Cost Of A Replacement Out Of Pocket And with Insurance

[Vagabond127]

I'm getting an implant soon. Medicare is covering 80%. How much less will a replacement surgery cost if Medicare still pays for implants? Also, how much would a replacement sugery cost if I have to pay 100% out of pocket? Just estimated figures.

THANKS!!

[alibaba]

I am still getting used to what Medicare pays and does not. My wife has had Medicare for 5 months now. I've 9 years to go myself. Isn't there a limit on your out of pocket that caps your 20% copay? I would think a supplemental policy would be a good idea to pay the out of pocket cost of your implant. A few hundred in premiums would certainly be better than a $4,000 bill. If shopping for a supplemental you should ask if it covers procedure code 54405 ( Insertion of Multi-component Penile Prosthesis) and N52.9 ( Diagnosis code for ED). I am not certain if this is the current ICD10 code Medicare is using or the old ICD9 code as the new code went into effect in October which I think was about the same time I was looking up codes. If the code is not covered, find a different supplemental. You can convert old codes to new codes using this program if they are old but keep in mind some codes will not convert as they have added MANY sub codes and more specific definitions. Hope this helps you some. d http://www.icd10data.com/Convert

[firstcav46]

I had Medicare, with a supplement, and had my implant done at Vanderbilt University Medical Center. The total charge to my insurance companies was roughly $75,000. I paid zero.

[palace01]

I have Medicare with Medigap. When I see people quoting $25k for EVERYTHING with Eid, I cannot believe that MY hospital charged $85k (for 24 hours) when implanted by Cornell 6 weeks ago. Especially after spending 6 hours in recovery room JUST waiting for a room !

After deducting $69 as non-covered, Medicare paid them the full $85k at 100% (Part-A Hospitalization).
Unless there are other EOBs that I haven't seen yet, Cornell claimed $4500. Medicare paid him $1215 ( 80% of their Fee Schedule) and my Medigap paid him the remaining 20% ($303).

I would be interested to know how it works if a Revision is needed AND ESPECIALLY if revision done by a different Surgeon.

I decided to look back at my Hospital Fee for Prostate Surgery 2 years ago at a different hospital where I stayed TWO nights. Again I may be missing an EOB but from what I can see it was $27k

btw I too paid ZERO