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Just curious

AnonymousUserAAnonymousUser Posts: 49,731
edited 06/11/2012 - 8:23 AM in Back Surgery and Neck Surgery
For quite a while I have read over and over where members recommend to other members to "get a second opinion". Some even say "get a third or fourth opinion". I've even recommended that members seek another opinion in certain cases.

What I'm curious about though, is how do members who have no insurance or poor insurance, go out and get that other opinion?

It seems that when this advice is given, it is given without thought as to whether it is even possible or not. I know I haven't checked into how hard it is for someone to do that, when I have recommended it.

The intention is well founded, but is it causing more grief to the person being told, who has absolutely no way of getting to another doc let alone another opinion.

Just curious,



  • You r so right and it just does not seem fair....ladybug
  • I have thought about this also. Even with insurance it is often a difficult task to get another opinion, especially with HMO's. You are entitled to a second opionion, but there are many hoops to jump through. You have to get a new referral, have it authorized by the insurance, make an appointment (many times these specialists are booked out months in advance), so this task could take months to accomplish. I know I didn't get a second opinion as a am a nurse and I had thoroughly investigated all local neurosurgeons who take my insurance, and I was recommended to only go to my surgeon. The Neuroscience nurses at the hospy where I work and had my surgery told me NOT to let any of the others touch me at all. Kinda sad, but at least there was one good one left, mine :). I can imagine it is probably even more difficult for people with workmans comp, medi-cal/care, no insurance, or public health insurance in other countries to get that desired second opinion. I considered going to UCSF for another opinion, but in the end I really didn't want to commute for surgery (no one to drive me, unfortunately), so I stayed with my guy. I feel for all these peeps with lousy docs who aren't helping them. I am sure many of them are stuck. I hope they all get the answers they need and deserve. Sue
  • Thanks Ladybug and Cali-Sue for your replies. Glad to know that I'm not the only one worried about this and how it might effect the thought process of the member being encouraged to get that next opinion.

    Is there anyone in one of these situations that would care to share how it made them feel and if they pursued it or not and how they went about it?

  • Like Cali-Sue mentioned, I belong to an HMO with over 200 doctors (or more?) between several clinics, so all I had to do was leave a message for my PCP to refer me for a second opinion. But my daughters had been without insurance at certain times of their lives, so I am very aware of how difficult it is for some people. On the other hand, I have a friend who is on permanent disability and is covered under Medi-Cal, and she seemed to be able to get referral when needed. People who don't have any coverage at all, I guess end up in the ER's. Not the best system, isn't it?

    But the advise to get a second opinion, if it is at all possible, is still a good one.

  • We all know that medical care is expensive. Those of us who have insurance are fortunate. So should members stop mentioning "second opinions?" I'm sure there are some cases where not getting a second opinion is very costly in a number of ways. In my opinion, there is more advice from SH members leaning towards mentioning how awful you will end up if you don't have surgery. Has anyone noticed this? I'm just wondering? One thing I have learned from folks on SH sharing experience is that surgery is not a cure all for everyone. ---Mazy
  • Mazy said:
    In my opinion, there is more advice from SH members leaning towards mentioning how awful you will end up if you don't have surgery.
    I agree with you that this is as prevalent a theme these days. Good catch!

  • I think it is always wise to get a second opinion,but having said that I admit that I often don't follow my own advice.

    I distinctly remember talking with my first surgeon about getting another opinion and I know that he was not happy..it was proven when my new surgeon (office) requested all of my old films and they were denied.They asked me to go in and get them,telling me that they could not deny them to me.They most certainly did deny me,not only my films but all of my records from that office were gone.That surgeon performed 4 operations and everything was gone.So they said.

    I believe too sometimes that if we were to go to 100 Drs that we would probably get about 50 different opinions(roughly speaking)But yes,I think if at all possible get a second opinion.Of course we are not experts at much other than ourselves and speaking only for myself that is questionable..but I think too that we should follow our instincts.As with Drs we would have to rely on trust.

    I doubt it if too many people with no insurance get a second opinion.Maybe some do,and I'm certain it causes some people stress if they can't afford to get the care that they want/need.

    Most people are resiliant and learn to adapt to a certain lifestle.That does'nt mean that they like it,only that it is what becomes their normal.

