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Old 08-13-2019, 11:54 PM
 
6,063 posts, read 4,420,928 times
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I would call the insurance and ask for someone "in network" who does the standard procedure so you don't waste a visit just trying to find out. Tell the insurance what you want done and ask them for a referral. They can't refuse to pay if you're in network and you don't have to spend your money to feel like a guinea pig. If they ask you why, tell them. I'd rather make the trip a little out of my area than have a ******* contest with some surgeon. You feel uncomfortable, you seem to feel he's confrontational and trying to do what he wants instead of what you want, and you shouldn't feel either of those things.
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Old 08-14-2019, 08:35 AM
 
10,226 posts, read 7,520,384 times
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Medicare doesn't have networks, as such, does it? I don't think so. Are you speaking of your Advantage supplemental insurance?

My stepmother had foot surgery three times, and she still has problems with her feet. It all started with bunion surgery many years ago. One of those surgeries was "experimental" and messed up her feet. The subsequent surgery or surgeries were to try to correct the problems caused by the first surgery. Be very careful with "experimental" procedures. As for me, I wouldn't be able to afford anything my ins. wouldn't cover, so I wouldn't have an option BUT the standard procedure.

If you present it to your doctor as "I can't afford to have any procedure done that my insurance won't pay for," he'll understand and won't be offended. No need to get into your lack of trust in the procedure or anything.

You need a second opinion for surgery as important as this. Find another in-network doctor to get a second opinion. I don't think Medicare cares WHICH doctor you go to, or WHICH city he's located in. But your supp. ins., I don't know. My parents have gone to the neighboring big city of Houston for much of their specialized medical care; Medicare covers it. Medicare is Medicare in all the states, as far as I know.

As for having to go to another city, think of it this way. If you lived in a big city, it's possible that another doctor you could go to would be IN that city but across town, and would be further away than your 2nd opinion dr in another city and/or would take you longer to get there. I wouldn't let the "other city" stop you, unless your supplemental ins. has a problem w/that.
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Old 08-14-2019, 11:18 AM
 
Location: Southern California
29,267 posts, read 16,619,492 times
Reputation: 18902
OP: Is your issue gout related? I would do all in my power to "fix" as best one can before a surgery.
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Old 08-14-2019, 12:08 PM
 
17,378 posts, read 13,150,314 times
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OP, are you seeing a podiatrist or an orthopedic surgeon??
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Old 08-14-2019, 03:52 PM
 
Location: Freakville
511 posts, read 489,210 times
Reputation: 556
Quote:
Originally Posted by Kayekaye View Post
I just had the same thing told to me today by my orthopedic doctor. She said there was some new treatment that involved brain stem cells used to try to regrow injured ligaments or tendons. But said there was no conclusive evidence yet and insurance probably wouldn’t cover it. Turned that down flat. I’ve had a lifetime of foot problems and surgery. Be very careful. I had doctors refuse to see me because I was Dr. So and so’s patient. It took years to get out of that network.
Brain stem cells?
Are you sure he said brain stem cells or just stem cells?
Stem cell therapy in orthopedics is getting pretty popular (although I don’t think many, if any, payors are covering it).
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Old 08-14-2019, 03:59 PM
 
Location: Southern California
29,267 posts, read 16,619,492 times
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Quote:
Originally Posted by Flem125 View Post
Brain stem cells?
Are you sure he said brain stem cells or just stem cells?
Stem cell therapy in orthopedics is getting pretty popular (although I don’t think many, if any, payors are covering it).
I have been using and studying Prolotherapy and PRP and Stem Cells fall in this category. I believe PRP is much more effective and less pricey than stem cells. OP, would do well to get a consultation from a provider who does PRP,, for the toe.
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Old 08-14-2019, 04:27 PM
 
Location: near bears but at least no snakes
26,648 posts, read 28,516,169 times
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Reminder: We are not allowed any more threads on prolotherapy, There were so many that it was getting annoying. You may make one POST but if it continues=infraction.
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Old 08-14-2019, 10:10 PM
 
9,446 posts, read 6,537,551 times
Reputation: 18898
Could you wait until you can change your insurance and get coverage with a different ortho surgeon? I know it's a while before medicare lets us change, so this may not be possible.
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Old 08-15-2019, 05:18 AM
 
9,952 posts, read 6,606,113 times
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Quote:
Originally Posted by mike1003 View Post
OP, are you seeing a podiatrist or an orthopedic surgeon??
It sounds like he is seeing an orthopedist. I don’t think there are many orthopedists who specialize in the feet, which may be the problem. Those that do may want to try the experimental procedures. Perhaps switching to a podiatrist would provide better options. Most should be more than willing to try the standard procedures.
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Old 08-15-2019, 07:18 AM
 
Location: Texas
5,843 posts, read 6,134,509 times
Reputation: 12290
Quote:
Originally Posted by RamenAddict View Post
It sounds like he is seeing an orthopedist. I don’t think there are many orthopedists who specialize in the feet, which may be the problem. Those that do may want to try the experimental procedures. Perhaps switching to a podiatrist would provide better options. Most should be more than willing to try the standard procedures.
I think you're correct that OP mentioned she's seeing an Orthopedic surgeon and you are also correct that in many locations, the supply of fellowship trained Orthopedic surgeons who specialize in Foot and Ankle is quite limited. By way of example, my husband specializes in this, and for his entire 5 years in private practice in a city of 100K in North Texas, he was literally the only surgeon trained in this subspecialty in a 100 mile radius. OTOH, when we were in Denver, he was one of about 15 or so that he knew of just in that city alone.

However, I would strongly recommend that OP only consider an Orthopedic surgeon, and not a podiatrist, for any surgical procedure on the foot. Of course, maybe I'm biased from listening to 15 years of stories about things podiatrists have messed up. Having said that, I think there are some podiatrists who are good surgeons, particularly if dealing with only the toe(s). I'm not sure I agree that any and every Ortho F&A surgeon is going to only want to do an "experimental" procedure, and I'm putting that word in quotations because it's entirely possible the procedure is experimental in Medicare's opinion, but it's something that's commonly done by surgeons because they feel it yields better outcomes with fewer complications. However, Medicare's rules about not paying for it are absolutely a major contributing factor in OP's decision.

OP, if you feel less than comfortable with what this surgeon wants to do, call his office and ask detailed questions about why he wants to do this procedure as opposed to the other, how many he's done, why he thinks it yields better results, and what the complication rates are. You should feel absolutely comfortable getting a second opinion. If and when you proceed with surgery, the surgeon can, and should, be the one to make all technical decisions about the case, and no, you shouldn't worry about the surgeon doing a "crappy" job (in your words), because they disagree with the procedure you chose. As bluedevilz previously mentioned, that just doesn't happen.

Last edited by Texas Ag 93; 08-15-2019 at 08:21 AM..
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