Implant Cost without Insurance Coverage

[antelope]

Askew,

Implant guys suggest that ice packs and pain meds are your best friends for the next several days. Good luck. Hope you feel better soon.

Greg

[KMeister]

I posted this message at another web site but some of the points are quite relevant here:

I recently saw a Clark Howard program in which he said when paying for health care out of pocket an individual should, whenever possible, negotiate with the doctor and hospital ahead of time. Mr. Howard suggests first telling the health caregivers that you plan to pay for your procedure out of pocket, then negotiating the costs up front and not simply paying with your credit card. He said it is very helpful to find out what the insurance companies allow for a procedure and starting with that figure. (If Aetna or Human pay $10,000 for a procedure, why should you pay $20,000?)

Another idea is to go out and buy health insurance on your own. Let's say you find coverage for $500 a month, even $1000 a month. That's still better than shelling out 20 grand. Of course, make sure you don't sign on with a company that excludes pre-existing conditions. There are independent brokers who can help you find health insurance, just like others hunt for mortgages or car insurance or life insurance.

I also recommend checking into a private loan (bank, credit union)rather than paying by credit card. The interest rate would be far lower.

One last thought: Just because some bean-counter who works for your insurance company says the company won't pay, that doesn't mean they won't pay. There is an appeals process within your insurance company that might work for you. (I've appealed with three different employee health plans and have and won all three times.) Also, your doctor might be able to code the surgery a certain way in order to get you coverage; two of the most common are post-cancer or Peyronie's Disease treatment.

These are just thoughts off the top of my head. Good luck!

KMeister

[blacke8184]

Since this general post is in regard to cost of the procedure I thought I should make a comment here.
As was pointed out in rimmy's initial post, I paid $15,000.00 for total cost of the implant, Dr.Williams fee, the surgery center and anesthesia fee!
This is by far the least expensive of the pre-mentioned posts. I would add that Dr. Williams was very professional and competent(sp?)
Also, the procedure was performed outpatient! Again, if you are in generally good health there is no reason why it can not be done outpatient.
I'm very pleased with the outcome. I would recommend that anyone considering an implant. See Dr. Williams(Williams Urology on the net) for a consultation

Blacke

[rlm1818]

Illuminist and bill1200 --

In re-reading some of your posts, it seems that you spent one night in the hospital. Is that right? Your costs seem pretty good for a one night hospital stay. Thanks.

[rlm1818]

I met with Dr Eid, and got a quote based on no insurance coverage (they checked with my insurer and confirmed no coverage) of just under $29,000 for everything including the pre-surgical testing that Eid requires. Eid's fee, allegedly discounted due to my no insurance situation, is over half the total. As far as I can tell, the primary difference between Eid and the others (Karpman, Milam, Williams) is the surgeon fee.

[Illuminist]

Illuminist and bill1200 --

In re-reading some of your posts, it seems that you spent one night in the hospital. Is that right? Your costs seem pretty good for a one night hospital stay. Thanks.

Yes I spent the night in the hospital. About 24hrs altogether. I was given all the morphine I wanted lol, and they sent me home with some percocets added to what Dr.Karpman prescribed. I also was able to eat like a pig too.

[shpargel]

My Insurance is only paying the Hospital Bill which is $10,400. I have to pay $5350. Surgical Fee and $450. Anesthesia Fee The Hospital Bill includes the Implant. Total $16200.

[ArtFirn]

I received an LGX on 1/11/12. I am covered by Medicare and have a supplement which picks up almost everything else. The summary I received from Medicare is unbelievable. Physician charges ( 2 surgeons were present) $16528. Medicare approved and paid $663.48. My supplement paid $305.87. The balance was disallowed. Anethesiologist charges $3870, Total approved and paid $288.20. I have not seen anything on the cost of the one night stay in the surgicenter. If these figures are correct, I can understand why doctors are becoming a little bit reluctant to accept medicare assignment.

[studley1]

Don't have all the bills yet but Hospital $24000. Surgeon $5000. Anesthesia $1200. all rounded and approx. Out of pocket after medicare and bcbs about $200.

Like someone said "Priceless"!

[barfinkl1]

I had my LGX surgery back on 7 Nov 11 and just now got my explanation of benefits...I too have Anthem BC/BS but mine is the federal Employee Program. I also have Tricare, which is government insurance for military retirees. Here's a breakdown of my costs so far. I'm also including the costs of the preop workup, as it was required for the surgery. This should be it:

Echo Cardiogram and EKG Billed $ 800.00 Paid $ 539.35
Inpatient Physician Visit Billed 204.00 Paid 0.00
Anesthesia Services Billed 2,324.00 Paid 980.00
Surgeon Billed 2,451.00 Paid 1,047.64 (two surgeons were present)
Presurgery Exam by uro Billed 436.00 Paid 140.70
Implant Surgery Billed 34,363.59 Paid 13,274.98 (stayed one night in the hospital)

TOTALS Billed $40,578.59 Paid $15,982.67

I have to assume this is all as I haven't seen any others come along. So the bill for just the surgery was about $40,000 and they were paid about $15,000. Because I have two good insurance policies (I'm very fortunate), I have no out-of-pocket expenses.

I don't know how this works if you don't have insurance, because the amount the insurance company pays for services is based on an agreement between them. Nonetheless, I hope this will help.