New to PPO and may need inguinal hernia taken care of

[GoodbyeYellow]

We were with Kaiser for 20+ years and if we ever knew, have forgotten how to navigate the PPO landscape. Switched to PPO this year due to premium pricing changes at Kaiser.
About 3-4 years ago, the Kaiser doc advised me of an inguinal hernia (IH) and told me to 'just keep an eye on it'.
This year, we had a physical with the PPO doc. Found him through online reviews as we are new in this town and don't have a friends network here yet.
My impression was he was more about the money than anything else. I had barely had a chance to mention the IH and he was all 'oh yeah you need that operated; I'll give you a referral'.
So far this year, thankfully that's been the only doctor visit for me or DW. But now the IH is on my mind... not painful yet, but at times I do get the sense that it is 'moving around', if that makes sense. Have started wearing a hernia belt and it helps a good bit.
So I am thinking to get it worked on. But I'd like to be able to make my own decision on the doctor etc.
We are with BCBS, Bronze plan, high deductible and don't need a referral to see a specialist. What's the best way to go about this? We have a list from BCBS of local surgeons; what should be the next step? Interview some on the phone? I guess most doctors will say get it done; how does one know if this is the right advice? (vs leaving it alone).
I am 61 BTW, BMI just under 30, quite active and easily get my 150 or so minutes per week, with biking, swimming, yoga, walking and some weights (light, 30-40 lbs max each side regardless of the exercise).

 

[RetiredHappy]

The key to one's health care starts with a good PCP. Do you belong to a sports / social club to meet people? What about neighbors? You should ask them about who they have for PCP and whether they like them etc.

With a good and well-connected PCP, he/she should be able to give you some guidance regarding your IH and referral to another good specialist.

Good luck.

 

[Aerides]

We are with BCBS, Bronze plan, high deductible and don't need a referral to see a specialist. What's the best way to go about this? We have a list from BCBS of local surgeons; what should be the next step? Interview some on the phone? I guess most doctors will say get it done; how does one know if this is the right advice?

So basically, what I've done is look at the list of Docs, then google their facilities. Call me a snob, but I do think the real estate counts. I don't want to go to a grungy looking doctors office, especially when so many are nicer. My PCP might be their colleague, but I guarantee she hasn't been their patient, so I don't take her recommendations as worth that much.

I look at the doctor's reviews on google and stuff. I look for photos and bios and go from there. Make an appointment. Do whatever tests they want to get current. But more importantly, that first office visit should be like you are hiring someone. You want to feel comfortable, feel that they are listening to you and what you want as an outcome. Have a list of questions - what hospitals do they utilize (and then look those up too).

Especially with someone who might eventually do surgery - that's the face you'll see when you wake up. The one that will help you through recovery, etc. Gotta feel super comfortable. And if you don't, you go to the next one on the list.

So far that's worked well for me. I don't think most docs will push for surgery, not good ones anyway, unless it's truly needed. And if it is, a good doctor will explain it to you and walk you through the reasons, the outcome, and the plan.

 

[Peter]

I've had two inguinal hernias. The first one was about 5 years ago, and my PCP said to leave it alone until it starts hurting. Which it did after 18 months or so. The surgery can either be done laparoscopically or with an open incision; I had open surgery, and recovery was quite quick. I was back swimming laps in the pool after 3 weeks. Repeated a few years later on the other side.

The standard procedure these days is to use a mesh product to make the repair. This is said to be better than the old fashioned way of stitching things up. I had mesh in both cases.

BUT ... the first surgery led to problems which required more surgery. Long story, but if I was to turn back the clock I would be asking lots of questions about mesh vs just stitching things together.

Good news is that all is well on both sides now.

 

[SecondCor521]

I had one done about a decade ago.

I don't recall how I ended up with the doc I picked. He was in network. When I interviewed him I had two questions:

How many of these have you done (IH repairs with mesh)?
How many have had serious complications?

You want the answers to be "hundreds" or "thousands" and "none". The bedside manner is just for a day; you'll live with the surgical results the rest of your life.

 

[Bamaman]

FYI: That surgery is most often done by a general surgeon, and most surgeons will try to do them with a laparoscope in order to be minimally invasive.

And like has been said, you can put the surgery off until they begin to hurt. And eventually they will. It's a wait and see thing.

 

[Freedom56]

Get a second opinion. Don't rely on online reviews to select a primary care physician. Also do an online license check on the PCP you saw.

 

[badatmath]

A coworker had his mesh rip open as I understand it. He found it pretty unpleasant.

 

[Telly]

There's mesh, and there's mesh. No, I'm not a mesh expert!

