My Negative experience with Dr. Kramer's office

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AST2123
Posts: 3
Joined: Tue Jul 28, 2020 7:54 am

My Negative experience with Dr. Kramer's office

Postby AST2123 » Sat Aug 01, 2020 3:47 pm

Many of you guys may find my post surprising, as from what I read here for several months, all are positive experiences with Dr. Kramer, which reflects his quality and skills. I really hate to criticize a successful surgeon like him.
I am not sharing my experience to discourage anyone from seeking treatment with Dr. Kramer. I believe he is a top surgeon, and if you have no issues with insurance, your process would go smoothly, and you will be giving a 5-star rating to everyone on the team. That was what I thought my path will be. I even suggested to a business partner of me, who literally has the biggest medical tourism establishment covering Europe, North Africa, and Middle East, to add implants surgeons Dr. Kramer and Dr. Eid to the network, but due to the Covid-19 situation and the fact that it is difficult to convince someone who doesn’t know the benefits of this surgery about it, without trying it yourself.
I have to post my issue here, because I know, with the way they are dealing with it now, I will be denied and can’t do it before next year.
My issue is with his office processes. I had and still having hard time communicating with his office
I had my prostatectomy performed in 2017, due to cancer, which was contained within the prostate. I had to do sperm banking before the surgery, and ever since that surgery, my wife and I had the most terrible days, and still having.
My wife had 2 IUI cycles before my surgery and one with stored sperm after the surgery, all unsuccessful for no reasons other than careless doctors.
My journey started, when I, after thorough search, contacted dr. Kramer’s office for scheduling the procedure, back in April. I got a reply from Jose Rodriguez, then a call from Dr. Kramer, stating that I will be informed when MD is reopened and medical procedures resume.
In May, I contacted the clinic again and this time Danielle replied that surgeries will start on June 11th. I was happy with that and requested an appointment on June 25th. I had a concern about a hernia, for which Dr. Kramer confirmed it is not an issue. I also asked Danielle if my insurance is going to cover it, she confirmed that she spoke to my insurance company, gave them the code, and they said it is covered with a co-pay.
As requested, I got all the surgery packet files, filled up all the forms, with the true facts, (made sure throughout the process to mention every fact as is) to avoid any problem with insurance.
I was then contacted by Leslie, billing specialist I think, who informed me about the copay, which was little more than 3000$, which wasn’t available with me at that time, but she gave me a couple of payment options that were reasonable. With my wife set to have IUI cycle in June itself, and after long discussions and arguments, I decided to postpone the surgery to July, and informed Danielle about that.
A week or so later, I requested another appointment on Thursday July 23rd. Both times I selected Thursdays because as I work from home as a programmer, I could rest Friday and weekend.
I filled up the information again, and waited for the insurance approval, followed up with Danielle, a couple of times, latest was on July 6th, and still there was no approval.
On Friday July 10th, Danielle emailed me the surgery packet, that my procedure is on 23rd , at 5pm, should be there at 4pm, please do the tests, etc. I literally wrote (This is good news. I was waiting for this confirmation), as I thought that she already received the approval. My reply to her was at 4.20pm, and I got OOO automatic reply, that she will be back returning all messages on July 14th. I had some questions about doing the tests, specially there was a Covid19 test required, and she mentioned that I have to give her the details about the place, I believe a request should be initiated by the provider. I scheduled an appointment with a lab immediately on Monday 13th, and sent her 2 or 3 emails, then summarized all my question and told her I grouped my questions in one email to make it easy for her.
I refilled the forms including the insurance request to access my medical records. I did the blood test and had to find a facility where I can do the EKG, and could find one. Remaining was the Covid test. I found a facility near that perform the test (call before you come) and sent her the details of the location. When I called them, they said they can do it only if the patient is referred to the provider by them. I checked another facility (patient first) and informed Danielle. On Tuesday, I didn’t get a reply from Danielle, and same on Wednesday 15th. I was really worried, only 8 days away from my surgery, and still uncertain. I texted Dr. Kramer wondering if the procedure is still in place, thankfully replied back in less than 10 minutes, stating that she is on vacation, and schedule is supposed to be the same. An hour or 2 later Danielle replied to my questions, and informed that she called Patient first. I immediately talked to them, and the nearest appointment was Monday 20th, that is 3 days before my surgery, and results will take 7-10 days. They suggested CVS. I scheduled an appointment the next day (Thursday) in a location 20 mins from my home, and did the test there. On Friday, I did the EKG test, and confirmed to Danielle by email that I did all the required tests.
Everything is fine so far, until on Monday 20th, I received a letter in the mail from my insurance with a Claimant form enclosed. I had to fill this form and return it asap. I just put the same details that the clinic put in the form sent to me before (Erectile dysfunction due to arterial insufficiency, malignant neoplasm of prostate, induration penis plastica.) I don’t really know what this means, but believe this what the doctors diagnose, although I noticed later the expression: “malignant neoplasm of prostate” may not be applicable to me. I don’t have a prostate!
