Finding a surgeon

Sorry. Meant Becker’s (not Beck’s) Spine Review and “10 under 45” is the title of the list I read.

@marlenec I wanted to welcome you to Connect. I'm sorry it took me a while to find you here. I recently went on Medicare after being on employer health insurance. I wanted to be able to continue to get health care at Mayo if that need comes up as I had spine surgery there a few years ago. I called Mayo and asked what insurance they took, and the answer for Rochester anyway, was Original Medicare and a Medigap supplement insurance plan that can be accepted anywhere in the US. They named Mutual of Omaha and the United Health Plan through AARP as policies they accept. The Mayo campuses are different in what policies they accept, and that can change, so call the billing office and they will answer your questions.

The Medicare "Advantage" plans tend to limit the doctors you can see to those in their plan, and I do know of a patient who had a consult at Mayo with an Advantage plan, but then the plan would not authorize Mayo to do the surgery that she needed, and she was forced to have surgery with a local surgeon and did not have any choice of surgeons. They would only authorize their one surgeon, and she was in too much pain to fight them and wait longer for treatment.

I think you will find good surgeons in Southern CA, but I don't have experience with any surgeons there. I also looked at Becker's Spine Review and I read the profiles of surgeons at their facilities I was interested in and looked up their research papers and read everything I found online about them. The Becker's list is useful, but it isn't everything. I saw a non-Mayo surgeon on their 100 Surgeons to know and he wouldn't answer my questions, yet he was very pushy about wanting to do surgery, but I had no choice in anything. He only did this his way with the hardware he wanted. At Mayo, I was able to have a cervical fusion without hardware which was a good choice for me, and I stayed in a collar until it fused.

Do you have an appointment scheduled with a spine surgeon?

Hi thanks for replying. I saw a USC Keck surgeon (he did a friend of a friend, he was listed in Beckers and I have read his publications ) a few weeks ago. Same response - “you will know when it’s time - when your pain stops being an annoyance and starts interfering with your life.” He specializes in spine only and also referred me to a USC endocrinologist to discuss the osteopenia issues. He would definitely want me on some bone med before surgery. He also wrote a PT order. So I’m thinking that I’ll stick with him if/when I think I need surgery but in the meantime I am trying to avoid it and I’m beating the bushes for info. Am in the middle of Stuart McGill’s book “Back Mechanic.”

If anything that will keep you from the knife it’s PT and your own follow through of your HEP from PT and don’t ever stop. PT for me has kept me from needing to replace my 1988 stainless steel fusion in lumbar spine. Obtain recommendations from patients not your doctors, who typically know nothing about the after care other docs provide other than what they do. Past patient satisfaction is important in my eyes. Because of your location you have choices but your health plan, as Jennifer pointed out, only contracts with certain docs and hospitals to keep their costs down. This is a hurdle you have to deal with, unfortunately. Good luck.

@marlenec Twocoastsm, I have heard other patients mention the "Back Mechanic" book. Does it provide useful information in understanding your situation? I probably read a similar book called, "Back in Control" by David Handscom who is a spine surgeon who himself became a spine surgery patient. You can find his information at https://backincontrol.com/

I heard the same response that I will know when it's time. I actually knew it was time long before several surgeons did and they were not listening to me, so that is why I came to Mayo.

With spine surgery, it is best to get at least a second if not several opinions from qualified spine surgeons. Most doctors will recommend that and understand the value in it. If you don't need to have surgery this year, you could possibly expand your choices in surgeons if you signed up for real Medicare and a Medigap supplement insurance that is accepted nationwide. That combination works for the main Mayo campus in Rochester which is why I made that choice when leaving employer group health insurance after calling the Mayo billing office to ask that question. It's best to ask the billing office for the surgeon too since that can change, and could be different next year for a particular doctor for what insurance they will accept. Spine surgery is way too expensive to pay out of pocket. You need a surgeon in network with your insurance plan.

You do have time now to look into building bone so you can be ready for spine surgery when that time comes. That is wonderful that you have been refereed to an endocrinologist. Poor bone quality is not good for spine issues. My elderly mom had a parathyroid problem that was pulling calcium out of her bones and it caused severe osteoporosis. This resulted in her foot fracturing when she was standing, and causing a fall which broke her pelvis, then a 3 month rehab. A few years later, she had a spontaneous spinal compression fracture which has now healed but caused a curvature that shouldn't be there. She isn't a spine surgery candidate. She does see an endocrinologist who specializes in bone loss and has been on Evenity injections monthly.

You might find discussions helpful in the Osteoporosis Group.
https://connect.mayoclinic.org/group/osteoporosis/
Your surgeon does sound like a good guy, and PT is great for building strength and better posture alignment to support the spine. Please keep in touch with how you are doing.

Jennifer

A couple of comments about Health Insurance from UHC:
1. Based on past and present health, UHC's Supplement Plan may be denied.
2. The Advantage Plan is "free" i.e., $0.00; the Supplement Plan may be several hundred dollars; mine is $510.00.
3. Medicare pays the Advantage Plan; it is a pass-through; the patient may be billed for any additional that the MD may charge beyond Medicare.
4. For the "Supplement" Plan, the MD will bill Medicare first; any additional service fees will then be paid by the Supplement Plan.
That is why the Advantage Plan is limited to the MDs that are willing to accept only Medicare as the payment for services; the Supplement Plan will mostly cover the additional fees that the MD may charge.