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Thread: Out of Network

  1. #1
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    Out of Network

    I have to go out of network for surgery because I will not let a surgeon in Kentucky touch me. Made 1post regarding living with 30 years of chronic back pain in 1st time surgery. I am currently with Humana Choice-PPO. From what Iíve read in threads the surgery itself is going to be sky high. Plus I have to stay 1-2 weeks on campus rehab. The surgery will be done by Dr Gupta in Saint Louis (about 6 1/2 hr drive). Because I am single w/o family or support system, Iíll have to pay for in home health aides 24/7 for at least a month. There is only 1 company with good reputation that does this. I found out cost for this will be over $15,800!!! My X has only agreed to help out some but my only source of income is disability which barely covers my bills. I know enrollment period starts 10/1 + heard that Anthem may cover in home health care aides. But Jesss! Even having to buy items for preparing for this surgery is adding up! Any help would be appreciated. Nancy

  2. #2
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    Hi...

    Not that it matters since you've already decided, but Leatherman is actually a highly regarded spine center.

    https://www.nortonhealthcare.com/ser...ons/spine-care

    --Linda
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

  3. #3
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    Quote Originally Posted by LindaRacine View Post
    Hi...

    Not that it matters since you've already decided, but Leatherman is actually a highly regarded spine center.

    https://www.nortonhealthcare.com/ser...ons/spine-care

    --Linda
    Linda, I had asked Dr Gupta when I saw him back in 12/17 and he told me about Leatherman in Louisville Kentucky. When I looked at reviews about the Leatherman center this year they were bad?? Are there any treads or somewhere else I can find out about their current reputation? Thanks Nancy

  4. #4
    Join Date
    May 2008
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    reno,nevada
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    If you look at reviews on "anything", your going to have both good and bad reviews. From surgeons to hotels to products, it doesn't matter what it is. It almost makes looking at reviews worthless. And if they are worthless, why bother typing in a bad review? Disgruntled peevish people seem to do this.

    I looked on FB and most of the reviews are about office personal. I will agree that this does present some problems, and have had this happen to me in the past. Usually its a scheduling or communication problem. One complaint was about having to wait one hour which is not really a complaint since you are seeing a specialist and they are busy people. It has little or nothing to do with their integrity or professional ability to perform something as complicated as scoliosis surgery.

    There is a pain complaint which is no surprise since many of us will have some pain related issues after scoliosis surgery. Only the really lucky adults get through without some sort of pain. We take what we can get. If there is an improvement, its worth it. This is the chance we take....

    Some of the best surgeons who generally operate on the hardest cases will have bad reviews. There are threads here about this. Its expected.

    Nancy, If I were in your shoes, I would go to Louisville. Its going to be a whole lot easier logistically and much cheaper.

    The surgeons at Leatherman have extensive scoliosis experience, that is not an issue.

    Ed
    Last edited by titaniumed; 08-31-2019 at 10:58 AM.
    49 yr old male, now 60, the new 55...
    Pre surgery curves C12,T70,L70
    ALIF/PLIF T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
    Dr Brett Menmuir St Marys Hospital Reno,Nevada

    Bending and twisting pics after full fusion
    http://www.scoliosis.org/forum/showt...on.&highlight=

    My x-rays
    http://www.scoliosis.org/forum/attac...2&d=1228779214

    http://www.scoliosis.org/forum/attac...3&d=1228779258

  5. #5
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    Quote Originally Posted by titaniumed View Post

    Some of the best surgeons who generally operate on the hardest cases will have bad reviews. There are threads here about this. Its expected.
    Exactly. The more complex cases that are taken on, the more bad outcomes, and thus the more bad reviews. We shouldn't always place blame on the surgeons who do complex revision surgeries. For the most part, they're doing their best to try to improve lives, and we should be grateful that there are some willing to take these surgeries on.
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

  6. #6
    Join Date
    Aug 2019
    Location
    Kentucky
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    Lo

    Quote Originally Posted by titaniumed View Post
    If you look at reviews on "anything", your going to have both good and bad reviews. From surgeons to hotels to products, it doesn't matter what it is. It almost makes looking at reviews worthless. And if they are worthless, why bother typing in a bad review? Disgruntled peevish people seem to do this.

    I looked on FB and most of the reviews are about office personal. I will agree that this does present some problems, and have had this happen to me in the past. Usually its a scheduling or communication problem. One complaint was about having to wait one hour which is not really a complaint since you are seeing a specialist and they are busy people. It has little or nothing to do with their integrity or professional ability to perform something as complicated as scoliosis surgery.

    There is a pain complaint which is no surprise since many of us will have some pain related issues after scoliosis surgery. Only the really lucky adults get through without some sort of pain. We take what we can get. If there is an improvement, its worth it. This is the chance we take....

    Some of the best surgeons who generally operate on the hardest cases will have bad reviews. There are threads here about this. Its expected.

    Nancy, If I were in your shoes, I would go to Louisville. Its going to be a whole lot easier logistically and much cheaper.

    The surgeons at Leatherman have extensive scoliosis experience, that is not an issue.

