Insurance Questions for self-employed with implant

The final frontier. Deciding when, if and how.
Minnesota#2
Posts: 96
Joined: Sun Aug 07, 2022 10:52 pm

Insurance Questions for self-employed with implant

Postby Minnesota#2 » Mon Nov 28, 2022 12:59 pm

I am hoping to gain some insight from those of you who are self-employed who do not receive health insurance coverage through an employer. I had my implant on 9/20/22 and currently have a good job with incredible benefits. My implant was basically free. However, I am going to leave my employer in the near future to work for myself. At the start, I will make less but in the long run I will be paid much more. I will have to buy my own insurance though. I am single and will just have to cover myself. I realize premiums will be high.

For those of you who have the implant and buy their own health insurance, who do you go through, what do you pay, and how did you find out that the insurance would cover the implant? I want to figure all of this out and make sure I am not paying for expensive health insurance in the future without getting a chunk of my implant revisions covered in the future.



Thank you!
27y/o. For 9 yrs was told it was PerfAnxiety. Tried Pills, therapy, long/short term relationships, etc. Diagnosed low penis inflow via Doppler. 9/20/22 Dr. Kohler Rochester Mayo. Titan 22cm no RTE 125cc. Pre Implant length:5.9 Girth:idk. Post: L:5.9 G:4.6

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

Re: Insurance Questions for self-employed with implant

Postby Gt1956 » Mon Nov 28, 2022 1:23 pm

Not an answer specific to your question. I would suggest checking groups that you can join. Group related policies are generally a better deal. Ask around at some of the larger local credit unions. Maybe a trade group that represents your skill type. A business association. Those kind of places.
Btw, the cost of a reasonable policy can easily trim several dollars an hour off of your projected self employed income. I did this calculation 30 years ago. There was a local HMO that sold individual policies so I had a valid quote. As I recall it would of equaled around $6 per hour of my income in around 1993. Renewed yearly, subject to changes, denial or being discontinued. It isn't cheap. Think long & hard.
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

newbie443
Posts: 1827
Joined: Fri Dec 01, 2017 9:41 pm
Location: Sedgwick county, Kansas USA

Re: Insurance Questions for self-employed with implant

Postby newbie443 » Tue Nov 29, 2022 8:10 am

Insurance is controlled by your state. That being said marketplace plans (Obamacare) will all have coverage. In my state of KS BCBS had a PPO plan with 4K max out of pocket and 1500 deductible. That cost almost 1200 a month. With a PPO plan BCBS told me where I could go for the surgery. And the plan and others I have heard about require prior approval. The coverage area was limited to only part of my home state. Anywhere else I had only lifesaving coverage. There was another plan that had out of network coverage but deductibles and max out of pocket was several times higher and the cost per month was about 2k.

Good information already given by GT1956. Go to your states marketplace web site and sign up for coverage. You may need to put in an earlier date than you intend to leave your job. What that will do is let you see all the companies and policies offered in your state. That way you can see what the cost for the policy, deductible and max out of pocket. Next you need to contact your doctor to see if they accept that insurance. I tried to go out of state for my repair using a part of my policy that stated I could only if the service was not available in my coverage area. No one did repairs so a doctor tried to send me to a doctor in TX but I was then told they did not take individual purchased insurance.

Insurance companies are powerful. They are difficult to fight by yourself. But if you are in a group as said you have more power. Insurance companies are more likely to make a single policy holder unhappy that to risk losing a large group of policy holders. And where a HR department can help in a group pool.

Good luck with this.
Injections failed. Implanted 3-21-18 AMS 700 LGX 21 + 1 RTE 100 cc reservoir 6.5" L 5" G Dr. Kramer.

Proximal Perforation Sling Repair 4/13/21 Dr. Broghammer

66 years young.

Will show and tell and talk with others.

