Advice choosing doctor for an implant, and their compensation for choosing an implant brand

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PeaceofPain07
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Advice choosing doctor for an implant, and their compensation for choosing an implant brand

Postby PeaceofPain07 » Wed Oct 21, 2020 5:26 pm

-I live in NY and it's surprising to know Dr. Eid only accepts like 3 or so insurances, yet he's so popular here. Are most people visiting him paying out of pocket, or he's popular from just 3 insurances? I visited him and saw he had a great bedside manner. However, he doesn't accept my insurance. My initial thought was to just pay for the implant, as getting a good doc is important. I went as far as paying 1-1.4K for an ultrasound with Eid, which can be deducted if I do the surgery with him.
Then I came across Dr. Perito in Florida and Dr. Valenzuela in NY. I think they might accept my insurance Multiplan since theyre listed on Multiplan's site. Perito's office said it'll take a couple days to determine that implant is covered. If it is, sounds wise to make the trip to Florida to see Perito. I haven't seen much feedback on Valenzuela for implants, so he'd be my last choice unless I know more. Not sure what Dr. Kramer's situation is right now, nor if he'll accept my insurance.

-I'm aware doctors may get compensated for choosing colonplast or AMS. Are you aware if any of these docs above get compensated for choosing one or the other, and how much? If they do, chances are I'll want to tell them that I'll pay whatever they're being compensated AS LONG as they choose the best implant for me.
Born 1986. Implanted 3/21, Eid. Titan 20cm + 1RTE. 5'11 178lbs.

A support group for ED in young males, but open to older males: facebook.com/groups/erectiledysfunction

Lost Sheep
Posts: 6133
Joined: Mon Jul 04, 2016 11:16 pm

Re: Advice choosing doctor for an implant, and their compensation for choosing an implant brand

Postby Lost Sheep » Wed Oct 21, 2020 7:43 pm

PeaceofPain07 wrote:-I live in NY and it's surprising to know Dr. Eid only accepts like 3 or so insurances, yet he's so popular here. Are most people visiting him paying out of pocket, or he's popular from just 3 insurances? I visited him and saw he had a great bedside manner. However, he doesn't accept my insurance. My initial thought was to just pay for the implant, as getting a good doc is important. I went as far as paying 1-1.4K for an ultrasound with Eid, which can be deducted if I do the surgery with him.
Then I came across Dr. Perito in Florida and Dr. Valenzuela in NY. I think they might accept my insurance Multiplan since theyre listed on Multiplan's site. Perito's office said it'll take a couple days to determine that implant is covered. If it is, sounds wise to make the trip to Florida to see Perito. I haven't seen much feedback on Valenzuela for implants, so he'd be my last choice unless I know more. Not sure what Dr. Kramer's situation is right now, nor if he'll accept my insurance.

-I'm aware doctors may get compensated for choosing colonplast or AMS. Are you aware if any of these docs above get compensated for choosing one or the other, and how much? If they do, chances are I'll want to tell them that I'll pay whatever they're being compensated AS LONG as they choose the best implant for me.

Since you live within a reasonable distance of Dr. Eid, you might want to ask your insurance company if they would pay (or how much they would pay) for Dr. Eid as an out-of-network surgeon. Get it in writing. You might have to front the money and get reimbursed by your insurance company and handle some of all of the paperwork yourself, but it might be an option you would like.

If the paperwork is daunting, you might want to contact a TPA (third-party administrator - an insurance adjusting company that can handle claims ad-hoc) to take care of those details. It would probably cost a few hundred dollars to get that taken off your plate, but it could be worth it.
Lost Sheep
AMS LGX 18+3 Nov 6, 2017
Prostate Cancer 2023
READ OLD THREADS-ask better questions -better understand answers
Be part of your medical team
Document pre-op size-photos and written records
Pre-op VED therapy helps. Post-op is another matter

Gt1956
Posts: 2859
Joined: Fri Apr 05, 2019 2:47 pm

Re: Advice choosing doctor for an implant, and their compensation for choosing an implant brand

Postby Gt1956 » Wed Oct 21, 2020 8:05 pm

The odds are that you'll never find out if or how much kickback they get. Just my guess on this. It wouldn't make a lot of sense to pay kickbacks if you had the #1 selling implant. Paying kickbacks helps you gain market share.
So out on that tiny limb I go. My guess without any backing info is that AMS likely pays the least back to them. Most likely they will earn points to go to a urology convention in Las Vegas. I just recently watched some short speaches by some of the well known implanters that was in Vegas & sponsored by AMS. Btw, Dr. Christine sure gives a good speach. Oh, Dr. Eid was there also. I hear that he does install a few AMS implants during a given year.
Further out on that tiny limb. I wonder if the reason that he likes Titans is because he can trim the rear tip to minimize the use of RTE's? I don't think that I've heard of a surgeon trimming an AMS implant.
Not bad mouthing either company. Many people are happy with one or the other. My prospective surgeon uses AMS but I have found a patient on here a few years back that he did use a Coloplast implant on.
68yo, HBP at 40, high triglycerides at 45. Phimosis at 57. Type 2 at 60. Dr. William Brant May 1, 2023 CX 21cm w/no rte's penoscrotal 6" girth @ 6 months

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

Re: Advice choosing doctor for an implant, and their compensation for choosing an implant brand

Postby SW0110 » Wed Oct 21, 2020 9:27 pm

A year or so ago. I saw a site where you can find out how much they got from each company. It was wierd to see all the names on the list. Pretty much every doc was getting something from one or other. Not something you have any control over.

