Can Medicare Pay for an Implant?

The final frontier. Deciding when, if and how.

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Anonymous3
Posts: 1307
Joined: Thu Aug 03, 2017 9:43 pm

Re: Can Medicare Pay for an Implant?

Postby Anonymous3 » Wed Mar 14, 2018 4:50 am

oldbeek wrote:In my area CA. the going rate that some advertise is 20k. If medicare only allows $13,000.00, I see why in demand Drs do not take medicare.

That is more than likely the private pay / care credit

https://surgeo.com/Penile-Implant-South ... iLEALw_wcB

oldbeek
Posts: 1353
Joined: Sun Sep 10, 2017 1:46 pm
Location: Los Angeles area

Re: Can Medicare Pay for an Implant?

Postby oldbeek » Wed Mar 14, 2018 1:22 pm

alterr wrote:I'm in my 40s and was informed that I'm eligible for Medicare (strange but true). Presently I got Medicaid bundled with Fidelis and live in NYC. Can Medicare pay for an implant? If so which Medicare plan does pay for it, A or B?


You live in NYC with medicare, Call Dr Eid, he is the best.
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

Tsanchez12369
Posts: 224
Joined: Fri Dec 23, 2016 7:52 pm
Location: SAN Francisco

Re: Can Medicare Pay for an Implant?

Postby Tsanchez12369 » Sat Mar 17, 2018 10:55 am

When you find a doc that accepts Medicare make sure they ACCEPT ASSIGNMENT. That means they cannot charge you more than the approved Medicare amount. (You still have to pay 20% of that unless you have the supplemental insurance.) If not, you also have to pay the difference between the Medicare approved amount and the private pay rate.
Sept 11, 2018: excision, grafting (human cadever tissue) and implant. Doc is Dr Edward Karpman in Mountain View, surgery at El Camino Hospital, LOS Gatos CA. AMS 700 CX infrapubic 18 cm + 3 cm RTE. http://www.peyroniesforum.net/index.php

Anonymous3
Posts: 1307
Joined: Thu Aug 03, 2017 9:43 pm

Re: Can Medicare Pay for an Implant?

Postby Anonymous3 » Sun Mar 18, 2018 8:46 am

I thought if they took Medicare they had to accept the assigned amount

CTR5000
Posts: 170
Joined: Wed Apr 01, 2015 9:51 pm

Re: Can Medicare Pay for an Implant?

Postby CTR5000 » Sun Mar 18, 2018 12:00 pm

Medicare is my primary insurance and covered 80% of everything involved in my implant... the device; my surgeon; surgical suite; and private room that night.

The balance was paid-in-full by our secondary insurance. I had no out-of-pocket expenses.

Once I hit my deductible for the year, any procedure I might need is covered this same way. But I MUST have my deductible met. I meet it by the end of January/beginning of February each year. Had I scheduled my implant surgery (or any other procedure) for sometime within the first 4 weeks of the year, I'd be running the risk of not having met that deductible and paying out-of-pocket costs.

My various medications are what put me over that deductible each year. Getting them filled within January all contributes to my deductible. A state-provided program pays for any out-of-pocket medication costs, so even in those first weeks of the year, my medications cost me nothing even though they are adding up to meet that deductible.

So, as far as my situation goes, I can't give a blanket answer without discussing that deductible.

Zxylpk
Posts: 156
Joined: Mon Apr 17, 2017 12:58 am

Re: Can Medicare Pay for an Implant?

Postby Zxylpk » Sun Mar 18, 2018 12:27 pm

Medicare paid 100% for me. Total cost was over $80K. I only pay $20 co pay for office visit.
74 y/o Implant 21cm, 1cm rte ams 700 CX, Feb 21, 2017, Dr. Karpman, Mt View, CA

David_R
Posts: 2145
Joined: Mon Nov 02, 2015 1:03 pm

Re: Can Medicare Pay for an Implant?

Postby David_R » Sun Mar 18, 2018 3:39 pm

CTR5000 wrote:Medicare is my primary insurance and covered 80% of everything involved in my implant... The balance was paid-in-full by our secondary insurance. I had no out-of-pocket expenses.

Same for me.

RayChez
Posts: 222
Joined: Sat Mar 17, 2018 11:25 pm

Re: Can Medicare Pay for an Implant?

Postby RayChez » Sun Mar 18, 2018 8:58 pm

I live in California and I have a medicare advantage which was Anthem Blue Cross and they paid 100%. The hospitals and doctors are paid by what ever they are contracted with Medicare. Doctors and hospitals might send a 10K dollar bill, but if they belong to the medical group in the plan they will get what ever is in the plan, not what they want. I believe on my latest revision the total bill they got paid was around seven thousand.
age: 75 First implant around 2001, 59 at the time. AMS 700 Ultrex
revision Dec 2016. 2ND implant 21CM, 1rte AMS 700 LGX MS pump

Anonymous3
Posts: 1307
Joined: Thu Aug 03, 2017 9:43 pm

Re: Can Medicare Pay for an Implant?

Postby Anonymous3 » Mon Mar 19, 2018 5:07 am

What my dr billed for everything was over 70k. Medicare assignment was 13k. They paid 10k. My secondardy paid zero. So I owe 3k

dirtman1993
Posts: 478
Joined: Thu Feb 05, 2015 4:12 pm
Location: Beech Mountain

Re: Can Medicare Pay for an Implant?

Postby dirtman1993 » Fri Mar 30, 2018 7:30 am

Dr. Kramer accepts Medicare also in Baltimore
Implanted March 2nd by Dr. Kramer with AMS/LGX. Had a problem lower left (scar tissue) and he placed a larger (thicker) implant as you can here on the YouTube video. Got all back, ED over 10 years before Implant.


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