    Ed
    Appreciate both you & Lindaís response. It will still be out of network and only 1 1/2 hour drive from where I live (which would be better). Totally understand about reading reviews. I did extensive research before I 1st saw dr g back in 2017. Plan of action is to get info on the doctors who are most experienced in performing this surgery & get an appt. Dr Gupta was at Leatherman early on (some kind of education? I just want to REALLY check dr/Hospital out before committing. I havenít explored the Scoliosis Foundation yet. Have struggled with a lot of pain since Thursday. Cancelled PT that day but made myself take dog for a short walk then went to PT yesterday but have been hooked up to my heating pad all day. Worried about not being physically fit for surgery. Anyway thanks for feedback. Nancy

  7. #7
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    Quote Originally Posted by Scared View Post
    Appreciate both you & Lindaís response. It will still be out of network and only 1 1/2 hour drive from where I live (which would be better). Totally understand about reading reviews. I did extensive research before I 1st saw dr g back in 2017. Plan of action is to get info on the doctors who are most experienced in performing this surgery & get an appt. Dr Gupta was at Leatherman early on (some kind of education? I just want to REALLY check dr/Hospital out before committing. I havenít explored the Scoliosis Foundation yet. Have struggled with a lot of pain since Thursday. Cancelled PT that day but made myself take dog for a short walk then went to PT yesterday but have been hooked up to my heating pad all day. Worried about not being physically fit for surgery. Anyway thanks for feedback. Nancy
    Dr. Gupta is great. He's not just a great surgeon... he's a great person. He did his fellowship at Leatherman.

    Since Leatherman is also out of network, I think I would choose Dr. Gupta if it was up to me.

    --Linda
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

  8. #8
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    reno,nevada
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    Quote Originally Posted by Scared View Post
    Worried about not being physically fit for surgery.
    This happens a lot you know, or at least we think about it. It was one of my main reasons for doing my surgeries (other than pain) at age 49. I knew it had to be done at some point, and I knew I couldn't make it without surgery. Too much damage was done. You see what happens when you have too much fun. Heck, it was worth it. Overexercise is overrated.....I skied hard for 52 years, now my hips, knees, ankles, and neck are shot. The fused area is great....it all worked out well and I wouldn't change a thing. I am old skier paying his dues now.

    We have to be in good enough shape to withstand anesthesia.....I would say that most of us think about the actual surgery itself, but you can get into trouble with anesthesia. Joan Rivers did not have a procedure done to her....The respiratory depression from morphine is a subject worth discussion.

    I don't know if I mentioned it, but years ago I was contemplating a move to San Francisco back when Dr Bradford was working. Reno had no scoliosis surgeons years ago, back in the 1980's there weren't that many scoliosis surgeons, I guess most of the patients really did have to travel for scoliosis surgery because of this. This move would have been for logistics and insurance purposes. California is a good state for scoliosis surgery because its so large, and it has a lot of surgeons. You can be in San Diego, and travel to San Francisco and your still in state. Does everybody in Rhode Island have to go out of state? You see what I am saying?

    I also think about retiring in the outback, not Timbuktu, but close. The problem with that is medical. Is it a good idea being far away, or is it that much wiser to be a whole lot closer to good progressive medical centers? Jackie is lucky to be located in the Chicago area....

    Be careful with the heating pad. I fell asleep on one 15 years ago and I woke up with major lumbar muscle spasms. (and then threw out the heating pad.) I have had muscle spasms in the lower spine twice in my life before my surgeries and they are painful! I have not had muscle spasms after my surgeries.

    Funny, I had my dads Zanaflex at that time, but didn't think about it. I have taken Flexoril, 40 years ago, it seemed weak to me.

    Ed
    49 yr old male, now 60, the new 55...
    Pre surgery curves C12,T70,L70
    ALIF/PLIF T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
    Dr Brett Menmuir St Marys Hospital Reno,Nevada

    Bending and twisting pics after full fusion
    http://www.scoliosis.org/forum/showt...on.&highlight=

    My x-rays
    http://www.scoliosis.org/forum/attac...2&d=1228779214

    http://www.scoliosis.org/forum/attac...3&d=1228779258

  9. #9
    Join Date
    Aug 2019
    Location
    Kentucky
    Posts
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    Ed, I have tried many times to ďescapeĒ Kentucky either through job prospects or other means but obviously didnít work out. Looking back wished that upon graduating h.s. wouldíve headed straight to Berkeley for undergrad. Love California but now have to play the hand Ií dealt with. Thanks for info re: Dr Joshi & use of Ketamine. Reached out & inquired to see if there were any anesthesiologists at Washington University for Medicine & answer was no. Also Dr Joshi will not give a recommendation unless he sees you ($350 + air/Hotel) bummed about that. I was very impressed watching Dr Joshiís presentation on YouTube. Thanks Nancy

  10. #10
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    Quote Originally Posted by LindaRacine View Post
    Dr. Gupta is great. He's not just a great surgeon... he's a great person. He did his fellowship at Leatherman.

    Since Leatherman is also out of network, I think I would choose Dr. Gupta if it was up to me.

    --Linda
    Really appreciate confirming my research & gut feeling re: Dr Gupta. Spent a lot of time looking at the Leatherman Center & a Dr Glasses but was waiting until Tuesday to call them. I didnít see on their website if they had an on campus rehab but probably a mute point presently. Thank you Nancy

  11. #11
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    Quote Originally Posted by Scared View Post
    Really appreciate confirming my research & gut feeling re: Dr Gupta. Spent a lot of time looking at the Leatherman Center & a Dr Glasses but was waiting until Tuesday to call them. I didnít see on their website if they had an on campus rehab but probably a mute point presently. Thank you Nancy
    I think you mean Dr. Glassman (not Glasses).
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

  12. #12
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    Aug 2019
    Location
    Kentucky
    Posts
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    Quote Originally Posted by LindaRacine View Post
    I think you mean Dr. Glassman (not Glasses).
    Yes I made a spelling error that sometimes occurs when youíre scared.

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