    ..and I realize that makes me sound cold and uncaring,but that is not the case I assure you.
  • The situation in Ontario is different. Our primary health care costs are covered so IF you could get a 2nd opinion it wouldn't cost you anything. However the problem is that you can only see a specialist by referral. You can't just look up the name of a surgeon in the phone book, call and make an appointment. You have to go back to your primary care doctor and ask him to give you another referral. It's all up to him and he could refuse. I had done a bit of research before my doc had given me the referral. I knew that I would not accept going to a particular hospital or surgeon that I had already heard some bad things about (met one of his patients who had a very bad outcome). I was happy when he didn't refer me there because I would have said no. I was lucky my doc referred me to one of the best surgeons in Canada. We're not all that lucky. Sometimes we don't get the best doctor or the best advice. In that case, if you can afford it, it is better to get another opinion. However, I think sometimes SH people respond with "get a 2nd opinion" because it's better than giving a diagnosis because we can't.....and they just want to help.

  • I always say when in doubt or troubled with a diagnosis / treatment to get a second or more...... I really never have thought about clarifying the statement for capability to do that.....
  • I must say that my opinion is to ALWAYS seek out a second opinion. I completely understand the financial strain of things. Believe me, I have a $5,000 deductible with my private health insurance, and we support our family on what has become a VERY modest income since I am not working now. Shelling out an extra hundred dollars or more for a 2nd opinion hurts. But, when you consider the seriousness of spine surgery, how can anyone take it so lightly that they don't seek a 2nd opinion? And if those two opinions conflict and you still aren't certain, seek a third. Even if you have to make small payments to them, or put it on your credit card, or go beg from a relative, get a 2nd opinion.

    I have said this before, but spine surgery isn't like having your appendix out. They don't just go in and remove the problem, sew you up, and you are good to go. Most of us are never the same again after having spinal surgery. Not to say that we shouldn't have surgery, because I for one am thankful that surgery was an option.

    Many of you know my story. With my first surgery, I was set up to have a 2 level ACDF. however, after thinking about it for a period of time, and knowing that I also had a large herniation and stenosis at the third level, I made a phone call to my surgeon's office requesting that they add the third level to the scheduled surgery. I didn't even talk to the doctor about it, just his nurse. I thought "No big deal." Just get it done while they were in there so that I didn't require future surgery. WRONG!

    Obviously my surgeon didn't have any issues with doing a larger surgery. I honestly had no idea that the more levels you have worked on and the longer they are working on your spine, the greater your chances for complications. And the greater your chances for needing more work done in the future anyway. And the greater your chances for having a non-union. what I thought was "no big deal" actually was a huge deal, complete with the major complications, the non-union, and the necessity to have even more work done with the revision surgery.

    Now, I had a 2nd opinion, but it was prior to requesting that the third level be added. I 100% believe that if I had only had the two levels done, I would be in a different place than I am now. This situation completely illustrates why it is so important to get a 2nd or 3rd opinion. Had I asked the 2nd opinion doctor about having the third level done, he would have told me no. There was no nerve root impingement at that time, and the risks of having it done then far outweighed the risks of needing it done later.

    Sorry for the length of this post, but sometimes I feel like people here are almost excited to have surgery. Sometimes it seems that many feel that it is "no big deal" and that if the doctor says it needs to be done, it must need to be done.

    One more example. I have a little neighbor lady (around 65 years old). She has a problem with her low back right now, causing some tingling and numbness down her leg, but not really a lot of pain. She had a consultation with a surgeon and was told that surgery was a good option for her. She sought a second opinion, not at her request but at the request of her insurance. She chose the doctor (I actually recommended my 2nd surgeon, Dr. H, to her.) Her appointment was this week. Dr. H told her that he does not feel that surgery will help her. He feels that PT and injections should be tried first, and even after those have failed, the type of surgery she was looking at would not really help her with the numbness in her leg. She basically has DDD with no cord impingement, and little pain.

    So there you have it. Two very differing opinions. One patient who is functioning fine with very little pain, just worried about the numbness and tingling. One doctor ready to put her on the operating table, one telling her that surgery wouldn't really help her at this point. Which one would you believe? Do you think she should have jumped on that operating table and had the surgery without checking out her other options? I think not.

