FrankTalk.org

Surely someone here has received an implant that medicaid and medicare paid for an knows the channels I need to take to get it approved. I have ED from something just like a stroke but the MD's can't find evidence of one. It's a mystery. Please help me or I will be unable to have it done. Where do I start?

Thanks,
Robin

Robin, I can't help you but I am sure some guys here will jump in shortly. Good luck.

Cajun Jeff

Robin,

Any uro surgeon worth his scalpel knows just how Medicare works and how to do the paperwork for an implant. I suggest you start with your doctor. I do know that Medicare paid for my uncle's bionic pecker. I do not know if such remedies are covered by Medicaid.

Good luck. Let us know how it goes.

Greg

Robin,
For Medicaid, I'm pretty sure the doctors only have to prove the need for an implant. They don't always have to define the cause. They can simply say "venous leak" to get approval. Start with a good Penile Implant doctor. Call them, talk to the billing person. They deal with this all the time. Get the ball rolling with that. Now, if you can't pay for the doctor's visit, tell them that. Many doctors will see you as a consult to determine if they are even a match for what you need.
Where do you live? Do you need help finding a surgeon? let me know
paul

Good input Paul,
As soon as you start to see a surgeon who performs implant surgery he will perform all of the necessary tests to prove that you qualify for an implant. You will most likely need to go through all other ED solutions and if they fail then insurance will see its a necessity.
-Colin

Does anyone know is you have to have an6 specific tests to determine if penile implant is justified? I have Medicare insurance which pays for the surgery. Thank you!

notaes wrote:Does anyone know is you have to have an6 specific tests to determine if penile implant is justified? I have Medicare insurance which pays for the surgery. Thank you!

My implant was paid by medicare. The doctor determined it was medically necessary and it was a slam dunk from there. Cost me $160 out of pocket total.

Medicare paid for mine. RP and nerves removed. Pills no good. Allergic to trimix. Done deal.

I live in Philadelphia… I have Pennsylvania state Medicaid and Medicare… I am smack dab between the two “best“. I had to try pills but after that, Medicare was able to approve me… I put my Medicaid through the test but I wanted to go out of state so they aren’t picking up anything… in the end, I will be paying 2900 out-of-pocket… I called my surgeon and he set me up on a payment plan “$700 a month for four months“. Kind of worth it to me as I really don’t unfortunately trust the urology department in any of the Philadelphia hospitals…. I know that I will be getting good work done… but yeah… No tests, just trial and error with the normal treatments… Medicare should put it right through given that you have the right surgeon… Best of luck, brother!

Just for comparison purposes to other federal insurance plans, I have Tricare. (What used to be called Champus)

Retired military. 23 yrs.

My cost share would be $8400 but the catastrophic cap kicks in so I will only be out $3000.

I'm not sure about the VA but I've never been impressed with the quality of care they provide.