Insurance approval and cost

The final frontier. Deciding when, if and how.
George03
Posts: 51
Joined: Tue Aug 07, 2018 2:25 am

Re: Insurance approval and cost

Postby George03 » Mon Feb 25, 2019 1:40 pm

I have Aetna also. The doc's office said was approved, then got a bill 6 months after procedure for over $4000, which is more than my deductible. Doc's office said they are filing an appeal, so see how that shakes out. I am not sure why in this day and time, it takes 6 months are longer to receive all the bills, and why a close estimate of costs can't be provided.
Prostate removal August 2017, AMS 700 LGX Implant August 2018 60's, generally good shape and health. PSA zero so far.

Lost Sheep
Posts: 4432
Joined: Mon Jul 04, 2016 11:16 pm

Re: Insurance approval and cost

Postby Lost Sheep » Mon Feb 25, 2019 3:01 pm

Robert51 wrote:What if you havemedicare and va

VA does perform implant surgeries. Dr. Kramer does VA work. My V.A. would not send me to Baltimore and the geographic hurdles for me to have it done there were considerable, but medically were not insurmountable. But my Alaska VA would have sent me to Seattle for Dr. Ostrowski to perform the surgery (he is also highly qualified).

In the end, Dr. Shaw dropped into my lap (pun intended) and I had the implant performed at the military hospital (cooperative sharing with the V.A.) here in Anchorage. (Joint Base Elmendorf-Richardson, JBER) to my great satisfaction.

My cost? zero.
Lost Sheep
AMS LGX 18+3 Nov 6, 2017 Dr Shaw.
READ OLD THREADS to ask better questions and better understand answers.
Make yourself part of your medical team.
Document your current penile size: photos and written records.
Pre-op V.E.D. therapy helps.

SW0110
Posts: 569
Joined: Sun Sep 02, 2018 6:15 pm
Location: Central Kentucky

Re: Insurance approval and cost

Postby SW0110 » Mon Feb 25, 2019 8:15 pm

I have a deductible and a copay. certain procedures the copay is more. Implant is a 15 % copay. We also have a family deductible as well. Max out of pocket for me each year is 10,000. So I pay 15 % of costs pus copay up to a yearly max of the 10 grand. Confusing huh,
18 cm plus 1 rte titan installed March 2019. Revision March 2020 by Dr. Andrew Todd, Richmond KY. He replaced the titan with an AMS 700 LGX 18 cm cylinder plus 2 rte for 20 cm total length.

Robert66
Posts: 655
Joined: Thu Dec 28, 2017 10:39 pm

Re: Insurance approval and cost

Postby Robert66 » Sat Mar 02, 2019 11:57 pm

Lost Sheep wrote:
Robert51 wrote:What if you havemedicare and va

VA does perform implant surgeries. Dr. Kramer does VA work. My V.A. would not send me to Baltimore and the geographic hurdles for me to have it done there were considerable, but medically were not insurmountable. But my Alaska VA would have sent me to Seattle for Dr. Ostrowski to perform the surgery (he is also highly qualified).

In the end, Dr. Shaw dropped into my lap (pun intended) and I had the implant performed at the military hospital (cooperative sharing with the V.A.) here in Anchorage. (Joint Base Elmendorf-Richardson, JBER) to my great satisfaction.

My cost? zero.




WHAT ELSE WILL VA COVER I HAVE A DISABILITY RATING FOR LOSE OF UNIT. SO FAR ALL THEY GIVE IS 2 VIRAGA A MONTH WHICH DONT WORK WONDER IF THEY WILL GIVE TRIMIX OR AT LEAST WRITE THE SCRIPT
edex and tri mix 45/1/27 26 units

bobsteel
Posts: 56
Joined: Fri May 04, 2018 9:22 pm

Re: Insurance approval and cost

Postby bobsteel » Sun Mar 03, 2019 5:52 am

Robert51 wrote:
Lost Sheep wrote:
Robert51 wrote:What if you havemedicare and va

VA does perform implant surgeries. Dr. Kramer does VA work. My V.A. would not send me to Baltimore and the geographic hurdles for me to have it done there were considerable, but medically were not insurmountable. But my Alaska VA would have sent me to Seattle for Dr. Ostrowski to perform the surgery (he is also highly qualified).

In the end, Dr. Shaw dropped into my lap (pun intended) and I had the implant performed at the military hospital (cooperative sharing with the V.A.) here in Anchorage. (Joint Base Elmendorf-Richardson, JBER) to my great satisfaction.

My cost? zero.




