A disappointing setback

The final frontier. Deciding when, if and how.

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OregonStrong
Posts: 146
Joined: Mon Mar 02, 2020 10:15 pm

A disappointing setback

Postby OregonStrong » Mon Jun 01, 2020 5:02 pm

So Kramer's office called, their insurance person who does precertification called my insurance provider and it appears implants are a plan exclusion. I thought I had good insurance but my employer is self funded for insurance costs and therefore they probably made decisions to keep costs down for all employees which I understand. This sucks though. I dont have $24,000 to pay out of pocket. Gonna talk to my HR to see what can be done. Didnt want anyone in my company knowing about this, but unavoidable now. This is disheartening. May have to cancel the surgery now. I dont want to wait til I'm 65 and Medicare to fix this.
46 yrs old. E.D. issues started around age 35, combo venous leak/testicular failure. Bilateral testicular implants for severely atrophic testes. Implanted 6/11/20 Dr. Kramer LGX 21cm + 1.

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Happy Toy
Posts: 738
Joined: Fri May 11, 2018 9:30 am

Re: A disappointing setback

Postby Happy Toy » Mon Jun 01, 2020 6:14 pm

So sorry to hear this! I hope something can be worked out for you. Good sex is just as important to a healthy life as any other health issue, what don't they understand about that??? Keep fighting for it.
Best of luck, Andy
Implanted 6/26/2018, Coloplast Titan 20cm, no RTE'S, infra pubic, Dr. Rhee, Kaiser :o 8-) 76yrs., married 53 yrs. ED for over 20 yrs.

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Masonjames
Posts: 95
Joined: Sat Mar 16, 2019 3:54 pm
Location: Georgia

Re: A disappointing setback

Postby Masonjames » Mon Jun 01, 2020 7:08 pm

OregonStrong wrote:So Kramer's office called, their insurance person who does precertification called my insurance provider and it appears implants are a plan exclusion. I thought I had good insurance but my employer is self funded for insurance costs and therefore they probably made decisions to keep costs down for all employees which I understand. This sucks though. I dont have $24,000 to pay out of pocket. Gonna talk to my HR to see what can be done. Didnt want anyone in my company knowing about this, but unavoidable now. This is disheartening. May have to cancel the surgery now. I dont want to wait til I'm 65 and Medicare to fix this.


So sorry to hear that. I know you're disappointed

medhatg
Posts: 289
Joined: Thu Sep 14, 2017 10:34 pm

Re: A disappointing setback

Postby medhatg » Mon Jun 01, 2020 7:53 pm

OregonStrong wrote:So Kramer's office called, their insurance person who does precertification called my insurance provider and it appears implants are a plan exclusion. I thought I had good insurance but my employer is self funded for insurance costs and therefore they probably made decisions to keep costs down for all employees which I understand. This sucks though. I dont have $24,000 to pay out of pocket. Gonna talk to my HR to see what can be done. Didnt want anyone in my company knowing about this, but unavoidable now. This is disheartening. May have to cancel the surgery now. I dont want to wait til I'm 65 and Medicare to fix this.


Dr. Hakky now has an option to do it at his office for just $16,000 all in. Just wanted to mention it in case you have to pay out of pocket.

OregonStrong
Posts: 146
Joined: Mon Mar 02, 2020 10:15 pm

Re: A disappointing setback

Postby OregonStrong » Mon Jun 01, 2020 8:02 pm

Makes me wonder, if they won't cover the initial placement, what would happen if I had some complication like an infection and need to have it removed, a salvage operation done, would they then deny coverage in those situations also? That could quickly bankrupt a person. I don't want to get into anything that I don't have insurance to back me up on for any complications.
46 yrs old. E.D. issues started around age 35, combo venous leak/testicular failure. Bilateral testicular implants for severely atrophic testes. Implanted 6/11/20 Dr. Kramer LGX 21cm + 1.

OregonStrong
Posts: 146
Joined: Mon Mar 02, 2020 10:15 pm

Re: A disappointing setback

Postby OregonStrong » Mon Jun 01, 2020 8:04 pm

medhatg wrote:
OregonStrong wrote:So Kramer's office called, their insurance person who does precertification called my insurance provider and it appears implants are a plan exclusion. I thought I had good insurance but my employer is self funded for insurance costs and therefore they probably made decisions to keep costs down for all employees which I understand. This sucks though. I dont have $24,000 to pay out of pocket. Gonna talk to my HR to see what can be done. Didnt want anyone in my company knowing about this, but unavoidable now. This is disheartening. May have to cancel the surgery now. I dont want to wait til I'm 65 and Medicare to fix this.


