a letter wanting information from the doc he sent the letters I had already payed my copays to the doc according to information from the insurance my surgery was only 2 weeks away at this point I received a letter from the insurance stating it was denied I called the docs office they it cant we already have the conformation it was approved they said they would take care of it 5 days before surgery they called and said insurance wont pay from what I have found out my insurance does not cover sexual wellness period nothing else matters that gets them out of paying no matter what the cause I guss as long as you can pee your good to go they don't take in to consideration what effect you physically and mentally heavy on mentally which in my opinion does affect you physically in a lot of ways like depression and so on so now its mine to pay not sure how but we will find away I still think I was the right decision getting the implant I feel a lot better about life now so in the long run it will be worth it hopefully no problems in the future
jim

[Gacleader1]

Jim, You and I have the exact same story...Exactly.

Whether or not insurance brokers are supposed to get answers for you or not, I tried for months to get an answer from the insurance company that my wife's employer uses. NO ONE would talk to me, unless I was a subscriber. It was like pulling a tooth. Thank goodness we finally asked her supervisor to call and ask. Since she had an ID number, they would talk to her.

Mine was approved by my primary insurance, and I even had a letter stating that. Unfortunately, it was an exclusion of my employer. Sounds a lot like yours.

Unfortunately, the only way to get a second policy, is if you have a spouse or partner who has insurance through their company. I hope this may be the case for you, and that if so, you will be covered.

Amazing. The stress this puts on a marriage, and the stress it puts on an employee, and they exclude this. If any other part of the body was broken, they would pay to fix it, but not the penis.

Good luck to you. Did you get a quote from your surgeon?

[rdnkbiker]

Gacleader1
I had the surgeon pretty much paid only because I used everything I had been saving in my HSA account which is now gone except all the extra work once in surgery 1 hour turned inti over 2 hours so I'm sure I owe him more as far as the hospital they wouldn't even give me a guess they said just had to wait until it was done that's the scary part but ill figure it out some how payment plan I guess.............yah its to bad the insurance cant see how ED can affect your life which includes health
thanks
Jim

[oldgoat]

Medicare and my secondary insurer covered mine.
Cost me less than $300 out of pocket.

[alibaba]

I tried for YEARS to get it covered by my insurance and have a number of denial letters in the file box. Doctors, called, hospitals called 2 times it was scheduled then cancelled due to denials. I even went as far as to hire a lawyer. I finally read the policy word for word, page by page, dissected it, took notes and enlisted the help of an AMS rep who helps with these matters and got United Healthcare to agree it is a covered procedure but they would not give any other info till the bill was sent to them. Last year I spent 3 days with brokers trying to get an additional policy and last month 1 day. I told them what I wanted it for and asked about coverage. Hours on the phone and all came back to tell me I could only find out after I bought the insurance and received the policy about a month later. It is a train wreck. Leaking tankers spewing toxic waste burning intense heat to deal with insurance on these matters. Number 1 thing is make sure it is not for conception purposes. Most polices I've found have an exception that does not cover for any purpose to promote conception. That was United Healthcare's argument for 3 years. Resiliently obstinate people. I continued to tell them I had a prostatectomy and part of it is a vasectomy. Conception is no-longer part of the picture. We need single payer universal coverage. Profit for stockholder medical care cost too much in paperwork and needless repeat doctor visits to try to get something simple accomplished. I saw 15 doctors over the years, some 5-6 times trying to get this done. Every single doctor visit cost me a day's travel to see them. Sorry about the rant. This crap burns me up.

[Gacleader1]

I agree. The biggest thing that bothered me is that no one would talk to me unless I had a policy in hand. How the heck are you supposed to make an informed decision if they will not answer questions. I guess that is how they keep people like me from buying a plan, using it for one surgery, and then cancelling the plan.

Of course, then there is the acceptance letter, with a little note on the bottom that this acceptance is not a guarantee that the procedure will be covered.

I was lucky; I already knew my employer considered this to be an exclusion, regardless of what Blue cross said, so when I got the letter of approval, I knew it was wrong. Sure enough, shortly before I actually had my surgery, the correction came. Fortunately before that time, I was finally able to find out that my wife's insurance would cover this, and I was good to go. Still a lot out of my pocket, but far less than going somewhere else, and I had the comfort of knowing I was covered if something bad happened.

That was one nice thing about Dr. Kramer's office. They quoted me an exact price, which by the way looks to be the same price they charged the insurance company.

[mrp2007]

It sounds like US health insurance sucks!
In AU (Medicare) like the UK (NHS) there is basic insurance which is paid with 1.5% income tax.
If I had to wait for an implant on this I'd be on a waiting list for a few years as it would be considered non-urgent.
Then there is private health insurance. We pay approx AUD$6k per year for the family top hospital cover. This gets you the surgeon you want when you want but you usually have to pay them a gap. For this surgery I paid about $5k gap for one of the best here. Medicare (public) covered some of the surgeons fees, assistant surgeon and anaesthetist, . Hospital stay covered by private (I think about $14k). Implant covered by public (due to RP). For my RP I had it done immediately, no waiting list.
Our private also covers most dental, chiro and other things like speech therapy (good for kids).
There are preferred hospitals and providers, but that is only for negotiated rates. They will pay anyone but the gap may be bigger.
Its like kramers gap would be bigger but still largely covered by insurance.
Wouldn't be without private cover, we hammer them hard .

cheers
Mark

[alibaba]

I've heard many good things about insurance in nearly every civilized country in the world beyond the States. My internist who is also a researcher and teaches at universities travels to Costa Rica for his surgical care. Profit driven motives for stockholders in every step of medical care in the states turns it into a horrid nightmare and great expense. In St. Louis where care is cheaper than where I live 2 hours south due to more competition, you can get a dental implant for $3500. In Costa Rica, they recently raised the price from $250 to $300. I have a friend who went down there for his implants. He has insurance and Medicare but still found it cheaper. This summer he told me his regular dentist told him the his implants were the best work he had ever seen.