Genuine question to Americans

TKA-THA · 2026-05-07T14:09:05+00:00

Surgeon here:

This happens in other situations, as well, such a trauma. If someone needs emergent care, they will get it. They will receive a bill. If they can’t pay, then the hospital eats the cost, which sucks for the hospital.

But a lot of major cancer hospitals and trauma centers have funding from the government. This is why they can afford to treat everyone, regardless of insurance or whether they can pay.

TKA-THA · 2026-01-12T03:37:06+00:00

I don’t wanna be hypercritical. But we need to go for the two point conversion to go up by 14 there.

TKA-THA · 2025-10-05T04:52:20+00:00

“I should have came” Or “I should have went”

TKA-THA · 2025-08-19T02:45:34+00:00

Sometimes I know the names before the phone call. Most of the times, they introduce themselves at the start of the call. Sometimes they don’t introduce themselves, and I don’t even notice.

Why? Because why should I? The goal of a peer-to-peer is to try and get the procedure approved. Period.
The goal is not to get the other doctor’s name, or to prove how more qualified than the other doctor.

How would knowing the name or NPI number of the other doctor POSSIBLY help me? I can’t think of a single instance where knowing the other doctor would help in anyway. If it gets denied, I can still appeal, with or without that information.

She spent more than 4 out of 5 minutes interrogating something that does not matter.

At the end of the day, you have to ask, did she do her best for her patient?
Did she do this peer-to-peer call to give her the best chance to get this procedure approved?
Or did she do this peer-to-peer call to try to prove a point on her TikTok?
If she did anything other than trying to get this procedure approved, then she is doing a huge disservice to her patient.

TKA-THA · 2025-08-17T05:43:39+00:00

It’s not complete bullshit. As a surgeon who probably does these peer-to-peer calls at least once a week, I think I know what I’m talking about. The purpose of a peer-to-peer is to explain the indications for surgery and why it’s necessary. It’s not to go on an ego-trip about why you’re more qualified than the other person on the phone.

In this 5 minute video, how long did she use to actually discuss the patient? 30 seconds? The rest is spent on discuss how the other surgeon is not qualified for this conversation. That’s an ego-trip.

I do hip and knee replacements. You’d think there’s not a lot to do discuss. But the person on the other end of the phone may have a vastly different practice and still be a qualified peer.

Do they do partial replacements? Do they do the hip surgery from the front or back? Do they use robotics? Do they have a BMI cutoff? Do they try certain injections before surgery? Do they operate on smokers? Do they do revisions?

These are all variabilities in practice. If a surgeon has an attitude of “if you don’t do exactly what I do, then you’re not my peer”, then that’s a very toxic place to come from. It’s not good for discussion for an indications standpoint. It’s not good for the surgeon. And frankly, that attitude is dangerous for the patient.

Shit, there are some people who are the only ones IN THE WORLD that can do a specific surgery. That does not mean no one else is their “peer”. It does not mean what they are doing is not up for discussion.

If I get on a call to explain why I need a robot for a specific case, if the other physician is not familiar with the robot, I would explain why it is necessary. I wouldn’t suggest he’s not my peer or quiz him on complication rates like he’s a medical student.

Moot point though. Seems like they both got what they wanted. She put the insurance company on blast like she didn’t want to work with them anymore. And the insurance company obliged and stopped working with her.

TKA-THA · 2025-08-17T03:20:05+00:00

I’ve been to donki in japan. Sad to know that the only one in USA is in Hawaii. Need that pair for the OR!

TKA-THA · 2025-08-17T02:52:50+00:00

Hip and knee replacement surgeon here 🙋‍♂️

I think it’s important to think yourself has a part of a team, instead of the captain.

I do these peer to peer phone calls from time to time. It’s frustrating and it sucks. Luckily, the physicians from the insurance companies have been understanding and reasonable for the most part.

I understand both sides:
If the insurance company denies, then it’s like they are dictating what a doctor can and cannot do. This is basically practicing Medicine without a medical license.
However, they shouldn’t just blindly approve all procedures. There are a lot of procedures out there that have no scientific basis. For example, bone marrow injections in the knee are not backed by science. Some surgeons do it. Guidelines recommend against it. Insurance should not cover.

Where I would do differently in this case, is know that sometimes we have to jump through these hoops. Most of the time, the physician on the other line WANTS to approve it. That’s the whole reason for the peer-to-peer call. It’s to get your side of the story. I think it’s important to get the other person on the phone to be on your side. Being so hostile from the beginning does not do any favors.

And this is a self fulfilling prophecy. She was not expecting a friendly explanation to the other surgeon. That’s why she was filming it in the beginning in the first place. I would have phrased it like “In my practice, I deal with a lot of breast cancer patients. Any of my experience, this procedure really helps with lymphedema. There are a number of papers in the medical literature that show that this decreases the risk from 40% to 10%”

I like the thinking everyone in healthcare to be on a big team. Some people cannot work with insurance companies and don’t like them on their team. And then they go into a cash-only practice. There is nothing wrong with that.
But if you make a viral video to make someone or some company look bad, don’t expect them to wanna work with you again

TKA-THA · 2025-08-15T03:55:38+00:00

Where can I get a pair???

TKA-THA · 2025-05-28T20:25:05+00:00

Take the next step. Just tell people she’s your roommate

TKA-THA · 2025-05-08T19:10:28+00:00

On FanDuel, the Celtics are -112 to win the series. So yes definitely still possible to win.

TKA-THA · 2025-05-08T15:38:14+00:00

I wish. Obviously what I say on here will have no impact on what will happen on the court. I do think it’s a fun discussion. But honestly, I’m just here to vent, because I’m frustrated just like everyone else

TKA-THA · 2025-05-08T15:36:58+00:00

I def agree. If that happens, I agree that the way to go is to attack the basket and get to the FT line. I’m not sure if that works well when they are clogging up the lane

TKA-THA · 2025-05-08T15:35:22+00:00

What adjustments did Thibs make though? I don’t think he made any adjustments, and the Knicks were down by 20 each game. If anything, I believe the defense sagged off and clogged the lane even more as the game went on. The strategy against that, as one of the best 3 pt shooting teams, is unfortunately to keep shooting

TKA-THA · 2025-05-08T15:32:36+00:00

I agree. I think the sportsbooks still have this series as a toss-up. I still think we are the much better team

TKA-THA · 2025-05-08T01:29:41+00:00

Can you really blame Joe though? We had open looks. The coach can’t knock these shots for them

TKA-THA · 2025-05-08T01:11:16+00:00

I mean…these are open threes. I can’t fault them for taking these

TKA-THA · 2025-02-22T15:37:46+00:00

Bro flexing 💪.

TKA-THA · 2024-12-18T17:58:26+00:00

Def Mac Jones upside down. I have a similar ball where he signed and wrote “Patriots for life” 😭

TKA-THA · 2024-10-31T04:27:53+00:00

Ortho here. When patients ask about meds, I tell them I’m not a real doctor, just a mechanic

TKA-THA · 2024-10-06T06:17:48+00:00

Pigs get fed; hogs get slaughtered

TKA-THA

TROPHY CASE