Dr. Hakky now has an option to do it at his office for just $16,000 all in. Just wanted to mention it in case you have to pay out of pocket.


I feel I don't want to get into a situation of trying to find the best bargain basement price to run into dealing with this issue. I have read some people not too happy with their outcomes with Dr. Hakky, but that may be more of an issue of the type of implant, pump failures than him per se, but gives me pause. I also have the added complication that I may be higher infection risk due to previous work I've had done on my penis, having testicular implants and some girth fillers which could introduce infection risks as a bigger concern.
46 yrs old. E.D. issues started around age 35, combo venous leak/testicular failure. Bilateral testicular implants for severely atrophic testes. Implanted 6/11/20 Dr. Kramer LGX 21cm + 1.

Larryb8x8
Posts: 70
Joined: Mon Sep 23, 2019 12:48 pm

Re: A disappointing setback

Postby Larryb8x8 » Mon Jun 01, 2020 8:13 pm

Wrong wrong wrong you have testicular implants they will do anything for you. play your I card say you want to complete transexual change and I guarantee they'll be paying for your implant. Nothing against transsexual people but insurance people will jump right now because of the situation in America
Larryb8x8, married straight Titan three pieces 22cm 3 rte. Implant 12/30/19. Dr. Prichart in Tulsa. Was 7.5 girth and 8 inch long After surgery so far 7.0 girth and 7.5 inch long. Doin well ninety pumps to Max him out.

OregonStrong
Posts: 146
Joined: Mon Mar 02, 2020 10:15 pm

Re: A disappointing setback

Postby OregonStrong » Mon Jun 01, 2020 8:34 pm

Larryb8x8 wrote:Wrong wrong wrong you have testicular implants they will do anything for you. play your I card say you want to complete transexual change and I guarantee they'll be paying for your implant. Nothing against transsexual people but insurance people will jump right now because of the situation in America


I know you're being funny, but I am not going to be a dishonest person and lie about conditions to get things approved, even if others do it all the time, just would never feel right about myself doing something like that. I'll keep my fingers crossed that we can come up with some type of workaround. I do have a flexible spending account through work, but that is only going to get me up to $2700 total (max yearly contribution I can have by law), and I've already spent it for the year on other medical expenses, so would have to wait until next year to be able to use it again, but that barely eats into the total cost of this procedure.
46 yrs old. E.D. issues started around age 35, combo venous leak/testicular failure. Bilateral testicular implants for severely atrophic testes. Implanted 6/11/20 Dr. Kramer LGX 21cm + 1.

Gt1956
Posts: 622
Joined: Fri Apr 05, 2019 2:47 pm

Re: A disappointing setback

Postby Gt1956 » Mon Jun 01, 2020 9:39 pm

OregonStrong wrote:
medhatg wrote:
OregonStrong wrote:So Kramer's office called, their insurance person who does precertification called my insurance provider and it appears implants are a plan exclusion. I thought I had good insurance but my employer is self funded for insurance costs and therefore they probably made decisions to keep costs down for all employees which I understand. This sucks though. I dont have $24,000 to pay out of pocket. Gonna talk to my HR to see what can be done. Didnt want anyone in my company knowing about this, but unavoidable now. This is disheartening. May have to cancel the surgery now. I dont want to wait til I'm 65 and Medicare to fix this.


Dr. Hakky now has an option to do it at his office for just $16,000 all in. Just wanted to mention it in case you have to pay out of pocket.


I feel I don't want to get into a situation of trying to find the best bargain basement price to run into dealing with this issue. I have read some people not too happy with their outcomes with Dr. Hakky, but that may be more of an issue of the type of implant, pump failures than him per se, but gives me pause. I also have the added complication that I may be higher infection risk due to previous work I've had done on my penis, having testicular implants and some girth fillers which could introduce infection risks as a bigger concern.

I posted the other day about this. My Aetna plan specifically states that a malfunctioning implant is covered. So not all hope is lost. Be sure to read all the fine print.
63 HBP at 40 high triglycerides at 45 Type 2 at 60

Old Guy
Posts: 219
Joined: Tue Mar 31, 2020 4:31 pm
Location: Ohio

Re: A disappointing setback

Postby Old Guy » Mon Jun 01, 2020 9:47 pm

Major bummer on insurance company. One thing that comes to mind, no implants? What if you blew out a knee and needed an implant? Arthritic hip?
Is your primary physician documenting your ED issues? Have they made a urology referral? Another issue that comes with ED is depression, and insurance companies usually want to avoid dealing with (paying for) therapy or drugs for that. That news alone is depressing, and at your age even more depressing.

Keep pushing for it.
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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