I immediately subscribed to an efax, and faxed the form back to the address mentioned in the letter. Later in the day, Danielle called me asking if I use ED medication, and I think I said yes. Then, after the call, I wondered if the clinic is thinking that I am still using ED treatments, I emailed her back telling her that I didn’t use any treatment since about 3 month, which is the truth.
On Tuesday 21st, I received an email to access the portal. I registered immediately and filled the required fields, but was curious that the surgery time is set to 1.15pm, instead of 5 pm. I thought this could be a mistake, I should be informed about it. Subsequently, I got a call from a nurse asking the routine questions before surgeries, and ended up confirming the procedure is at 1.15pm, and I have to be there at 11.45am!!!!
Then I got an email from Danielle stating that the insurance said I have to wait for 12 month (preexisting condition waiting period) and would pull the records to make sure that I didn’t use ED medication during the past 24 months! Does this make sense? Of course almost all implant patients suffered from ED, and tried some treatment before opting for the implant. Chesapeake urology diagnosis sent to my insurance is mentioned ED, and was initially approved. Why was it approved? And why no one could argue this decision? Why I was told to do all these tests without having approval?
I called the insurance, and got some confusing information, one agent telling me that they are working on it, and another is saying he cannot see the request from the provider! I communicate this to Danielle, and she said thanks for update.
Then while checking on insurance posts here, I saw an advice for someone who was issued approval and then the insurance company rejected it. The point was the insurance company shouldn’t back out and should commit to their initial approval.
I immediately emailed Leslie, mentioning this point to her, didn’t get a reply, then emailed Danielle, without a reply also. Again, when no response, I decided to fight for it myself. I asked Leslie to provide me a copy of the approval that she should be having, but she didn’t reply. I knew that this is going nowhere. I texted dr. Kramer, and as usual, he was very supportive, although he is not aware of these insurance issue. I appreciated that, as I believe his primary task is to use his skill to solve the medical condition, which I believe that he is performing this at top level.
I then sent an email to Danielle, with cc to dr. Kramer, asking for her support and follow up with insurance, as I believe having a valid case. To my surprise, Dr. Kramer was the one to reply with a disappointing statement, briefly, didn’t work here, can recommend you other surgeons so that I can get this done. It was really shocking for me, how come the attitude towards a certain issue changes 180 degrees in less than an hour? It must be something major that I have no idea about. I just replied: Thank you.
Believing that if the insurance rejected my claim this time, they will not approve with another provider, I contacted the insurance again. On July 30th. They said that a letter was sent today to Chesapeake urology requesting some records. I just sent an email to Danielle communicating this and requesting her to keep me updated. No reply.
To summarize my issues:
1. Since the appointment was scheduled on July 23rd, I kept on following up on almost weekly basis to know if the approval is received.
2. Danielle may have just got a reminder 9 days before my surgery date, and without having received the approval, she confirmed the appointment and requested me to do all the tests. I had to excuse 3 times from my work, at least 2 hours each time, in addition to exposing myself to the virus, going into medical labs.
3. If the procedure is denied by insurance, I will be required to pay for all these tests myself. These could be more than 1000$.
4. The covid19 result took 10 days to be issued, ie 2 days of my scheduled surgery. My surgery would have been postponed/cancelled without the test, as Danielle said it is a must.
5. Changing the time of procedure from 5 pm to 1.15pm without informing me. I told my team lead that I will be working the day of surgery from 6am to 2pm, and take Friday off. With this change that is not communicated to me I must have Thursday itself off.
6. I arranged with a friend of me to accompany me, and he had to make similar arrangements in his work. But that is also messed up.
7. Was the condition statement made (malignant neoplasm of prostate) an uncorrectable mistake that is made by Chesapeake Urology, And that is why they believe it is a hopeless case?
8. Ignoring my emails, before and after the scheduled date. Why I need to contact Dr. Kramer, if his office staff is corresponding with me in a timely manner.
9. I do not know anything about Danielle, except my interaction with her during this process. My question is: while she is not replying, how and why she could persuade other to do same? Leslie didn’t reply to 2 emails from me.
10. How and why dr. Kramer himself came to the conclusion that it is over here, and I have to contact other surgeons, while the process is still not over? I wish he didn’t answer.
11. Where are “Patient first, customer satisfaction” and other customer services best practice? Why should I be struggling to get information and updates? I don’t think the present conditions with remote work should have any effect on this. A reputable surgeon, like Dr. Kramer, whose name pops up in 598 pages on FT only, so far, if you search it, should have a higher service level, than any other doctor in the field. His office is making me feel like I am asking for a donation, not a patient right, and because I was patient with them all the time, they just think it is fine to ignore. I am being paid for 40 hours a week, but have to work a lot of free extra hours, because I have to address every single issue. These people don’t even care to reply. Would I expect them to take the initiative and do their best to get patients approved? Insurance companies look for any excuse to avoid paying $20k+. Such a team just provide this excuse, and get back to the patient that his claim is denied. Simply like that.
12. You can get good credit working with easy cases, but solving issues, specially complex ones, is what makes you outstanding.

