How Can I Pay for an Implant?

[alterr]

I called Dr. Eid's office and hes expensive when it comes to implant surgery. I'd like to know what can be my options to financially pay for this?

[flyweed]

would love to know his price..if you'd care to share. I don't even know what mine is going to cost, as my insurance covers it.

[roksolid]

I called Dr. Eid's office and hes expensive when it comes to implant surgery. I'd like to know what can be my options to financially pay for this?

Alterr,

When I started this (after I had gotten a lot of information, but before I had seen a surgeon), I dealt with insurance first. After seeing no outright exclusion in my Summary of Benefits document, I called mine up (Care First BC/BS in the Mid-Atlantic region) and asked them if my benefits covered a CPT procedure code of 54405 (implantation of a two or three piece penile prosthesis) with a diagnosis code of N52.9 (erectile dysfunction, other cause). I didn't have to tell them it was penile or anything, just look up the codes. They said it was a covered benefit.

This was really helpful when talking to my surgeon, who had assumed that he would have to step through intermediate treatments I really don't care to deal with. He was fine with it.

Once I talked to his medical billing office I found out I was right, only the doctor set the diagnosis for my case at N52.03 (erectile dysfunction, organic cause).

rok

[Bigred]

Pick a surgeon. Have them do the pre-authorization with your insurance ( they know the correct codes). Most surgeon have a lesser price for those with no insurance coverage. Get a quote in writing. If you need financing,, ask about options.

[alterr]

When I started this (after I had gotten a lot of information, but before I had seen a surgeon), I dealt with insurance first. After seeing no outright exclusion in my Summary of Benefits document, I called mine up (Care First BC/BS in the Mid-Atlantic region) and asked them if my benefits covered a CPT procedure code of 54405 (implantation of a two or three piece penile prosthesis) with a diagnosis code of N52.9 (erectile dysfunction, other cause). I didn't have to tell them it was penile or anything, just look up the codes. They said it was a covered benefit.

This was really helpful when talking to my surgeon, who had assumed that he would have to step through intermediate treatments I really don't care to deal with. He was fine with it.

Once I talked to his medical billing office I found out I was right, only the doctor set the diagnosis for my case at N52.03 (erectile dysfunction, organic cause).

Hi roksolid,

I called my insurance which is Fidelis (bundled with medicaid) and a rep there said I'm eligible! The only thing is that I need an 'Authorization Request'. Basically its getting an approcal letter from the doc. The problem with this is that Dr. Eid doesnt take Fidelis. And so far hes the only surgeon I trust. What do you recommend?

[Larry10625]

When I started this (after I had gotten a lot of information, but before I had seen a surgeon), I dealt with insurance first. After seeing no outright exclusion in my Summary of Benefits document, I called mine up (Care First BC/BS in the Mid-Atlantic region) and asked them if my benefits covered a CPT procedure code of 54405 (implantation of a two or three piece penile prosthesis) with a diagnosis code of N52.9 (erectile dysfunction, other cause). I didn't have to tell them it was penile or anything, just look up the codes. They said it was a covered benefit.

This was really helpful when talking to my surgeon, who had assumed that he would have to step through intermediate treatments I really don't care to deal with. He was fine with it.

Once I talked to his medical billing office I found out I was right, only the doctor set the diagnosis for my case at N52.03 (erectile dysfunction, organic cause).

Hi roksolid,

I called my insurance which is Fidelis (bundled with medicaid) and a rep there said I'm eligible! The only thing is that I need an 'Authorization Request'. Basically its getting an approcal letter from the doc. The problem with this is that Dr. Eid doesnt take Fidelis. And so far hes the only surgeon I trust. What do you recommend?

You may have to put your trust in someone else or, find another way to pay for it.

Larry

[roksolid]

I called my insurance which is Fidelis (bundled with medicaid) and a rep there said I'm eligible! The only thing is that I need an 'Authorization Request'.

An "authorization request" seems like Fidelis-speak for a pre-approval letter.

The problem with this is that Dr. Eid doesnt take Fidelis. And so far hes the only surgeon I trust. What do you recommend?

Are you going to Eid because he's local, or because of his track record? If it is the latter and you're willing to travel, Kramer might take Fidelis, but ultimately it is up to you. You might try to get a list of urological surgeons from Fidelis and start to work from there...but doesn't Medicare kick in for some of this too?

rok

[alterr]

You may have to put your trust in someone else or, find another way to pay for it.

Larry

Hi larry,

Dr. Eid has a $27,000 package which is good I guess since I've heard that surgeries from other docs can run as high as $60,000. But he's not available until end of July which sucks.

[alterr]

Are you going to Eid because he's local, or because of his track record? If it is the latter and you're willing to travel, Kramer might take Fidelis, but ultimately it is up to you. You might try to get a list of urological surgeons from Fidelis and start to work from there...but doesn't Medicare kick in for some of this too?

rok

For both reasons. I dont mind traveling as long as Kramer accepts Fidelis and Fidelis can cover the surgery out of state. I'm in NYC and I think Kramer is in Baltimore, if this is correct.

As to your other question, I dont qualify for Medicare so I dont know.

--- EDIT ---
Fidelis policy will NOT cover med expenses out my state which is NY.

[Maverick2dog]

There are good surgeon that will do it for less than $20,000.