Subsequent problem after private pay

[Musson]

I am with a large HMO system. Wondering what would happen if I private paid for an implant but then had a subsequent problem requiring urgent medical care? Anyone experience this dilemma?

[bionicbrother]

I would believe your provider would pay for it because its not cosmetic anymore( its your life and health).. doesnt matter if you paid out of pocket originally or not - NOW you have medical condition that needs attention( but you do need to check your policy documentation on whats covered and whats not covered to be sure)..

[Time2Change]

My doctor will not do the surgery unless it is covered by insurance for the issue you're presenting.

According to him, if he lets someone pay out of pocket for the surgery, and then there is a problem afterwards, such as an infection, it creates a lot of problems for him and the patient.

[newbie443]

I am with a large HMO system. Wondering what would happen if I private paid for an implant but then had a subsequent problem requiring urgent medical care? Anyone experience this dilemma?

I was in a network only plan. It only covered part of my home state. Anywhere else I had only life threatening coverage. So if i broke a bone and it was not life threatening I had to either make it back to my coverage area or pay out of pocket. The doctors in my coverage area only did 2-3 implants a year each and part of my counseling with the business office was that the results from the doctors were poor enough that many of the men they implanted had the device removed. And the cost was more than my deductible and max out of pocket as the uro group required an over night stay and other parts that were not covered by insurance. I self paid and I did have problems. I had very little help from either my local or the doctor that did the surgery. After years of trying to get help with my insurance (I could not self pay a second time) I was finally able to get my gastro doc to do a CT scan that showed the proximal perforation. None of the local doctors did repairs or revisions. They are more difficult and it seems they had enough trouble with doing the virgin implant that they did not do them. I tried to use a clause in my insurance that permits me to go to an out of area doctor if the service is not offered in my coverage area. I had Blue Cross and tried getting to a Texas and a Atlanta doctor for the repair with no luck. My insurance hates to pay for any part of this and has to approve this ahead of time. I was finally able to get a repair closer to my home but just out of my coverage area in my home state. Even then the doctor I went to told me the only reason he was doing the surgery was for training. He was at a teaching Hospital (KU Med) and had a number of his students examine me to "feel" the problem. And there were also some in the OR.

I would research my local doctors well. Find out if they do revisions and repairs. Try to find a good doctor in your coverage area. Local care is best. If not and you are in the same situation as I was and Travel and self pay is your best option for a good outcome then you might look at Sergeo. They have a number of well known doctors that accept the plan. And it has a third party 25K insurance for complications. They also have financing listed on the site. Even the really good doctors are not perfect. They just have a lower number of men with problems. So research the doctor you will travel to also.

Best of luck to you with this and if I you'd like to talk send me a PM.

[OregonStrong]

It's really ridiculous. Women aren't treated this way by insurance companies after having reconstructive breast surgery which may include breast implants after breast cancer surgery.