Impant qustions.

[Nash3222]

61, no more boners, prostectomy, 2 years ago, did me in. Injections not working as well as they once did....

So questions:

1. Did you insurance cover you implant, no questions asked?
OR
Did you have to file an appeal to get it covered?
OR
Did you pay cash for it? If so How much did it cost?

2. I have United Health care through my employer---UHC---SUCKS!!!!...... they said its not covered, but I can file an Appeal, have not got to the Appeal stage yet.

3. How much pain did you have post surgery? on the suck factor from 1-10----how bad was the pain?

How long did the pain last for?

4. How long before you felt "normal" post surgery?

5. Do you have any issues with having sex if your a ways out? ( pain etc)

6. Any issues in general if you a ways out post surgery?


Thanks Guys.

[Bandbaustin]

Well I am only 2 weeks out but United covered mine upfront. It depends on your employer. I am still in a decent amount of pain. First 2 days I was at 8 due to the peeing felt like razor blades. Caused by catheter in and put during surgery. Now it goes and comes. I need to ice much more often. Quit taking prescription meds after 2 days now just tylenol.

[Nash3222]

Well I am only 2 weeks out but United covered mine upfront. It depends on your employer. I am still in a decent amount of pain. First 2 days I was at 8 due to the peeing felt like razor blades. Caused by catheter in and put during surgery. Now it goes and comes. I need to ice much more often. Quit taking prescription meds after 2 days now just tylenol.

Why did you stop pain meds? Is the Tylenol cutting it for the pain?

[SteveSW]

Most exclusions to a group/employer plan are determined by the employer. They exclude surgeries like implants to keep costs down, not provide good insurance for their employees. I know UHC has covered many implants under other employer plans.

[Txagq8]

61, no more boners, prostectomy, 2 years ago, did me in. Injections not working as well as they once did....

So questions:

1. Did you insurance cover you implant, no questions asked?
OR
Did you have to file an appeal to get it covered?
OR
Did you pay cash for it? If so How much did it cost?

2. I have United Health care through my employer---UHC---SUCKS!!!!...... they said its not covered, but I can file an Appeal, have not got to the Appeal stage yet.

3. How much pain did you have post surgery? on the suck factor from 1-10----how bad was the pain?

How long did the pain last for?

4. How long before you felt "normal" post surgery?

5. Do you have any issues with having sex if your a ways out? ( pain etc)

6. Any issues in general if you a ways out post surgery?


Thanks Guys.

My insurance covered it. Since I had hit (or was really close to) the annual family catastrophic cap, I had almost no out of pocket expense. Less than ten bucks. They (hospital, surgeon, anesthesiologist, etc) billed around $53K. They ended up getting paid about $18K. There were no problems. But I had done my homework. I had called the insurance carrier beforehand. They wanted the CPT code. This is why I ended up not going east. I tried to get the CPT code Kramer’s clinic would use to bill. Never could get an answer or a returned phone call. I called the doc I had decided upon in Austin. They gave me a code. I called the insurance carrier and gave it to them. They put it in the computer and came back on the line and said “yeah, we will pay that, no problem.” I did ask the doctor that if I had to pay (in the event my insurance carrier got stupid) how much we were really talking for a self pay. He told me (this was 20 months ago) roughly $17,200.

On the suck factor with 1 being I have a winning lottery scratch off ticket and 10 being I’m begging someone to shoot me, I’d give it a 3. I’m a veteran of quite a few hernia repairs-an inguinal on each side, an umbilical, and 2 epigastric. This was a lot like a hernia repair. I bruised, was sore, and was somewhat concerned about my bruised, stiff but discernibly smaller dick. I never had any serious pain. Worst pain was when I peed after they had me catheterized during the operation. I’ll second the idea of it being like peeing razor blades. Or maybe shards of glass then using ammonia to make it feel better. Good news: in 2 days or less peeing was back to normal.

I was feeling normal within days. I was kind of judicious in learning to use it, it wasn’t really scary but hey, we are talking about a guy’s junk here. The doc and his PA were very encouraging about me starting to pump, starting to cycle, etc. at two weeks I was told it was ok to have sex although I waited until week 3. The cycling back to normal size (or original size) took time but we got there.

Sex now is better than at any time before, although that might be clouded by memories of frustration with E D.

It looks normal, it feels normal. I’ve got the LGX so my flaccid is a good size but not so big that it doesn’t look real. I just look like a guy with a fairly big dick. How to phrase this appropriately???? I just don’t think it gets better than this.

If other things work well with ED keep using them. If it has gotten to the point that you dread sex because of the likely frustrating end result then this is a very real option. A guy has to make this decision for himself, and I think each guy will know when it’s time.

[joeban]

Txagq8 wrote
I tried to get the CPT code Kramer’s clinic would use to bill. Never could get an answer or a returned phone call. I called the doc I had decided upon in Austin. They gave me a code. I called the insurance carrier and gave it to them. They put it in the computer and came back on the line and said “yeah, we will pay that

I am trying to figureout if UHC will approve the implant procedure. I know it might not help but do you mind sharing the CPT code so I can call my insurance and see what is covered and what is not.
Thank you

[Txagq8]

Sorry I had to dig out my notes I kept on surgery, they were in one of those plastic tub storage containers.

54405 was the magic number. Not sure why it was such a big deal but the insurance carrier insisted I find out what procedure would be billed as. Then they immediately said “yeah we pay that.”

[Bandbaustin]

Well I am only 2 weeks out but United covered mine upfront. It depends on your employer. I am still in a decent amount of pain. First 2 days I was at 8 due to the peeing felt like razor blades. Caused by catheter in and put during surgery. Now it goes and comes. I need to ice much more often. Quit taking prescription meds after 2 days now just tylenol.

Why did you stop pain meds? Is the Tylenol cutting it for the pain?

I dont like the way they make me feel. Tylenol takes edge off but I also believe I am doimg too much and not.enough icing.

[Gt1956]

Sorry I had to dig out my notes I kept on surgery, they were in one of those plastic tub storage containers.
54405 was the magic number. Not sure why it was such a big deal but the insurance carrier insisted I find out what procedure would be billed as. Then they immediately said “yeah we pay that.”

For those that are interested. I believe that the code is consistent across all insurance companies. So as long as your procedure will conform to the treatments listed under that code you should be covered. Also, if you already have an implant & need some kind of revision. This is not the correct code to use.
Oh, it might only cover an inflatable implant, not maleables. I'm guessing they'd be a different code.

[Lost Sheep]

Sorry I had to dig out my notes I kept on surgery, they were in one of those plastic tub storage containers.
54405 was the magic number. Not sure why it was such a big deal but the insurance carrier insisted I find out what procedure would be billed as. Then they immediately said “yeah we pay that.”

For those that are interested. I believe that the code is consistent across all insurance companies. So as long as your procedure will conform to the treatments listed under that code you should be covered. Also, if you already have an implant & need some kind of revision. This is not the correct code to use.
Oh, it might only cover an inflatable implant, not maleables. I'm guessing they'd be a different code.

I web searched for "Medical Code 54405" and clicked on a likely looking link and found this list of codes.

https://www.unicare.com/dam/medpolicies ... 51152.html