Some docs only do one brand, others both and might let you choose. Others might do both and wait to see what your body looks like once they get in to decide which is best for you.

I would focus on if I want insurance to pay for it. Find the best one covered.

If not insurance and you live in ny, eid is probably a good option. None are infallible but he seems to stand behind his work. Several years ago I read of a guy he did and might have oversized his titan. Just what every guy wants right. This guy was experiencing bad pain in tips. Since it was not a defect. The guy said eid told him he could comp a shorter set of cylinders and his fee but surgery center costs would have to be paid. Or he could give it six months and do it then if he still wanted. It was his choice.

The guy if I remember decided to wait and see what happened after cycling a while. I think he grew into the longer cylinders and kept them.

Does give you an idea of what can happen and what one said he would do to fix it. Moral is find a good doc you trust. Look up your insurance and see how the covered ones stack up. Make sure they answer your questions.

My titan was done by a pretty active doc. 1 to 2 a week sometimes 3, according to the nurses at the hospital I was in for surgery. Nothing like querying hospital staff right up till they put you under. Found out my surgeon did one of nurses husbands implant. I felt in pretty good hands then.

My revision was by my local urologist who does not do as many as my first surgeon but does several a year. He is thorough and takes pride in what he does. I was happy with both.
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.

stephen54
Posts: 481
Joined: Sun Nov 10, 2019 11:43 am
Location: Chicago

Re: Advice choosing doctor for an implant, and their compensation for choosing an implant brand

Postby stephen54 » Thu Oct 22, 2020 1:11 pm

PeaceofPain07 wrote:-I live in NY and it's surprising to know Dr. Eid only accepts like 3 or so insurances, yet he's so popular here. Are most people visiting him paying out of pocket, or he's popular from just 3 insurances? I visited him and saw he had a great bedside manner. However, he doesn't accept my insurance. My initial thought was to just pay for the implant, as getting a good doc is important. I went as far as paying 1-1.4K for an ultrasound with Eid, which can be deducted if I do the surgery with him.
Then I came across Dr. Perito in Florida and Dr. Valenzuela in NY. I think they might accept my insurance Multiplan since theyre listed on Multiplan's site. Perito's office said it'll take a couple days to determine that implant is covered. If it is, sounds wise to make the trip to Florida to see Perito. I haven't seen much feedback on Valenzuela for implants, so he'd be my last choice unless I know more. Not sure what Dr. Kramer's situation is right now, nor if he'll accept my insurance.

-I'm aware doctors may get compensated for choosing colonplast or AMS. Are you aware if any of these docs above get compensated for choosing one or the other, and how much? If they do, chances are I'll want to tell them that I'll pay whatever they're being compensated AS LONG as they choose the best implant for me.


Untrue. At least in a strict sense. This is commonly misunderstood. I'll rant just a bit to explain...

I work on the sales/clinical marketing side of the medical device industry - what you're referring to in a strict sense is illegal and simply does not happen. There is absolutely not a direct legal path whereby physicians/surgeons are compensated for their selection of a specific company/specific brand of device. It's patently illegal. Note, though, that I said "direct".

Enforcement actions come through FDA's Office of General Counsel and its Office of Criminal Investigations, which enforce the provisions of the Federal Food, Drug, and Cosmetic Act. The HHS Office of the Inspector General (OIG) in conjunction with the Department of Justice further enforces the Medicare and Medicaid fraud and abuse laws. Chief among these is the Anti-Kickback Statute (42 USC 1320-7b, for those wanting a very dry, but very informative summary!). This federal statue criminalizes any payment by a medical device manufacturer to a physician/customer made (in whole or in part) to induce sales.

Having said that...!

There are definitely numerous ways in which medical innovation companies compensate physicians, academics and healthcare professionals for their time, expertise and intellectual property, in connection with the development of new medical technologies, the improvement of existing technologies, and training and education of other health care professionals. For example:

Consulting Fees are common and important in the physician-industry relationship. Physician expertise is critical in the development of new medical technologies as well as the refinement and improvement of existing medical devices.

Honoraria may be paid when physicians provide their time and expertise to medical congresses and conferences to share experiences and research and to provide information around new innovations or to discuss challenges with existing devices.