GoodbyYellow (the OP) - Get it done! It won't get better. Hernia belt is 1950s! Yuck!

I selected my hernia surgeon via fate... what? Well, I had an emergency Gall Bladder removal via Laproscopic. It turned out he had a big job of it due to infection swelling it up. When he came to see me in my hospital room about 2 hrs. prior to surgery, I mentioned that I also had an IG hernia. The GB surgery went well for me. So a month later I had him do the IG hernia surgery. At the pre-op appointment in his office, he laid out the return-risks for Lapro vs. open-cut method. I went with the lower-returns open-cut method. It IS more painful afterwords then Lapro, and I was using the Opioid pills. Early morning surgery, home in early afternoon. Felt pretty good! But during the evening, the swelling started and went on for days. One week later, swelling was almost gone. His specialty is abdominal surgery. He's a younger guy, so he should be around for years. If I need any abdominal surgery in the future (hope not!), I'll seek him out.

EDIT: I forgot to add that the surgeon was the abdominal surgeon that was on-call when I was in ER after 11 PM. They called him at 1 AM. I'll never forget his absolute joy later that morning when he lifted the sheet on my in-patient bed, and exclaimed "A flat stomach!!! I never get to work on a flat stomach!" He was so happy!

 

[grasshopper]

I had a IG hernia repaired 2 years ago. I happen to be at my urologist and asked for a referral. He gave me the name of a general surgeon, that had repaired his father's IG recently.

Laparoscopic with mesh, easy recovery.

 

[bmcgonig]

We were with Kaiser for 20+ years and if we ever knew, have forgotten how to navigate the PPO landscape. Switched to PPO this year due to premium pricing changes at Kaiser.

About 3-4 years ago, the Kaiser doc advised me of an inguinal hernia (IH) and told me to 'just keep an eye on it'.

This year, we had a physical with the PPO doc. Found him through online reviews as we are new in this town and don't have a friends network here yet.

My impression was he was more about the money than anything else. I had barely had a chance to mention the IH and he was all 'oh yeah you need that operated; I'll give you a referral'.

So far this year, thankfully that's been the only doctor visit for me or DW. But now the IH is on my mind... not painful yet, but at times I do get the sense that it is 'moving around', if that makes sense. Have started wearing a hernia belt and it helps a good bit.

So I am thinking to get it worked on. But I'd like to be able to make my own decision on the doctor etc.

We are with BCBS, Bronze plan, high deductible and don't need a referral to see a specialist. What's the best way to go about this? We have a list from BCBS of local surgeons; what should be the next step? Interview some on the phone? I guess most doctors will say get it done; how does one know if this is the right advice? (vs leaving it alone).

I am 61 BTW, BMI just under 30, quite active and easily get my 150 or so minutes per week, with biking, swimming, yoga, walking and some weights (light, 30-40 lbs max each side regardless of the exercise).

Just had an inguinal hernia repair 4 days ago. Laparoscopic but not robotic. So far recovery is relatively easy. Ibuprofen only. Discomfort but no real pain. Slow improvement every day. But easy to move around and I could drive easily yesterday.

Got the the hospital at about 7am. Surgery at 815. Woke up in recovery at 10.15. Left hospital at 1130.

The surgeon I used was recommended by a doctor friend, and he says he does 3 or 4 a week and has been doing them for 20+ years. I see you’re in CA. I’m in the Bay Area so if you’re there please DM me for the name if you’re interested.

 

[Gotadimple]

With a PPO you can be in control of who you select to do your surgery. Go back to your health plan. Many have a member website where you can search for surgeons in the network and select who you want. Many have member reviews of the surgeons to use in your research. That's point 1.

If your current PCP gave you a referral for a surgeon who either isn't in your provider network, or isn't one you want to use, contact your provider for a specific referral to the one you DO want. You should be able to do this with either a phone call or an email. If the provider won't refer to the one you want, you have time. Choose a new PCP - you can change anytime you want.

PPOs are a bit more work, but you have many more options for care.

- Rita

 

[chassis]

We were with Kaiser for 20+ years and if we ever knew, have forgotten how to navigate the PPO landscape. Switched to PPO this year due to premium pricing changes at Kaiser.
About 3-4 years ago, the Kaiser doc advised me of an inguinal hernia (IH) and told me to 'just keep an eye on it'.
This year, we had a physical with the PPO doc. Found him through online reviews as we are new in this town and don't have a friends network here yet.
My impression was he was more about the money than anything else. I had barely had a chance to mention the IH and he was all 'oh yeah you need that operated; I'll give you a referral'.
So far this year, thankfully that's been the only doctor visit for me or DW. But now the IH is on my mind... not painful yet, but at times I do get the sense that it is 'moving around', if that makes sense. Have started wearing a hernia belt and it helps a good bit.
So I am thinking to get it worked on. But I'd like to be able to make my own decision on the doctor etc.
We are with BCBS, Bronze plan, high deductible and don't need a referral to see a specialist. What's the best way to go about this? We have a list from BCBS of local surgeons; what should be the next step? Interview some on the phone? I guess most doctors will say get it done; how does one know if this is the right advice? (vs leaving it alone).
I am 61 BTW, BMI just under 30, quite active and easily get my 150 or so minutes per week, with biking, swimming, yoga, walking and some weights (light, 30-40 lbs max each side regardless of the exercise).