Agfa13
Posts: 874
Joined: Thu Oct 31, 2019 6:03 pm
Location: Laurel, Maryland

Re: My Negative experience with Dr. Kramer's office

Postby Agfa13 » Sat Aug 01, 2020 4:34 pm

Just my 2 cents, but this is not a negative experience with Kramer.
Rather, just a negative experience.
From what I have read, and mind you, I may have missed something, but there seems to be a disconnect somewhere, and Kramer is not an end-all for surgery/implants.
You were diligent in taking notes and names, but somewhere, someone dropped the ball, and Chesapeake Urology can only proceed IF insurance goes through (unless you are paying yourself). By what you wrote, the clinic is just proceeding according to what they were told. Someone at the insurance gave them the wrong info.
You yourself said somewhere at the insurance company someone said something that was on your insurance info, and that another place said it was not coming up on their end?
56, Maryland, revised with Titan on 3/2/20
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oldbeek
Posts: 1405
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Location: Los Angeles area

Re: My Negative experience with Dr. Kramer's office

Postby oldbeek » Sat Aug 01, 2020 5:29 pm

There is no rhyme or reason when fighting with an insurance company. His staff is probably doing as much as possible. Now days people are working from home with limited resourses. Do you know for a fact that the girls were even in the physical office. I had mine done at a large teaching hospital and call returns were ????? questionable. But, this is life as we know it. I am a type A person and expect perfection out of everyone. I hear type A in your explanation. Have to learn to chill. P.S. I am not in the Eid, Kramer cheering squad. Lots of excellent doctors out there doing implants.
78, good health, RP 7-2017, all nerves taken , PSA 0.05, 4-18,, .08 11/18,.07 1/19,.05 4/19, .06 2/20 Pain with trimix, implant 4-18, Infra-pubic, AMS lgx 15 cm with 5cm rte. Implant at USC Keck. Dr Boyd and Dr Loh Doyle 6 x 4.5, 800 AUS 7-21-20

OregonStrong
Posts: 138
Joined: Mon Mar 02, 2020 10:15 pm

Re: My Negative experience with Dr. Kramer's office

Postby OregonStrong » Sun Aug 02, 2020 1:37 am

I think you can place about 80% of the blame on insurance companies. I work in the medical field, and it's such a shit show. They will approve everything and deny it last minute, or even after the fact leaving you with a huge bill of which the burden is on you to prove it's not valid. They love to pull that crap, and it's an endless cycle of paperwork and calls, too many middle men many of whom don't even understand their own processes. I will say Danielle sometimes is a bit less than available with communication, or at least not timely responses, which doesn't help the situation, but most of what happened to you is really on poor customer service and processes within the insurance company.
These implants are an expensive undertaking and it's not in the insurance company's interest to let you go through with getting one. You're just set up to fail before you even start, and that's the way they want it. They want you to give up. Just keep thorough records of names, times you spoke to people since they will conveniently have no record of your calls 3/4 of the time. Sorry to sound so cynical, but I've dealt with this crap for 20 years and it never gets better.
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: 603
Joined: Fri Apr 05, 2019 2:47 pm

