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AUS Insurance Coverage?

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Posted 3/6/2015 3:02 PM (GMT 0)
Greetings everyone,

Just wondering for all the guys who have been lucky enough to have successfully had an AUS800 installed, I say lucky because now I assume that you are NOT leaking anymore, LOL. Although your still unlucky because you had to have it installed in the first place! I am wondering how hard it was to get this covered by you insurance? I am retired from the Army and have Tricare Prime, they are good for some things but crazy for others, and just wondering as I am working on getting my appointment scheduled to see the uro again , which took another referral and approval from insurance, on how tough it is to get this procedure approved?

I had my original RALP doen on 11-12-13 PSA .064 1 month .074 3 months....33 9 Months red alert!!!
SRT 37 treatments OCT-DEC '14 PSA JAN '15 .04 Yeah...now its time to stop the leaking so i can be like my little brother Icahbod who had his RALP done last month and is now dry!!!

Thanks in advance all.
Posted 3/6/2015 6:48 PM (GMT 0)
Hi Paul,
I had no problem having BCBS pay for it but my out of pocket was $3000. I paid $1500 down and the hospital carried the remainder for 12 months with no interest charges.

I figure the cost savings in pads and taking my pants to the cleaners will more that pay it all back in 3 years. yeah

But it was well worth in QOL alone!

Doesn't it piss you off, no pun intended, when someone like your brother has no incontinence issues and you do?

Bill from Florida cool
Posted 3/6/2015 8:28 PM (GMT 0)
Same deal for me, at least in theory. 3000 dollar out of pocket cap. Of course nobody has been paid yet.
Posted 3/6/2015 8:59 PM (GMT 0)
I worked for a fairly large furniture company, and the insurance covered my AUS and the re-implantation of it after I developed an infection.

I switched doctors and hospitals. It went ok. I also had a medical gap coverage that pad the gap between my insurance and my out of pocket.

I read the total bill, before it was deducted by the insurance company.. Over $100,000. Total cost. The pay out was in the $20,000 range I believe.

NEO
Posted 3/6/2015 9:04 PM (GMT 0)
Neo,
I also work for a very large retail furniture company. Obviously not as large as yours, sounds like you had a better insurance plan.

When I had my DaVinci, I was on my wife's plan and it cost me only $15 !!!!!!

Bill from Florida cool
Posted 3/6/2015 9:14 PM (GMT 0)
I just saw the bills for my RALP. $4800 for the surgeon and $32K for the hospital before BCBS discounts. My deductible is $3000, and 20% of the rest up to another $3000. Sigh. And I work for a $B corporation.

And the system isn't screwed up?
Posted 3/6/2015 10:53 PM (GMT 0)
Just got my EOB from BCBS as well. They paid the hospital $23,000, (that's what was actually paid out to the hospital) My out of pocket was $300, +$650 for a private room, which was my choice

The surgeon billed about $25,000, and got paid $2200. Crazy
Posted 3/6/2015 11:44 PM (GMT 0)
No problem getting the AUS covered from Medicare (primary) and Anthem (secondary). The total was about $40,000 before insurance adjustments. We paid a few co-pays, but that was all. Thankfully, we've always had good insurance. By the way, the surgery has been a life changer.
Posted 3/7/2015 11:50 AM (GMT 0)
Thanks everyone for all the insight, I have since talked to my Docs assistant and she said that my insurance company will pay for it! Scheduled for my initial appointment on the 9th of April.

Bill, I a, very happy that Eric is dry, that was my biggest fear him going into surgery, knowing what I have been through, wouldn't wish this on any one, and as you know I get pissed off , no wait ON everyday LOL?
Posted 3/7/2015 9:20 PM (GMT 0)
Big Mac, I still had to pay out. but I had already hit the max out of pocket.. by that point.. I was making payments for several years.. not fun.

NEO
Posted 3/7/2015 11:25 PM (GMT 0)
Neo,
I understand, since you hit the max, might as well get it all done!

I was never told this is what getting older was going to be like.

I just had a CT scan for my sinus this week, Cha ching $$$$

Bill from Florida cool
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