Choices

When more than one doctor can be seen for a problem, deciding which one to call can be tricky.  What matters most?  Skill?  Bedside manner?  Convenience?  Cost?

It probably depends on the situation.  In this case, I need a cortisone injection.  Okay, I’m not a doctor.  Maybe I’m not qualified to make such a decision.  In the past, though, when my shoulder has felt like this, I’ve gotten a steroid shot, and it’s helped.  Whom should I call?  Rheumatologist, orthopedist, or family physician.

My rheumatologist might be able to do it at my next appointment.  That would be simplest.  No extra appointments, no extra time required.

Another option is to see the orthopedist.  Last summer he said that he suspects I’ll need surgery on the shoulder within a year.  I’d like to prove him wrong.  If he’d said he could fix my shoulder, I might be interested, but that’s not what he said.  There’s only a 50/50 chance of surgery helping, and those odds aren’t nearly good enough.  A better plan is to resume the exercises that have helped in the past (and not stop once my shoulder is better).  Steroids would make the PT exercises a lot more doable.

I’d rather have my family physician do the injection.  His cortisone shots seem to work better and hurt less than steroid injections I’ve gotten elsewhere.  I don’t know if it’s individual skill, or if it’s the fact that he uses kenalog and everyone else has used depo-medrol on me.  It doesn’t matter.  That’s where I’d prefer to go.  The drawback is that if I go see him about my shoulder, he might tell me to go back to the orthopedist.

That’s my choices of whom to see.  Then there’s the financial aspect.

My old insurance policy covered injections at 100%, so cost wasn’t really a factor.  New insurance only covers 80% so expense is now a consideration.  Add in the fact that under this will be entirely out-of-pocket since I haven’t yet met my annual deductible.

Steroid injections vary widely in price.  Looking back through my old EOB’s, I found:

  • My rheumatologist charged $172 when I got a depo-medrol injection from her.  Insurance allowed $128.51.
  • My orthopedist charged $269 for the exact same thing.  Insurance allowed $168.33.
  • My family physician has charged $134 for the kenalog injections (plural) that he’s given.  Insurance allowed $41.18.

That means I can pay $128.51 for the convenience of getting a cortisone injection at my next rheumy appointment, or I can pay $41 plus a $30 co-pay and get the shot from my PCP.  Although this reduces my costs, my insurance company will be out an extra $70 since they’ll be stuck with the tab for an extra office visit.  For a savings of $57, it’s worth making an extra appointment to have my PCP be the doctor jabbing a needle into my shoulder.

When you have a choice, how do you choose?

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5 thoughts on “Choices

  1. WS, thanks for the post. It’s a good discussion of a common situation. Incidentally, there’s a high probability that most people will remember another problem they might address with the family physician when they are there. Better yet, they might actually schedule the appointment to include the extra problem so the right amount of time will be scheduled for all the problems. Each year family physicians get better at understanding how they’re under-billing for services, so don’t be surprised if the family physician charges $150 total and gets allowed $126 or so. New year=new adventure. Good luck.

  2. I choose my orthopedic surgeon who uses Kenalog. I assume he is more skilled because there is less pain during the injection, more effective pain relief after and I never get the after injection flare that I’ve gotten with other doc’s and depo medrol. I didn’t notice if there was a cost difference, it’s worth it if there is. Unfortunately they only last about 8 weeks and still leave me with a fair amount of pain. So I’m finally researching what my orthpedic doc has recommended, shoulder replacement.

  3. I choose the doctor that is most likely to treat the problem so that they have a complete record of what’s been done. With my shoulder problems, I go to my shoulder specialist, although my PCP, my rheumatologist, and my orthopedic surgeon could all do the injection. I am fortunate that the insurance copays, etc., aren’t so different that I have to take that into consideration. If there were a $50 or $100 difference, I might make a different decision.

  4. Dr S – I was shocked at the difference in fee, but didn’t know if it was due to difference in drug, or something else. The closer I’ve looked at things, the more it seems like my family physician charges less than everyone else. Since he spends more time explaining things to me than anyone else, that seems really wrong. I’m not looking to pay more than I have to, but I believe people should be fairly compensated for their work so understand if his prices rise. Thank you for offering your perspective.

    Ronda – It’s frustrating when the shots don’t last as long as they’re supposed to. Sounds like maybe a new shoulder is in your near future. I hope the whole process goes smoothly for you and that you end up with a well-working shoulder. Good luck!

    Carla – Given your shoulder history, that makes sense; I’d do the same. I wonder sometimes if I’ll end up with separate orthopedists for knees, hips, ankles, elbows, wrists… Hope all is well with you.

  5. Pingback: Next! « ∞ itis

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