Help me put together a question for the insurance company.

[Skidmore]

I need to convince my insurance company to let me go see a specialist without going through the primary care people first. I just think it is ridiculous to have to pay for two levels of care when you know where you are going to end up. I'm unemployed and need to watch expenditures right now.

Well anyway. I've noticed when I kneel to wash the tub out or to garden, that I cannot put my weight on my left knee without experiencing very sharp pain on the exterior side of my leg at the knee. And when I stand on the leg, sometimes I feel a little lower down the calf below that area a sensation like tingling. I can walk on level ground okay, but when going up and down stairs, I'm having a little problem. I need to know what kind of doctor I need to request and a little info on how best to present what I need to have looked at. My guess is that I have torn something, but I don't know what.

[Nite Owl]

1. If you called your primary care

doctor would he/she give you the referral?

[MannyGoldstein]

2. FWIW

I'm not a doctor, but I work in a vry related field.

I know that you don't want to hear this, but...

If it were me, I'd avoid a specialist - they really like to do procedures (operations, etc), because that's how they make yacht payments - however, orthopedic procedures usually cause more damage than good in situations that are non-debilitating, such as yours.

First thing that I'd do is to take ibuprofin (e.g., Advil - over-the-counter, quite safe , may even help reduce cancer), two tablets every six hours for a few days. If it felt better, I'd keep up the Advil for a week or two, then see if I was better after I stopped taking it.

If this doesn't help, I'd see a primary care person - they tend to be less aggressive in their approach, which is actually a good thing - sometimes more medicine is worse.

Good luck!

[hvn_nbr_2]

3. "I need to know what kind of doctor I need to request"

That statement sounds to me like almost a literal translation of "I should see a primary care physician first."

[Orrex]

4. I agree

Contrary to the scaremongerers' view, let's assume that specialists are honest human beings whose goal is not to yank every last dime out of your pocket.

Now, suppose that you go to the knee-ologist, who runs you through an appropriate battery of tests. But after these are concluded, she says "Your copay is $20, but I think that you need a femurologist."

So you go to the femurologist, likewise an honest human being, who checks you out and eventually says "Your copay is $20, but you need to see a tibia-ologist."

And so on, until you get to the patella-ologist, who says "Here's a script for some physical therapy. And your copay is $20."

If you go to the GP in the first place, you'll have your copay, but your insurance network might charge less for the follow-up visit to a specialist with a referral. But by going through the gatekeeper of your primary care physician (and what the hell--let's go nuts and say that she's honest, too), you can get a reasonable assessment right off the bat. And some insurance networks aren't too fond of referrals to one specialist from another.

Go to the primary physician first.

[Warpy]

5. You might need an orthopedic surgeon eventually

but a primary care doc is capable of evaluating which tendon is to blame and whether or not a combination of medication, rest, and physical therapy would solve the problem.

It sounds like severe tendonitis to me, but a doc needs to evaluate it.

Your primary doc might be able to treat it without sending you off for an arthroscopy, something you don't really want unless you desperately need it.

Good luck!

[knitter4democracy]

6. I'll admit it, I sometimes skip my internist. Not usually, though.

When I do, though, it's because tests have already been done or I already have a diagnosis that doesn't need yet another primary follow up and referral.

When there's no diagnosis, you need to go see your primary doc. You might not have torn anything--it might be a hairline fracture, it might be a form of arthritis, or it might be fluid of some other origin. All of those a primary care doc can handle. Heck, my hubby, an internist who's horrible about going to his doctor, treats a lot of that kind of stuff himself. He even does injection therapy in his office so his patients don't have to pay another co-pay to yet another doctor for yet another office visit.

An orthopod is a surgeon, and he's going to be more likely to want to operate or something like that. It's how they're trained. An internist is a medical doc, so he's going to be more likely to trust tests and medicines. It's how they're trained. That's why, in a perfect world, there's synergy between the two.

[Citizen Number 9]

7. Follow your insurance rules

You're better off going to the PCP. If you have an injury that a specialist can treat it is likely that is where they will send you. If it is a nothing, they will likely give you some treatment and follow you there. Either way you get the most cost-effective treatment.

As someone else mentioned, you will not be adequately covered by your insurance if you go directly to the Orthopaedic Surgeon.