    Getting a 2nd opinion takes time and money. But isn't your health worth it? I would never ever ever recommend spine surgery without one first checking out all their options and knowing what they are getting into. If a doctor has an issue with you seeking a 2nd opinion, I would say run from that doctor as fast as you can, because he/she obviously doesn't have your best interest at heart. Most doctors will actually set you up with another surgeon for the 2nd opinion; and get you in much quicker than if you make the appointment on your own. Care about your health and your spine enough to make sure you are doing the right thing before you let anyone that close to your spinal cord.


    Surviving chronic pain one day at a time, praying for a reprieve because living another 40 years like this doesn't sound too fun!
  • how differnent and how difficult it is for you guys in the US.
    Here in Aussie, everyone is covered for basic medical and hospital no matter what your circumstances. Then we have the option of getting private cover for hospital and incidentals such as dental and physio.
    To see a specalist, if someone is on a low income they can go to the hospital clinic and see a specalist there, all they need is a referal from the local Dr.
    If you want to see a private specalist you get a referal but will probably pay an excess fee which could be between $40 & $200 depending on what that Specalist charges. You can see as many as you like as long as your Dr gives you a referal.
    Also patients keep their own films, MRIs etc and just take them to the appointment with them.

    For hospital everyone can go to the public state run hospital - you will have to go on a waiting list except for emergencies and it is by no means "plush" or if you have private insurance you can go to the private hospital that your specalist works at. Private health cover should cover all this. They wont cover excess Drs fees and when I had my hip done I went private. It cost my insurance 66K for 4 weeks hospital and physio, surgery etc and I paid and excess of 4.5K to the surgeon.
    I could have seen him at the public hospital (he works at both) but I couldn't wait, it had to be done ASAP.

    I would go barmy having to jump through all your hoops (maybe I'd be pretty fit) :))(

    Now for my back I am on workers compensation so that is a different and more difficult ball game altogether.

    So I apologise to anyone I made feel awkward by suggesting getting a second opinion but at the same time it is important and as Cindy says this type of surgery is not to be taken lightly.

    Sara O:)
  • Yep, our system here is pretty screwed up and probably gonna get worse with our economy in shambles right now. The government has been bailing out big business, so maybe next they'll have to bail out healthcare. That one would probably do them in. Crazy though it seems to me if you have no insurance and are poor you have an easier time getting care than people with money. Just show up at the local ER and they are required by law to see you. For insured folks in the US most of us have either a PPO or an HMO. A PPO lets you go see whoever you want and you pay a deductible yearly (anywhere from a couple hundred to a couple thousand dollars) and you pay like 10-20 % of your hospital/office bills. PPO's often exclude some surgeries, ex. gastric bypass, and often have pre-existing clauses, so if you have a problem already, they won't cover it. Now I have an HMO, and I am required to have a referral from my primary MD for everything and they don't always hand them out that easily. I can't go to a dermatologist, a podiatrist, NS, etc.. unless I get a referral. The referral process can take a couple weeks to a couple months, but not years. Often the referral is for 3 visits/3 months and needs to be renewed for more. I can only go to doctors within my healthcare system. I pay co-pays ($20) for visits, meds, PT, etc. Until this year hospital charges were free, but now it is 10% of the bill, but since I work for the hospital it is waved. Hmo's normally have less exclusions and no pre-existing clauses. I pay about $200 a month through my employer for this coverage. If I am off work for longer than 12 weeks, that will go up to about $1100 a month (YIKES!) as my employer pays part of the premium and will stop doing so. With HMO's everything is contracted, for instance my hospital bill is $128,000, but the hospital is settling for $44,000 and will write off the rest. With government healtcare (medicare/medical) they get re-imbursed even less. So when you see your bill, it really is just a bogus number, because the hospital will never recupe it all. That is why the prices are so inflated. Sadly if you are private pay, you still get billed the higher amount, although hospitals often will negotiate this number down. Anyway, there is the US health system in a nutshell, :) Sue
  • This may be a little off subject but I've also notice how difficult or how long it takes for doctors to get the ball rolling on some issues. I've noticed some mention being in pain for months before getting an MRI, and proper diagnostic testing. Is this because of insurance limits? Or is it just up to a doctor to decide when the appropriate time is.