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

Re: Insurance Questions for self-employed with implant

Postby Gt1956 » Tue Nov 29, 2022 12:48 pm

Newbie443 is giving real world advice. The HMO that I posted about was the company that I already had coverage with through my employer. They ran their own medical system. Many clinics, a hospital & at least two small surgery centers. Co-pays were $4 if I remember correct. If you learned how to work their system it all worked quite well. If something happened put of the area then they had other rules that I never had to use. I had my gall bladder removal covered by them.
The system & very low co-pays were hard to beat. They were eventually bought by Aetna. Facilities all closed. We followed the one doctor we liked to his private practice. I carried tthe Aetna policy into my retirement to this day.
$1200 a month is $7.50 an hour plus whatever price you feel the deductables would cost on an hourly basis.To a self employed guy that can be a big load to carry. Fortunately I didn't get forced into making that choice.
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

Minnesota#2
Posts: 96
Joined: Sun Aug 07, 2022 10:52 pm

Re: Insurance Questions for self-employed with implant

Postby Minnesota#2 » Sun Dec 04, 2022 4:24 am

Gt1956 wrote:Newbie443 is giving real world advice. The HMO that I posted about was the company that I already had coverage with through my employer. They ran their own medical system. Many clinics, a hospital & at least two small surgery centers. Co-pays were $4 if I remember correct. If you learned how to work their system it all worked quite well. If something happened put of the area then they had other rules that I never had to use. I had my gall bladder removal covered by them.
The system & very low co-pays were hard to beat. They were eventually bought by Aetna. Facilities all closed. We followed the one doctor we liked to his private practice. I carried tthe Aetna policy into my retirement to this day.
$1200 a month is $7.50 an hour plus whatever price you feel the deductables would cost on an hourly basis.To a self employed guy that can be a big load to carry. Fortunately I didn't get forced into making that choice.




Thanks for the solid advice, Gt. I appreciate it. It is definitely another factor making it tough to make the jump to the entrepreneur lifestyle. But absolutely, breaking it down, 1200 a month is a lot. Many fail to remember that these are after tax dollars too, not gross. Unless having HSA funds of course, but you get the point. So if one started with 50k per year in gross income, 1200 net eats away at a lot of your hard earned money… I will do some shopping around and homework. Thanks again!
27y/o. For 9 yrs was told it was PerfAnxiety. Tried Pills, therapy, long/short term relationships, etc. Diagnosed low penis inflow via Doppler. 9/20/22 Dr. Kohler Rochester Mayo. Titan 22cm no RTE 125cc. Pre Implant length:5.9 Girth:idk. Post: L:5.9 G:4.6

Minnesota#2
Posts: 96
Joined: Sun Aug 07, 2022 10:52 pm

Re: Insurance Questions for self-employed with implant

Postby Minnesota#2 » Sun Dec 04, 2022 4:36 am

newbie443 wrote:Insurance is controlled by your state. That being said marketplace plans (Obamacare) will all have coverage. In my state of KS BCBS had a PPO plan with 4K max out of pocket and 1500 deductible. That cost almost 1200 a month. With a PPO plan BCBS told me where I could go for the surgery. And the plan and others I have heard about require prior approval. The coverage area was limited to only part of my home state. Anywhere else I had only lifesaving coverage. There was another plan that had out of network coverage but deductibles and max out of pocket was several times higher and the cost per month was about 2k.

Good information already given by GT1956. Go to your states marketplace web site and sign up for coverage. You may need to put in an earlier date than you intend to leave your job. What that will do is let you see all the companies and policies offered in your state. That way you can see what the cost for the policy, deductible and max out of pocket. Next you need to contact your doctor to see if they accept that insurance. I tried to go out of state for my repair using a part of my policy that stated I could only if the service was not available in my coverage area. No one did repairs so a doctor tried to send me to a doctor in TX but I was then told they did not take individual purchased insurance.

Insurance companies are powerful. They are difficult to fight by yourself. But if you are in a group as said you have more power. Insurance companies are more likely to make a single policy holder unhappy that to risk losing a large group of policy holders. And where a HR department can help in a group pool.

Good luck with this.



