Insurance and the "rock star" docs.

The final frontier. Deciding when, if and how.
eisenhower
Posts: 16
Joined: Thu Mar 12, 2015 5:34 pm

Insurance and the "rock star" docs.

Postby eisenhower » Sat Jun 13, 2015 6:31 pm

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
Posts: 1159
Joined: Mon Apr 25, 2011 9:34 am

Re: Insurance and the "rock star" docs.

Postby dg_moore » Sat Jun 13, 2015 7:47 pm

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.
Dave, 74, Maryland - Implant (Titan) 2008 by Dr. Andrew Kramer - never used due to a stroke that, among other things, ended my sex life.
Life is not the way it's supposed to be, it's the way it is.

eisenhower
Posts: 16
Joined: Thu Mar 12, 2015 5:34 pm

Re: Insurance and the "rock star" docs.

Postby eisenhower » Sat Jun 13, 2015 9:55 pm

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
Posts: 446
Joined: Sun Aug 28, 2011 5:43 pm

Re: Insurance and the "rock star" docs.

Postby KMeister » Sun Jun 14, 2015 3:06 am

eisenhower wrote: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
Posts: 313
Joined: Sat Feb 28, 2015 1:50 pm

Re: Insurance and the "rock star" docs.

Postby RelievedofED1 » Sun Jun 14, 2015 7:16 am

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.
61 year old with ED intermittently for years constant for 2 years. Tried all the treatments. AMS CX 21cm plus 1 cm RTEs implanted by Dr Kramer April 29, 2015. Great choice for me both the implant and surgeon.

dg_moore
Posts: 1159
Joined: Mon Apr 25, 2011 9:34 am

Re: Insurance and the "rock star" docs.

Postby dg_moore » Sun Jun 14, 2015 9:02 am

eisenhower wrote: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.
Dave, 74, Maryland - Implant (Titan) 2008 by Dr. Andrew Kramer - never used due to a stroke that, among other things, ended my sex life.
Life is not the way it's supposed to be, it's the way it is.

eisenhower
Posts: 16
Joined: Thu Mar 12, 2015 5:34 pm

Re: Insurance and the "rock star" docs.

Postby eisenhower » Sun Jun 14, 2015 7:54 pm

Thanks, all. Very helpful.

eisenhower

firstcav46
Posts: 73
Joined: Sat Mar 10, 2012 3:25 am

Re: Insurance and the "rock star" docs.

Postby firstcav46 » Wed Jun 17, 2015 11:36 pm

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.
71. Married 35 yrs to sexy woman; ED at 62; pills/injections eventual fails; AMS implant 5/29/14 (Dr. Milam); yr later - severe burning, pain around shaft on inflation. Remove & replace with Coloplast Titan 10/18/17 (Dr. Kramer).
Auburn, Ala.


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