    My PCP ordered my MRI just three weeks after my sciatica issue began. I have good insurance. I feel fortunate to have a doctor that wasted no time getting me the care I needed.
  • As a child of 12 I dislocated my hip in the surf in Hawaii. Luckily it was the last day of our holiday and when I told my Dad (I knew what had happened) he made me rest till leaving time then put a bandage on my foot. Told the flight crew I had sprained my ankle so he could carry me onto the plane.
    He kept saying - we just have to get home! Now I know why! :))(
  • You are not at risk of causing a problem, because as you see, the title of this thread is "Just Curious".

    I am curious as to how others feel on this issue, and you simply gave me your answer.

  • I am in a difficult situation and I cant go into all of it at this time but in the last three months i have seen been to 3 different surgeons and 2 different neurologist this all in just 3 months that does not include all i have seen before the last 3 months. the 3 surgeons all agree my only option is surgery other than suffer and become paralyzed. but none of these surgeons will do my surgery because 1st surgeon says i have to many issues, and my survival rate was not good. and he told me to go get a second opinion this was the first time i really understood i was in big trouble and it was very scary for my hubby and i to hear and i balled my eyes out in the doctors office. after getting the report from that surgeon. for which he stated i had emotional problems on top of everything else because i became so upset after what he had told me. well what would anybody feel after being told what i was told and you only know a piece of what he had told us. my 2nd and 3rd surgeons I seen basically said that I was to much of a high risk. one even compared me to someone having cancer that was not curable. can you imagine that. all these surgeons are highly recommended and I feel sumtimes i might mess up there good record ..if that makes since... the surgeons all know that my neck a mess but they all think I may have multiple scleroses too ( I have had every test under the moon done to prove i do not have M.S.) Im even gonna have another brain MRI done i have had so many i have lost count. the last two neurologist say they DO NOT think I have M.S. but that does not change what the surgeons think. I know I dont have M,S, ....... But even if I did.... I cant understand why they wont fix my neck If i do nothing you know where im headed and I know and believe i can stop this myeolpathy from getting any worse if i could just get my neck fixed. so im still tryin to find a surgeon, i was turned down about a month ago from even being seen by a N.S.....I do have a doc appointment on the 30th with my good ol rhumy and im praying so hard he will be able to send me, help me get in to another surgeon. we are to the point now that we will travel far to get help. months ago i believed why would i have to go to ---- or ------- we have good surgeons right here well I now believe different. im gonna quit now. I know all on here are good people and if anyone would keep me in there prayers for me to find a surgeon that will help me i would love that. thanx for reading my long words always
    ps sometimes we need 1-2-3-4 opinions!!! we cant give up praise the LORD!..............Patsy
  • I didn't realize this post was really to do with not having insurance
    but I was thinking more about the idea of getting more, or different opinions from diff doctors
    so I'm truly sorry for goofing up a bit
  • Isn't it amazing how pain gets to us? I wrote my response when I was hurting bad last night, and I think the effects of being in pain took away from my normal level of compassion. I'm glad to see that my message wasn't taken as offensive.

    I do understand the lack of fund issues. I just want everyone to realize how important spine surgery is and encourage everyone to do whatever it takes to get that second opinion, if it is at all possible.

    Everyone have a great day!

    Surviving chronic pain one day at a time, praying for a reprieve because living another 40 years like this doesn't sound too fun!
  • What state or country do you live in? Also, have you tried going to a large teaching hospital? Have you had a spinal tap to check for MS?

    I can't imagine your frustration. Surgery is not always the answer, and sometimes we just have to accept things the way they are and do our best to live with our limitations. I do respect if a surgeon tells you no because he thinks he would make you worse. For some of us, surgery actually brought on new issues that are just as difficult to live with. Wouldn't it be nice if we could be completely re-wired like an old junker car restored to new condition? Unfortunately our bodies don't work that way

    If surgery is not a solution for you, are you in physical therapy? Are you taking steps to strengthen your core? your upper body muscles need to be strong to support your weakened neck. Hopefully technology will continue improving and they will be able to do something to help you later on. I'm sorry for your pain.