WHAT ELSE WILL VA COVER I HAVE A DISABILITY RATING FOR LOSE OF UNIT. SO FAR ALL THEY GIVE IS 2 VIRAGA A MONTH WHICH DONT WORK WONDER IF THEY WILL GIVE TRIMIX OR AT LEAST WRITE THE SCRIPT


For me they covered a couple viagra per month. Muse a few per month. They offered caverject no tri-mix. Implant was free for me.
Married 71 yrs old Implanted 5/30/18. AMX 7oo cx ms 18 cm with 1 cm and 2cm rte. ED for many years. Pills stopped working and injections sort of helped. I sure miss the inch I lost but it works.

jmack858
Posts: 25
Joined: Thu Aug 16, 2018 9:50 am

Re: Insurance approval and cost

Postby jmack858 » Sun Mar 03, 2019 8:00 pm

I'm retired Military with Tricare Prime. I paid a $30 co-pay for all my Dr visit to urologist. For Implant and 2 day hospital stay I paid Zero.$$
60 years old , Mild ED since mid 30's tried all the pills, trimix, Implanted with Titan Touch 22cm + 3cm rte 11/13/18 by Dr Rayford
Memphis

Robert66
Posts: 655
Joined: Thu Dec 28, 2017 10:39 pm

Re: Insurance approval and cost

Postby Robert66 » Sun Mar 03, 2019 9:31 pm

bobsteel wrote:
Robert51 wrote:
Lost Sheep wrote:VA does perform implant surgeries. Dr. Kramer does VA work. My V.A. would not send me to Baltimore and the geographic hurdles for me to have it done there were considerable, but medically were not insurmountable. But my Alaska VA would have sent me to Seattle for Dr. Ostrowski to perform the surgery (he is also highly qualified).

In the end, Dr. Shaw dropped into my lap (pun intended) and I had the implant performed at the military hospital (cooperative sharing with the V.A.) here in Anchorage. (Joint Base Elmendorf-Richardson, JBER) to my great satisfaction.

My cost? zero.




WHAT ELSE WILL VA COVER I HAVE A DISABILITY RATING FOR LOSE OF UNIT. SO FAR ALL THEY GIVE IS 2 VIRAGA A MONTH WHICH DONT WORK WONDER IF THEY WILL GIVE TRIMIX OR AT LEAST WRITE THE SCRIPT


For me they covered a couple viagra per month. Muse a few per month. They offered caverject no tri-mix. Implant was free for me.[/quote



DID YOU ASK FOR THE CAVERJET AND MUSE I HAVE A YEARLY VISIT COMING UP AND WILL SEE MY PRIMARY DOC
edex and tri mix 45/1/27 26 units

Lost Sheep
Posts: 4432
Joined: Mon Jul 04, 2016 11:16 pm

Re: Insurance approval and cost

Postby Lost Sheep » Wed Aug 12, 2020 7:50 pm

Robert66 wrote:
Lost Sheep wrote:
Robert51 wrote:What if you havemedicare and va

VA does perform implant surgeries. Dr. Kramer does VA work. My V.A. would not send me to Baltimore and the geographic hurdles for me to have it done there were considerable, but medically were not insurmountable. But my Alaska VA would have sent me to Seattle for Dr. Ostrowski to perform the surgery (he is also highly qualified).

In the end, Dr. Shaw dropped into my lap (pun intended) and I had the implant performed at the military hospital (cooperative sharing with the V.A.) here in Anchorage. (Joint Base Elmendorf-Richardson, JBER) to my great satisfaction.

My cost? zero.




WHAT ELSE WILL VA COVER I HAVE A DISABILITY RATING FOR LOSE OF UNIT. SO FAR ALL THEY GIVE IS 2 VIRAGA A MONTH WHICH DONT WORK WONDER IF THEY WILL GIVE TRIMIX OR AT LEAST WRITE THE SCRIPT

I educated myself to the point where my primary care physician remarked that I knew more about erectile function and dysfunction and treatments than he did. I made myself a part of the medical care team and he accepted my inputs. I had no problem getting his recommendation for a urological surgeon outside the VA and from there, implantation was the prime option. Summary advice: Get each member of your medical care team on board with whatever you want to do.
Lost Sheep
AMS LGX 18+3 Nov 6, 2017 Dr Shaw.
READ OLD THREADS to ask better questions and better understand answers.
Make yourself part of your medical team.
Document your current penile size: photos and written records.
Pre-op V.E.D. therapy helps.

Old Guy
Posts: 499
Joined: Tue Mar 31, 2020 4:31 pm
Location: Ohio

Re: Insurance approval and cost

Postby Old Guy » Wed Aug 12, 2020 7:55 pm

Implants are not cheap, for sure. After the office cleared the cost with my insurance (UHC) my co-pay was still almost $3,000 plus the doc for $350. Surgery in Nov, 3 months later I get a bill from the uro office for $14,000. Billing calls me, update my info for the new year with my insurance. If the surgery was last year, why does it matter this year? Long story short, updated info with insurance and bill got paid. Whew!
68 years old when Coloplast Titan OTR implanted 11-08-2019. Viagra, Trimix, QuadMix all failed after a while. Married to my beautiful 17 year younger wife for 32+ years. As much as it was a tough recovery for me I'm glad I had it done.


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