I possibly have arterial or venous TOS. I went to a surgeon that I didnt like for help. I learned the best doctor to go see for this who has a high cure rate of surgery for vascular tos and my insurance wont pay for out of network visits etc. What am I to do? I hear there arent any reputable surgeons on the east coast. I live in new york. Any advice would be appreciated .

For all your arterial or venous patients should I be worried that somerhing terrible is going to happen to me in the midst of finding a good.doctor ?? I had a doppler done which showed no clots. Apparently that test doesnt show much or i just have a shitty doctor. He didnt tell me much. Thanks

Where did you hear there aren't any reputable surgeons on the east coast? That's ridiculous. Sure, TOS is rare, but just take a look at the sticky thread about recommended docs and you will find plenty of names given by patients. Dr. Donahue at MGH gets consistently good reviews on this site and Boston is somewhat close to NY.

I looked on the sticky thread and there were none in New York. I even posted if anyone knew.of any and unfortunately ive heard more bad things than good. this Boston doctor did you go to him personally ? I'll definitely look into him. Thank you. Either way my insurance company is claiming they won't help me. Idont understand why or how to get them to pay. I knnow people travel all the time for their health.

Scaredsilly: If you have an HMO or a plan which only allows you to see Doctors that are under contract with your insurance Company, you may be out of luck.

Sometimes you can appeal and declare that there is not a Doctor in THEIR network who can treat you, but it would have to be a pretty extreme case to let you be treated by an "out of network" provider. It would cost them money.

Don't know where you work or who you get your insurance through, but this time of year is "open enrollment" at most companies. If you have the option of another carrier, now is the time to change - run, don't walk as the window may already be shut.

Look for coverage under a PPO or POS type plan if you can, so you always have the option of seeing who you want. Good luck!

Anne

In New York City, I can recommend Dr. Mark Adelman at NYU Langone Medical Center. Also had seen a Dr. Mark Ginsburg at Columbia/Presbyterian, not as nice a personality, but well experienced. There are plenty of others, you just have to start looking up the hospital websites and calling the offices, some deal with TOS, some don't, just start looking. Some of the bigger hospital websites do not readily pop it up for you, you have to dig to find it, not well set up, so don't give up too easily. The list on this website is rather limited for our area.

I also saw Dr. Donahue at MGH, but he made a VERY SERIOUS error mixing up my tests with someone else's, which influenced his diagnosing me. When I found this out (reading the report he sent to my gp) and called him about it, (for several weeks before getting a call back) he dumped me. Apologized for the mistake, refused to take responsibility for it, and said, "well, if we didn't connect that badly, then I'm not the doctor for you." This was after waiting over 3 months while his office was supposedly trying to get the botox injections approved with my insurance but actually had done nothing after the first, immediate rejection, until I got involved and then found his error, as well. So, while most people having nothing good to say about him, I must disagree with "gets consistently good reviews on this site". Hopefully, my case is one in a million with him, but if ANYTHING doesn't seem right if you go there, QUESTION right away. I lost 5 months of my life between him, his office, and then waiting to get to a new doctor (Dr. Adelman).

Nope, haven't seen him myself. Just going by what I've read on the boards. Of the docs whose names come up, he seems to get more positive reviews more of the time than others. Of course, no surgeon has a 100% success rate (either with the surgery itself or with providing an accurate diagnosis, as winic1's story makes clear).

Call Ins carrier and question how to go about getting a out of network dr or surgeon approved.

or if you have severe sx and a dr /drs strongly suggest surgery (and it's documented in your records) then have the dr's office apply for acceptance with your ins.

There are ways to go about it but calling and asking the various offices for help on how to do it is the best way.

Usually searching on your ins company website will be the best place to start - many have a dr finder link that shows who is in the plan.
If none of those seen acceptable, they go on to the other options.

Or if you locate a dr you are interested in call their office to see if they take your ins, and if they can help you with coverage, if not.


I don't recall how severe your pain level or sx were?
Or if you tried good PT at more than one place or therapist?
Usually it isn't a fast change, it takes time, and PT isn't cheap even with ins.
Lots of time "home work" and self care is needed to see results.

Depending on how severe the sx/pain & how much time has passed from beginning of those - that is often a big decision maker.