Education is an essential component of the innovative process and physicians can be compensated if they are called on to provide training on the correct technique, application and usage of the technology.

Research is obviously critical. To move from concept to market with a medical device, there are obviously years (sometimes decades) of R+D at significant cost. Manufacturer research payments compensate physicians and research institutions and others who deliver expertise to the R+D journey.

Royalty or licensing. Physicians generate new ideas, designs, methods, and in exchange for the physician’s intellectual property rights and knowledge a medical device manufacturer may enter into an agreement whereby a physician innovator is paid royalties (which can accrue based on sales of products that use that physicians’ intellectual property).

Direct compensation for serving as a faculty or a speaker. Physician-to-physician sharing of medical and scientific knowledge is vital to disseminating information on the most effective uses and applications of new medical innovations, and in training other practitioners on the safe and effective use of technology.

There is a federal "Open Payments" program which is fairly recent; this strives to publicly publish more transparency around what kind of dollars physicians are being compensated and in which of these sorts of categories those payments fall. Just note that there is no legal way to compensate the doc directly for prescribing/usage behaviors, that's an express train to hefty fines and/or prison terms.

But it should go without saying that, of the many ways physicians can and are generating incoming dollars from industry, it's really not credible to think that there is a net zero effect on the choices and recommendations physicians make, even when the dollars changing hands are, as noted above, for wholly ethical business reasons. There's some interesting work being done where, in surveys and in other data collection methodologies, even physicians who genuinely do not believe they are affected by their relationships with industry...even those physicians who believe they are upholding the utmost in ethical boundaries...they are frequently found to exhibit some degree of favorable bias to a specific manufacturer or product. Human nature.

So just be informed and aware. Ask your surgeon questions to scratch away at how and why they make the recommendations they make. Be really prepared to understand things related to your clinical condition and the devices available, and be prepared to challenge your surgeon with well thought out questions. Some surgeons won't care for your tenacity and preparedness. Walk swiftly away from those and find another.
54 yrs. Blessed with highly sexual 52 yr old wife. Pills 10 years, then 9 yrs Trimix. 28 cm Titan Touch XL 2019, Laurence Levine, Rush Univ Med Ctr, Chicago. Implant = nonstop fun. Hypogonadal, so also 10+ years testosterone replacement.

Lost Sheep
Posts: 6133
Joined: Mon Jul 04, 2016 11:16 pm

Re: Advice choosing doctor for an implant, and their compensation for choosing an implant brand

Postby Lost Sheep » Thu Oct 22, 2020 1:44 pm

stephen54 wrote:So just be informed and aware. Ask your surgeon questions to scratch away at how and why they make the recommendations they make. Be really prepared to understand things related to your clinical condition and the devices available, and be prepared to challenge your surgeon with well thought out questions. Some surgeons won't care for your tenacity and preparedness. Walk swiftly away from those and find another.

I am a particularly participatory patient. My primary care Physician and my Surgeon both remarked on my research and knowledge, and not just to me. One factor in my choice of Surgeon was his acceptance of my participation.

Not everyone likes to be that involved with their medical team's decision-making. I do not fault them for that preference. For those patients, faith and the recommendations of former patients must suffice.

We all make our own choices for our own safety and the quality of outcomes.

Stephen54, thank you for the remarkably lucid and in-depth report of the protections we enjoy (in this country) through the efforts of our legislators. Your effort is MUCH appreciated. Note also that the American Medical Association (I hope) has guidelines for its members the further protect the patient population.
Lost Sheep
AMS LGX 18+3 Nov 6, 2017
Prostate Cancer 2023
READ OLD THREADS-ask better questions -better understand answers
Be part of your medical team
Document pre-op size-photos and written records
Pre-op VED therapy helps. Post-op is another matter

Gt1956
Posts: 2859
Joined: Fri Apr 05, 2019 2:47 pm

Re: Advice choosing doctor for an implant, and their compensation for choosing an implant brand

Postby Gt1956 » Thu Oct 22, 2020 3:23 pm

Stephen54, since I've posted on this thread up higher. My post fits (I hope) your position. My PCP has treated me with mostly generic meds. I respond to them very well. I feel like my generics were cutting edge 10-15 years ago. If they work, I'm ok. He did specify 1 diuretic. I had been taking a HBP med that contained a diuretic. He changed me to a version that didn't have the diruetic in it but prescribed a separate diuretic. I asked him why the change. His reply was the new 1 was a better diuretic but didn't get promoted as well as the more popular one.
As Lostsheep has said. Be an informed patient. Politely ask about changes in your treatment. If you can't or don't trust your dr. You should find one that you do.
Btw, I'm almost positive that the generics don't encourge the doctors. Very few of them even provide samples to them.
Thanks for your informative post.
68yo, HBP at 40, high triglycerides at 45. Phimosis at 57. Type 2 at 60. Dr. William Brant May 1, 2023 CX 21cm w/no rte's penoscrotal 6" girth @ 6 months


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