Re: My Negative experience with Dr. Kramer's office

Postby Gt1956 » Sun Aug 02, 2020 2:09 am

I don't know how valid this story might be. I was told once while trying to get approval for a surgery for my wife. The insurance companies "plan" on expenses to happen at a predictable pace. Too many requests in too short of time span will get some of them denied. Part of it is hoping than you might go away. But part of it is to shift that cost into the next month or quarter. Whatever time frame they use for budgeting. That is part of the reason that stuff gets approved on appeal. It has moved into the next budget time frame. In our case, sure enough. It was approved a few weeks later.
63 HBP at 40 high triglycerides at 45 Type 2 at 60

Hrc714
Posts: 44
Joined: Thu Aug 24, 2017 4:13 pm
Location: Baltimore area

Re: My Negative experience with Dr. Kramer's office

Postby Hrc714 » Sun Aug 02, 2020 7:46 am

My issues were not with Dr K or his staff, but with his formet affiliate University of Maryland Medical Center. In my case, the good Dr K always responded in minutes. His staff was within a few days, and the UMD staff almost never. I was told by his staff that they knew my insurance and I was covered so nothing to worry about. Had the surgery and was denied. Only support I got from the UMD team after that was a request for payment. Dr K did assist by advising who to contact at UMD but they would not respond. I eventually had to shell out full payment while I worked out insurance issues. They eventually paid and then the fun started with trying to get my payment refunded. Eventually they did process a refund. I can see why Dr K moved his affiliation away from UMD.

On a related note, as part of this I was billed by UMD for a proceedure that they cancelled do to OR availability. That could not be covered. They kept billing and began collection action. When I finally got to someone at UMD, they advised the only thing they could do was for me to pay, then they would refund. They advised they would process the refund first and trust me to pay. So I paid and never got that refund and never heard from them again.
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AST2123
Posts: 3
Joined: Tue Jul 28, 2020 7:54 am

Re: My Negative experience with Dr. Kramer's office

Postby AST2123 » Sun Aug 02, 2020 9:30 am

Thanks guys for the replies.
my points:
1. Insurance companies are for profit. No reason for them to pay such large amounts, if there is a possibility to avoid them. That is why every medical provider has a specialist who is aware of this and does it on daily basis. It is not like a patient who tries to connect to a customer service once in a lifetime.
2. Diagnosis submitted to insurance (Erectile dysfunction due to arterial insufficiency, malignant neoplasm of prostate, induration penis plastica.) clearly showing ED, and I am not sure why prostate is mentioned. This was initially approved. My question here, as a provided, if it then denied, wouldn't you argue this denial? Because I didn't want to go through this process without being sure it will be approved, On May 22nd I emailed Danielle, attaching a copy of the exclusions in my policy to check if this procedure would be approved, as I was having (Plan B, employer insurance) only before July 1st. She replied that she spoke to insurance and they confirmed that code (54405) is approved. Leslie also confirmed the same. So, who put me in this and now is considering my follow up requests overwhelming?
3. Despite several reminders to get the confirmation for the rescheduled procedure, I was sent for tests without this.
4. Working from home is an advantage, especially with this type of work. You can email a patient or call insurance why laying on the couch. For me, I used to spend 12 hours from time I wake up, go work and get back home with traffic,while working 8 hours. Now, while working from home, I work 10 hours a day, and still I have more free time.

AST2123
Posts: 3
Joined: Tue Jul 28, 2020 7:54 am

Re: My Negative experience with Dr. Kramer's office

Postby AST2123 » Mon Aug 03, 2020 4:56 pm

I am considering finding an implant surgeon within DC area or nearby states. Who are the best ones?


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