Navigating Your Health Plan to Choose the Right Surgeon

Brit Creelman is an active man in his early 50s who recently had an anterior hip replacement procedure, which he discussed in part 1 of this blog series. In part 2, Brit shares about the challenges he faced in choosing the surgeon he wanted for his surgery and how he overcame them.

When my hip osteoarthritis was getting worse and it was clear I would need surgery, my primary care doctor referred me to a surgeon, who I really didn't like. I asked if there were other options and I was told he was the only orthopedic surgeon in my medical group who performed hip replacements. Because I was enrolled with an HMO plan through my employer, I was limited to receiving care from doctors in that medical group.

If you are considering an anterior hip replacement, it’s important to seek out a surgeon with a lot of
experience in this approach. Read more: All About Anterior Hip Replacement

So I changed medical groups and got a new primary care doctor. My new doctor referred me to another surgeon, who I felt a little better about but still wasn't comfortable with. I checked to see if I could be referred to another surgeon, and there wasn’t another available to me because of the limitations of my insurance.

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Specialized surgical needs, limited insurance options

In addition to not feeling very comfortable with the two surgeons I saw, I wanted to have a hip replacement done with the newer anterior approach and both of these surgeons performed only the traditional posterior approach. I didn't think I'd be able to find a surgeon my insurance would cover who would have the level of experience I was looking for, given that anterior approach involves a higher level of difficulty for the surgeon and going to an inexperienced surgeon can lead to poorer outcomes.

At this point, I thought about changing my insurance to a PPO plan. It was a more expensive plan, but the prospect of going to any provider I wanted without regard for medical group was so attractive I decided to change at open enrollment. That's when I really started to research and get interested in the anterior approach. I found a stand-out surgeon who had pioneered the anterior approach procedure and also developed new hip hardware. I thought I had found my surgeon.

Unfortunately, the PPO plan offered by my employer was terminated unexpectedly. I tried to fast-track surgery with the surgeon I wanted, but that didn't work out. By this time, I was feeling pretty dispirited.

A new idea

Then I had a great idea: I decided to work backward. I made a list of all the surgeons in my area who perform the anterior approach and had the qualities I was looking for. Because I live in a big city, I was able to find 5 surgeons for the list. Then I checked each doctor to see what insurances they accept. Out of the 5 on my list, only 1 accepted my insurance. I found out what medical group he was in and then changed my group accordingly.

After seeing a primary care doctor in that group, I got the referral I needed. I met with the surgeon, liked him, and took the first available date for surgery on which I would be his first surgery case of the day.

I think that my experience in successfully choosing the surgeon I wanted for my anterior hip replacement is particularly relevant to people in HMO plans. If you are not satisfied with your options due to your medical group, then it might help to work backward like I did. Do research, to make a list of surgeons who look promising, see if they accept your insurance, and switch your medical group accordingly.

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Post written by Carrie DeVries