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Old 08-13-2019, 12:51 PM
 
2,410 posts, read 5,789,988 times
Reputation: 1916

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I recently saw an orthopedic surgeon for a consult on doing a procedure on my foot. He recommended a new surgical procedure that is considered experimental and "investigational" by Medicare, and therefore they aren't going to pay for it. (I checked with Medicare on this.) I'd prefer the standard procedure for this issue anyway, since there are mixed reviews on the outcomes of the investigational procedure from patients who have gone through it.

The investigational procedure is a modification of the standard procedure, it's not totally different.

However, the surgeon argued with me during the appointment about how much better the investigational procedure was, yada yada, how "most' patients do well, etc. When I left, I said, "I'll think about it."

The problem is that there aren't any other doctors in my area that do this standard procedure at all, and to get another opinion, I'd have to go to another city and he/she might say the same thing, and there might be network issues. A big hassle.

I'm concerned that if I stick with the first guy, who is "in my network," and I insist on the standard procedure, he won't be happy, maybe do a crappy job, or maybe he'll go ahead with the investigational procedure and I'll get stuck with a huge bill.

Can doctors refuse to do a standard (vs investigational) procedure if that's what the patient wants? Or if their insurance doesn't pay for it?
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Old 08-13-2019, 01:05 PM
 
Location: on the wind
22,871 posts, read 18,160,783 times
Reputation: 74075
In the end, YOU are the paying customer. If this ortho doesn't want to do the procedure you are most comfortable with, tell him you'll find someone who will. He can't force you to do anything. He can try to persuade you but that's it. If he resists, vote with your feet (painful as that is). Check with your insurance about traveling distances to get care. There's probably a way to do it if care isn't available locally. Explain why you are looking. Consider that even if a provider in the other city ends up preferring the same experimental procedure, at least you got that valuable second opinion.

Last edited by Parnassia; 08-13-2019 at 02:27 PM..
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Old 08-13-2019, 01:10 PM
 
Location: Southern California
29,267 posts, read 16,568,121 times
Reputation: 18901
OP: I don't know your issues but my daughter has two feet with collapsed tendons/arches and she's had 3 opinions, one surgeon wanted to do surgery, one surgeon said COULD END UP WORSE, don't do it. This is major work and long down time, in her case it would be reconstruction surgery. She's on a product now and doing very well, no pain in the feet and I will send you info...I'm realizing improvement with my arthritic feet as well.
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Old 08-13-2019, 06:43 PM
 
Location: Central Florida
3,255 posts, read 4,960,182 times
Reputation: 14987
Quote:
Originally Posted by xz2y View Post
I recently saw an orthopedic surgeon for a consult on doing a procedure on my foot. He recommended a new surgical procedure that is considered experimental and "investigational" by Medicare, and therefore they aren't going to pay for it. (I checked with Medicare on this.) I'd prefer the standard procedure for this issue anyway, since there are mixed reviews on the outcomes of the investigational procedure from patients who have gone through it.

The investigational procedure is a modification of the standard procedure, it's not totally different.

However, the surgeon argued with me during the appointment about how much better the investigational procedure was, yada yada, how "most' patients do well, etc. When I left, I said, "I'll think about it."

The problem is that there aren't any other doctors in my area that do this standard procedure at all, and to get another opinion, I'd have to go to another city and he/she might say the same thing, and there might be network issues. A big hassle.

I'm concerned that if I stick with the first guy, who is "in my network," and I insist on the standard procedure, he won't be happy, maybe do a crappy job, or maybe he'll go ahead with the investigational procedure and I'll get stuck with a huge bill.