Do nothing. You said it causes no pain. Do nothing. New practitioner seems like he/she is grubbing for money.

 

[OldShooter]

Our city magazine runs an annual feature listing top docs, based on recommendations from health care professionals. I have used that as a starting point for resume reviews. I have no interest in the doc-rating sites; what patient has the experience and education to accurately assess a doc's skills? All they can assess is whether the doc is a nice person. I am not trying to hire a friend.

This is the doc I found and chose to do my cataract surgery:

... She ... was the valedictorian of her high school class. She attended Cornell University as an undergraduate, graduating summa cum laude in mathematics with distinction in all subjects (top 5% of her class). She was inducted into the Phi Beta Kappa, Phi Kappa Phi, and Mortar Board National Honor Societies.

She was selected as a Presidential Scholar and received several research awards. Dr. xxxx completed her doctor of medicine degree at Johns Hopkins University School of Medicine, graduating first in her class. She received a Dean’s Award and Lange Medical Student Award each year of medical school. She also received the Franklin Paine Mall Prize in anatomy, Hewlett-Packard Top Medical Graduate Award, and the Janet M. Glasgow Memorial Award. She was elected into the Alpha Omega Alpha Honor Society and won research awards as well as the prestigious William Stewart Halsted Award in surgery. She completed four years of cardiac surgery residency at Johns Hopkins before changing specialties to ophthalmology. At Johns Hopkins, she also completed a two-year immunology research fellowship, being supported by an American Heart Association Fellowship Award and Stetler Research Award.

For her ophthalmology residency, Dr. xxxx attended Massachusetts Eye and Ear Infirmary, Harvard Medical School. She then received a HEED Ophthalmic Foundation Scholarship to complete subspecialty fellowship training in cornea, external disease, refractive surgery, and glaucoma at yyyy. She ranked in the 99th percentile on her Ophthalmology Board examinations.

​

The good ones are out there, but hard for mere customers to find.

 

[badatmath]

From my personal 30 years of PPO, I would be surprised if you needed a referral, I have not ever needed one. Sometimes I ask who they recommend but that is not the same thing.

I doubt very much anyone will talk to you on the phone, you would have to make an appointment.

YMMV.

 

[folivier]

A few years ago I had an umbilical hernia and my PCP suggested getting it fixed and recommended a surgeon in my network. Got it done laparoscopically and after a year of continual infections found a local doc who was a specialist in mesh repairs. Saw him one day and had it removed by him the next day. Be very careful who you use for a hernia repair. If/when I have to have it done again I'll use this guy who teaches hernia repairs and has written books on it. He is also a specialist in robotics. That year was a painful year of continual oozing infections from the incision site. Not pretty.

 

[MrsHaloFIRE]

Just here to offer Halo Fire had a double laproscopic hernia repair. Supplies we had to scramble for that helped: tightish boxer briefs vice boxers or briefs. And an ice pack that looks more like a shower cap with a screw on plug you can fill with ice water vice it being a solid block of ice. Alternate ibuprofen tylenol. And br prepared for your balls/base of penis to be black for a few days. Dont panic. Its just bruising. Expect tiny adherances to "pop" in the following months needing a little more ice. Not a bad surgery, resist the urge to pull on the skin to "look at it" like him. Have someone take a pic if you wanna see. Godspeed and good luck! Also lay a towel or soft coat across your lap on the drive home underneath the seatbelt.

 

[MrsHaloFIRE]

Do nothing. You said it causes no pain. Do nothing. New practitioner seems like he/she is grubbing for money.

We considered this but in our case if that thing twisted and strangulated when we were somewhere remote it was bad news.

 

[The Rodent]

Scheduled for a bilateral IH repair in December. I'm with Kaiser. The surgeon will use a single incision laparoscopic technique. Just a small 1" incision below the belly button to repair both sides.

The more traditional laparoscopic repair uses 3 incisions. You may want to look into the single incision technique.
For me, getting it repaired was much more a quality of life issue than pain (no pain, so far). But after living with it for a year, I'm done.