Thanks for the response, newbie. So in your PPO plan with 4k max out of pocket and 1500 deductible for a total of 1200/month, is the 4k and 1500 included in the 1200/month? Might be a dumb question, but assuming it is. So your deductible of 1500 + 4k out of pocket = 5500/yr took up $460/month, and then the remaining $740 made up the total monthly payment of $1,200? 14.5k per year after tax money.... wow. And for a single, not family right? It is unbelievable how expensive this all is…. Costs more than my rent where I live lol. But great info on the groups and going on my state page and contacting my doc regarding insurance coverage, etc. I had my implant done at the mayo in my home state of MN, so I think a state plan like BCBS PPO would do me good… I will have to see. I have about 10 months before I officially make the jump so we will see!
27y/o. For 9 yrs was told it was PerfAnxiety. Tried Pills, therapy, long/short term relationships, etc. Diagnosed low penis inflow via Doppler. 9/20/22 Dr. Kohler Rochester Mayo. Titan 22cm no RTE 125cc. Pre Implant length:5.9 Girth:idk. Post: L:5.9 G:4.6

User avatar
rdnkbiker
Posts: 276
Joined: Thu Dec 22, 2016 5:49 am

Re: Insurance Questions for self-employed with implant

Postby rdnkbiker » Sun Dec 04, 2022 9:35 am

Minnesota #2 question when you got your implant what was the insurance provider where you work?
jim
HBP since my 20s Full ED i was 55 when i received my implant January 17th 2017 sever scare tissue through corpora cavernosa clear to the glands (no blood flow) complete revision new equipment july 10th 2023 AMS CX 21cm by DR.William Brant very happy

newbie443
Posts: 1827
Joined: Fri Dec 01, 2017 9:41 pm
Location: Sedgwick county, Kansas USA

Re: Insurance Questions for self-employed with implant

Postby newbie443 » Sun Dec 04, 2022 10:33 am

Minnesota#2 wrote:Thanks for the response, newbie. So in your PPO plan with 4k max out of pocket and 1500 deductible for a total of 1200/month, is the 4k and 1500 included in the 1200/month? Might be a dumb question, but assuming it is. So your deductible of 1500 + 4k out of pocket = 5500/yr took up $460/month, and then the remaining $740 made up the total monthly payment of $1,200? 14.5k per year after tax money.... wow. And for a single, not family right? It is unbelievable how expensive this all is…. Costs more than my rent where I live lol. But great info on the groups and going on my state page and contacting my doc regarding insurance coverage, etc. I had my implant done at the mayo in my home state of MN, so I think a state plan like BCBS PPO would do me good… I will have to see. I have about 10 months before I officially make the jump so we will see!


My premium of just under 1200.00 was every month. And it was more than my house payment was. Then on top of that there is the 1500 deductible and 4k out of pocket. I paid 17.6K last year(2021) for medical when I had my repair done. Now there is reduced cost going through the market place depending on how much money you make. I think it is just over 50k a year. If you make under that there are reduced premium costs for the plans. I went on Medicare this year so I have had no reason to check my states market place.

As far as doctor choice I do know that my BCBS plan excluded the Kansas City area of my state and the larger medical groups and better doctors. They only let me go there when I pushed using a clause in the policy that lets you go out of area if the service is not available in the covered area. No one did repairs in my covered area. They really were nasty about it and kept dragging this out. Took over a year after I had a CT scan that showed the perforation. So make sure that you doctors will take your insurance. Again when I was first sent to a doctor in TX they advised they did not accept insurance from a self pay or individual pay policy. Could be an out of state thing though but worth checking about. And again insurance is controlled by your state. Yours may be different than mine.

Good luck.
Injections failed. Implanted 3-21-18 AMS 700 LGX 21 + 1 RTE 100 cc reservoir 6.5" L 5" G Dr. Kramer.

Proximal Perforation Sling Repair 4/13/21 Dr. Broghammer

66 years young.

Will show and tell and talk with others.


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