    Surviving chronic pain one day at a time, praying for a reprieve because living another 40 years like this doesn't sound too fun!
  • i have had spinal tap, my c6-7 is impinging on my cord really bad and i think it is worse then it was a couple months ago it was 50% back then. if they dont fix that it will just keep getting worse sometimes my legs cant hold me up already
    surgery is my only option because otherwise i will become paralyzed completely, its not only my legs being effected my arms and hand are too surgery for me will prolly not give me back what i have lost but it would stop it from getting worse im 45 i have alot of living to do and i dont want to do it in a bed.
    i can have no physical therapy right now i have to wear a brace when im up walking or riding in a car because my cord could be damaged more by just the smallest fall or bump.
    i live in Byron IL. thanks for your concern hugs patsy
  • My MRI's show i have problems starting with c3through c7
    but c6-7 is the level that has the most impingement
    on my cord patsy
  • dilaurodilauro ConnecticutPosts: 9,722
    Under any circumstance, I would ALWAYS recommend getting a Second or Third opinion. To me the capital outlay for this is very important.
    When you are in the process of remodeling your house, you bring in several contractors to give you estimates. You see which one is going to give you the best quality for the money. Same when buying a car. How many people work into 1 dealership and buy a car on the spot?
    Ok, the money involved with those items are for the most part less than for medical attention. But then think what is more important, the new kitchen or your spine taken care of?
    For those who have insurance coverage, second opinions are almost mandatory before surgery. But even without surgery, I would find ways to make sure I had a second pair of eyes looking at my situation before the time it came for surgery.
    No medical system is perfect. You could list the pros and cons of America's medical system as you could do for many other countries throughout the world.
    Bottom line, its your body, its your spine on the line...
    And to me, there is nothing that should take precedence over that.
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • I was seeing my PCP for quite sometime for my back. He would write me a script for a few (like 5 days worth) of pills, and send me on my way. We did this for about 6 months.

    He finally ordered an xray. I told him that I was VERY concerned about my back. This pain was not normal, and the meds weren't even touching it. He said, do you want me to write you something stronger? I told him, no, I want to know what is wrong! I get a letter in the mail that says the xray shows muscle spasms. I called and firmly requested an MRI. Well ok, I demanded it. The doctor didn't think it was necessary, but because I was having strange sensations in my legs, he ordered it. That's when I found out I had all these problems.

    Now here's the kicker. He said I needed to have surgery. After speaking to MANY friends and family who have had surgery on their spine themselves. If I spoke to 20 people, 18 told me not to do it, unless absolutely necessary. They all said... get a second, third, even fourth opinion. I got all of my "opinions" 3 actually. A neurologist, and a neurosurgeon, and a pain management doctor. All three said that at this point, at my age, the injury is not severe enough to warrant surgery. At least not yet.

    Now, even with opinions from all of these doctors, my PCP feels the only way for me to get better is to have surgery. This is what he told me. Since then, he basically has refused to give me even basic medical care. I have called him a few times with different medical concerns, relating to medications and stuff, and have gotten the brush off. Its as if he is angry that I got all these "opinions" and doesn't even want me as a patient anymore. Who would you believe? I think I prefer listening to the doctor who actually specializes in these types of surgeries, over my PCP. Needless to say, I have found a new PCP, who already in one visit, has shown more compassion and concern for my health than my old PCP ever has.

    I was fortunate enough to have the medical coverage needed to get to see all of these doctors. I have a PPO, and up until the 17th of this month, I also had state benefits, that picked up my co-pays and deductibles. Thankfully I was able to have all of these tests done, before the extra coverage ran out... I was blindsided by my sudden loss of state benefits. If I hadn't had them, there is no way I would have been able to afford all of the visits to specialists, all the tests and treatments.
  • "Crazy though it seems to me if you have no insurance and are poor you have an easier time getting care than people with money"

    I think fortunately, and unfortunately you are right. I am one of those people who wound up with no insurance. I am both happy and angry at the way my health care coverage turned out because of it.

    Let me explain:

    In April/May of 2005 I found out we were pregnant. One week after being laid off from my job (fired). My ex boss agreed to let me keep my insurance for 6 months, but dropped me suddenly.

