Surgery recommendation (physicians, treatments, foot, price)
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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.
Your husband is probably a second opinion orthopedist, so he gets all the failed foot and ankle surgery folks in the area. There are probably more likely lots of successful foot and ankle patients. The main thing to look for is experience with the particular procedure and any reviews. Obviously if the only options are brand new foot and ankle surgeons, it makes no sense to go with those surgeons until they get some more experience. However, if there are foot and ankle surgeons available with extensive experience in the particular procedure and good reviews, see no reason to travel 200 miles to an orthopedist who will do the same procedure.
Your husband is probably a second opinion orthopedist, so he gets all the failed foot and ankle surgery folks in the area. There are probably more likely lots of successful foot and ankle patients. The main thing to look for is experience with the particular procedure and any reviews. Obviously if the only options are brand new foot and ankle surgeons, it makes no sense to go with those surgeons until they get some more experience. However, if there are foot and ankle surgeons available with extensive experience in the particular procedure and good reviews, see no reason to travel 200 miles to an orthopedist who will do the same procedure.
Those are good points, and perhaps I am not seeing the forest through the trees, because you are correct, he sees many patients who have been referred by other physicians or podiatrists as well as a lot of complex issues and failures. He does get self referrals from local folks though, or people who've been referred by patients of his. As you point out, if you know where to look, you can often find well trained physicians close to home. In my experience, there are some very well trained physicians in smaller/mid sized cities and suburban areas that people often overlook.
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.
Yes, I have traditional Medicare, so no network. I also have a Medigap supplement, also no network. Medigap pays the 20% that Medicare doesn't cover for procedures, etc. If Medicare pays 80%, Medigap pays 20%. I have Plan F. These Medigap plans travel with you across state lines, just like Medicare.
So, the insurance issue is about Medicare not paying for an "experimental" or "investigational" procedure. My Medigap also doesn't pay for it.
Good points about foot surgeries, they can be messed up. Thanks for posting.
OP: Is your issue gout related? I would do all in my power to "fix" as best one can before a surgery.
No gout. Osteoarthritis in big toe joint and a big, painful bone spur has formed on top and side of joint over the last 2 years. Cartilage has worn out. Not a bunion. Injections into the joint don't work any longer. Surgery is the only option at this point. Gettin' old is fun, isn't it?
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.
Totally agree that an ortho surgeon is needed, not a podiatrist. Very different training and credentials. You are correct that the foot and ankle ortho surgeons are a small number, even in bigger cities. It's a subspecialty of orthopedics. 15 in Denver? Maybe that's where I should move....
The issue with calling the current surgeon's office is that the people who answer the phone are clerks and schedulers, not medical professionals. Talking on the phone to a doctor is nearly impossible. Maybe an email, but they don't spend a lot of time giving out detailed info on email. They ask you to make an app't for a consult, which I already did. The questions you raised are excellent.
Unfortunately, doc app'ts aren't long enough for extended discussions these days. You are lucky to get 15 minutes and a lot of the questions come up after you leave and have had a chance to think about what went on in an app't. Doctors, quite honestly, like to be in charge during app'ts, and it's a rare physician that allows for a genuine "back and forth" during an app't.
I will need to get a second opinion, for sure. Great post. Thanks!
OP, are you seeing a podiatrist or an orthopedic surgeon??
Ortho surgeon. A podiatrist wouldn't be as well-qualified for this surgery, and ortho surgeons also address how this foot issue is impacting the rest of my walking mechanisms (hip, leg, etc) vs podiatrists that focus only on feet. Different training, fellowships and experience.
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.
I may wait until after I move and probably change insurance. It's painful, but that may be the best option. Also with any type of foot surgery, I have to plan how I'm going to get around for groceries, etc, Uber?
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.
Hopefully, this is correct. Maybe "crappy" was too strong, but I'd hate to be in a situation with someone who "reluctantly" did the standard procedure, and in the follow-up appts was continuing to remind me that I "chose" the standard treatment vs the investigational treatment. Hopefully, the surgeon would be able to let it go and move on as a professional, and do an excellent job regardless of the procedure. After I get a second opinion, I'll have a better idea of where there is a good fit for doing the surgery.
OP: Often the old and trusted "standards" are the best. I found that out when I had the latest and greatest more pricey hip replacement and ended up with nasty complications. We don't learn until all is said and done.
OP: Often the old and trusted "standards" are the best. I found that out when I had the latest and greatest more pricey hip replacement and ended up with nasty complications. We don't learn until all is said and done.
Very true. A lot of pricey procedures are offered due to the $$$$ they make for the docs and facilities. Very unfortunate that the US healthcare system is built on making money vs "what's best for the patient" even if it means less revenue.
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