Can doctors refuse to do a standard (vs investigational) procedure if that's what the patient wants? Or if their insurance doesn't pay for it?
If you really think your surgeon is capable of doing a "crappy job" out of spite, or doing a procedure against your expressed wishes, then you need to see a different surgeon.
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Old 08-13-2019, 08:25 PM
 
17,328 posts, read 13,066,463 times
Reputation: 32629
You need a second opinion, or no surgery for you
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Old 08-13-2019, 08:27 PM
 
5,644 posts, read 13,177,149 times
Reputation: 14170
Quote:
Originally Posted by xz2y View Post
I recently saw an orthopedic surgeon for a consult on doing a procedure on my foot. He recommended a new surgical procedure that is considered experimental and "investigational" by Medicare, and therefore they aren't going to pay for it. (I checked with Medicare on this.) I'd prefer the standard procedure for this issue anyway, since there are mixed reviews on the outcomes of the investigational procedure from patients who have gone through it.

The investigational procedure is a modification of the standard procedure, it's not totally different.

However, the surgeon argued with me during the appointment about how much better the investigational procedure was, yada yada, how "most' patients do well, etc. When I left, I said, "I'll think about it."

The problem is that there aren't any other doctors in my area that do this standard procedure at all, and to get another opinion, I'd have to go to another city and he/she might say the same thing, and there might be network issues. A big hassle.

I'm concerned that if I stick with the first guy, who is "in my network," and I insist on the standard procedure, he won't be happy, maybe do a crappy job, or maybe he'll go ahead with the investigational procedure and I'll get stuck with a huge bill.

Can doctors refuse to do a standard (vs investigational) procedure if that's what the patient wants? Or if their insurance doesn't pay for it?
1. No surgeon is going to do a "crappy job" out of spite....that just doesn't happen.

2. If you aren't happy with what you heard then you absolutely should get a 2nd opinion.

3. The surgeon isn't going to do the investigational procedure unless you consent to it, if you didn't consent to it then he can't do a "switch" in the operating room

4. While the patient is the "customer" that doesn't mean he/she gets to dictate the procedure. If the surgeon doesn't want to do the "standard procedure" (would help to know what we are talking about) because he feels the newer procedure is much better, the "customer" can't tell the patient to do the other procedure anyway....

That is to say, you don't have to have surgery at all with this surgeon but you don't get to tell him what procedure to do....ultimately that is the surgeon's call.
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Old 08-13-2019, 08:35 PM
 
1,487 posts, read 869,928 times
Reputation: 2102
Quote:
Originally Posted by bluedevilz View Post
1. No surgeon is going to do a "crappy job" out of spite....that just doesn't happen.

2. If you aren't happy with what you heard then you absolutely should get a 2nd opinion.

3. The surgeon isn't going to do the investigational procedure unless you consent to it, if you didn't consent to it then he can't do a "switch" in the operating room

4. While the patient is the "customer" that doesn't mean he/she gets to dictate the procedure. If the surgeon doesn't want to do the "standard procedure" (would help to know what we are talking about) because he feels the newer procedure is much better, the "customer" can't tell the patient to do the other procedure anyway....

That is to say, you don't have to have surgery at all with this surgeon but you don't get to tell him what procedure to do....ultimately that is the surgeon's call.
Actually.....the patient certainly does have the right to decide what procedure he wants...esp in this case where one is experimental..thus no proven track record of success..

Yikes..The patient is always in charge!
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Old 08-13-2019, 08:52 PM
 
Location: Brawndo-Thirst-Mutilator-Nation
22,572 posts, read 24,373,053 times
Reputation: 20219
Surgery and new-procedure..............yikes, I would be kinda wary.
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Old 08-13-2019, 10:08 PM
 
5,644 posts, read 13,177,149 times
Reputation: 14170
Quote:
Originally Posted by Lola The yorkie View Post
Actually.....the patient certainly does have the right to decide what procedure he wants...esp in this case where one is experimental..thus no proven track record of success..

Yikes..The patient is always in charge!
Patient is NOT in charge of telling the surgeon what procedure to perform in an elective or emergent situation

The patient does have a right NOT to have the procedure recommended by the surgeon and go elsewhere

But to tell the surgeon what to do.... nope
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Old 08-13-2019, 11:44 PM
 
4,096 posts, read 6,176,379 times
Reputation: 7406
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.
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