    I was on unemployment, pregnant, and had no insurance. I called and was immediately approved for state benefits. (good for me and my baby)

    Now, I wasn't married yet but was living with my fiance when the baby was born. I got a letter in the mail, with a new insurance card with my fiance's name on it. My fiance had a job at the time, and had just got insurance from that job. I called them, and said basically... whooaahh, I never applied for this, he doesn't need it! He has his own insurance, and we're not even married. They told me that because he was the father of my child, and lived in the same household as us, he automatically qualified. How is that right? I know so many people who need this kind of help but don't get it, and here's my fiance who doesn't need it, didn't ask for it, and here it is for him to use.

    A messed up system if you ask me. As I said, we were fortunate. A few months later, we got married, and a month after that, we lost the family business, along with his coverage from that job. Again, fortunately we still had state benefits.

    I'm not complaining about the help we received. In the end, it was needed, and greatly appreciated. But what kind of system, gives insurance coverage to a person who not only didn't need it, but never even asked for it?
  • Hi Amanda, what state are you in? I don't think they hand it out quite so readily in CA (unless you are a pregnant illegal alien, but that is for another topic), but I know what you mean. I worked with a guy and his wife left him. He had his kids on his insurance of course, well she went and signed up for state monetary help. They insisted to give her medical for herself and the kids even though they all had private health insurance. Then they wanted him to pay child support to the government. It was crazy, luckily they got back together, and it fixed it all. Our system is weird. I feel for those people stuck in the middle, no private insurance, but make too much money to qualify for state benefits :( Sue
  • I'm In Massachusetts. I used to live in California, so believe me I KNOW how they work there. Like I said, I was fortunate. I got the help I needed. But it really isn't fair, to give this coverage to someone in my household, who at the time didn't need it at all, nor did he even ask for it!

    Also, I have gotten more than a few awkward stares from nurses, and reception, when I told them I had both insurances (BCBS PPO and state) They're like... How in the heck do you get this??? You have great insurance... and you get this too? Like I was cheating the system. When my husband got his new job, I reported it, along with our new insurance right away. They continued my coverage for another year! I'm not sure as to why, but I believe it was like, well you DID qualify, so even though you have income and insurance, you STILL qualify for the next year.

    Very weird how it works. And I can't take it out of the system either. As long as the state said I was eligible, doctors were not allowed to bill me for services. Copays, deductibles, they HAD to go to the state. And when they type in my SS# there it was, right in front of them.

    Not that I could afford to pay all of that, but I think that money could be better spent on someone with a worse financial situation than me. Does that make sense? Yah, its a lot of money for my family to handle, but we probably could find a way. There are many people who can't.
  • I'm one of the millions of uninsured. I keep house in exchange for room and board for a gentleman who is self employed, we are not married and I have no money of my own, no car, no job, no way to pay for anything but extremely grateful that I atleast have a roof over my head.

    As one of the great uninsured I went to the ER as my only option on Monday where they said I have grade 1 spondylolisthesis at L4-L5. I never even saw a doctor, just a PRN and a RN who told me I had degenerative discs, films showed narrowing at L4-L5 and that it would only get worse. Shot me in the hip with 60mg of Toradol, gave me 2 oxycodone, 1 Valium, advised me to see an Ortho doctor, get PT, take 1800mg of calcium a day, gave scripts for pain meds for 4 days, a course of prednisone ($50) and sent me on my way. I spent the rest of that day and all of the next sick as a dog, I'm assuming from being over medicated by the nurses.

    Know what Medicare said? I have to be pregnant, 65 or on disability for 2 years before I can get any coverage. Income no longer matters. The hospital said, sure, we'll cover any trips you make to ER or any charges if you are admitted except, doctors, radiology or anesthesiology. So now what do I do? LOL, heck with second opinion! I'm trying to figure out how to get ONE opinion.
  • Welcome to Spine Health. Sorry to hear that you are in such a sad state of affairs at the moment. I really wish I knew what to say that would make you feel better some how.

    Hang in there. I know there are so many people on this board who have found programs and ways to get other members help. Never say never.

  • I really appreciate all the feedback so far, both in regards to the original issue of getting multiple opinions as well as the real root it seems ... insurance.

    There is no right or wrong opinion to this thread. I was wanting to know how others feel. I really appreciate this insightful discussion.




    JOHN B
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