In Jan 2011, I had an AMS 700 and 800 done in same surgery. both were covered by Medicare and my secondary insurance. Earlier this year I was evaluated for a revision of my AMS 800, artificial sphincter. As I was thinking about it, my AMS 700LGX failed. Apparently a sudden and serious leak. So, I contacted Dr. Lipschultz's office to schedule another dual implant operation and they said that Medicare now will not pay for both operations to be done at the same time. They must be done separately in order to be covered.
Has anybody had this issue? Is there a work around or can this be appealed?
no more AMS 1500?
no more AMS 1500?
age 74 married, Robotic RP Dec.2009. Implanted Jan 2011 with AMS 700LGX and AMS 800 AUS. (AMS 1500). IPP failed March 2018 , leak. Planning an AUS revision (total replacement) in 2018, now I need the IPP too.
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Larry10625
Re: no more AMS 1500?
knotreel wrote:In Jan 2011, I had an AMS 700 and 800 done in same surgery. both were covered by Medicare and my secondary insurance. Earlier this year I was evaluated for a revision of my AMS 800, artificial sphincter. As I was thinking about it, my AMS 700LGX failed. Apparently a sudden and serious leak. So, I contacted Dr. Lipschultz's office to schedule another dual implant operation and they said that Medicare now will not pay for both operations to be done at the same time. They must be done separately in order to be covered.
Has anybody had this issue? Is there a work around or can this be appealed?
You would think it would be covered as a general aesthetic once is much safer and you would think it would be less expensive because of everything being done while you are asleep all in one go.
Larry
Re: no more AMS 1500?
not to mention the cost of the operating room and hospital admissions and rooms
age 74 married, Robotic RP Dec.2009. Implanted Jan 2011 with AMS 700LGX and AMS 800 AUS. (AMS 1500). IPP failed March 2018 , leak. Planning an AUS revision (total replacement) in 2018, now I need the IPP too.
Re: no more AMS 1500?
Could it just be a billing issue? What if the doctor submits two separate bills to Medicare, one for the AMS 700 procedure and one for the 800? Does Medicare require a waiting period between two procedures? Ask the doctor's billing department, must be a way to do this.knotreel wrote:... they said that Medicare now will not pay for both operations to be done at the same time. They must be done separately in order to be covered?
Implant - Dr Eid 12/2017, Titan Touch 20/21cm no RTE, 125cc reservoir
Re: no more AMS 1500?
good point. I am wondering if the fact that both of theses operations are revisions to previous surgeries will make a difference. I was surprised and didn't ask many questions when they told me
age 74 married, Robotic RP Dec.2009. Implanted Jan 2011 with AMS 700LGX and AMS 800 AUS. (AMS 1500). IPP failed March 2018 , leak. Planning an AUS revision (total replacement) in 2018, now I need the IPP too.
Re: no more AMS 1500?
Just like the stupid rule. You can not have 2 office visits on consecutive days. Have to have one day in between. BUT if you stay in a hospital($$$$$) the doc can come see you every day. Govt + medicare =stipid rules
82, good health, RP 7-2017, all nerves taken , PSA 0.05, 4-18,, .07 1/19,.05 4/19, .03 11-21, .04 11-23, implanted 4-1-18, Infra-pubic, AMS lgx 15 cm with 5cm rte. Implant at USC Keck. Dr Boyd and Dr Loh Doyle 6.5 x 5, 800 AUS 7-21-20
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Baseballfan11
- Posts: 216
- Joined: Thu Mar 29, 2018 3:13 am
Re: no more AMS 1500?
knotreel wrote:In Jan 2011, I had an AMS 700 and 800 done in same surgery. both were covered by Medicare and my secondary insurance. Earlier this year I was evaluated for a revision of my AMS 800, artificial sphincter. As I was thinking about it, my AMS 700LGX failed. Apparently a sudden and serious leak. So, I contacted Dr. Lipschultz's office to schedule another dual implant operation and they said that Medicare now will not pay for both operations to be done at the same time. They must be done separately in order to be covered.
Has anybody had this issue? Is there a work around or can this be appealed?
I have an appointment with Lipshultz soon. What should I expect from him?
26 years old. USA. ED problem since teenage years. Doctor prescribed ED meds showing some efficacy but not a guarantee. As much as I’d like the implant I now think I should hold off if I’m seeing some results from pills
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Larry10625
Re: no more AMS 1500?
knotreel wrote:good point. I am wondering if the fact that both of theses operations are revisions to previous surgeries will make a difference. I was surprised and didn't ask many questions when they told me
I would hope that's not it... the revisions could be because of faulty equipment not lack of skill.
Larry
Re: no more AMS 1500?
Baseballfan11 wrote:knotreel wrote:In Jan 2011, I had an AMS 700 and 800 done in same surgery. both were covered by Medicare and my secondary insurance. Earlier this year I was evaluated for a revision of my AMS 800, artificial sphincter. As I was thinking about it, my AMS 700LGX failed. Apparently a sudden and serious leak. So, I contacted Dr. Lipschultz's office to schedule another dual implant operation and they said that Medicare now will not pay for both operations to be done at the same time. They must be done separately in order to be covered.
Has anybody had this issue? Is there a work around or can this be appealed?
I have an appointment with Lipshultz soon. What should I expect from him?
you should expect a good result. I am totally satisfied with his work and hope this "billing" issue can be resolved.
age 74 married, Robotic RP Dec.2009. Implanted Jan 2011 with AMS 700LGX and AMS 800 AUS. (AMS 1500). IPP failed March 2018 , leak. Planning an AUS revision (total replacement) in 2018, now I need the IPP too.
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