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Sports Medicine in NYC
March 5, 2014 8:26 AM   Subscribe

Does anyone have a good Sports Medicine doctor in NYC who takes Health Republic and/or Magnacre? Also, can you explain to me how health insurance works in this case?

I messed up my knee about two years back being stupid doing squats. Now it hurts when it is cold (I can't run without INTENSE PAIN if the temperature is under 30F) and I can't sit crosslegged or go into a squat position or sit on my knees.

I went to my GP last year, got x-rays, and she said there's nothing they can spot on the x-rays and that I should go see a Sports Medicine doctor with a copy of the x-rays they took. Now that I have better insurance, I'm actually going to do that.

So:

-I need a Sports Medicine doctor, preferably in the southern Brooklyn or lower Manhattan. I know I can go on ZocDoc or whatever, but someone's actual "this guy/lady is not a total quack" recommendation would be great.

-I need to figure out how my insurance applies to this. I have a Health Republic plan (PrimarySelect Gold) which uses MagnaCare's network, so that means I can use a MagnaCare doctor, right? HealthRepublic's website is not 100% functional at the moment. How do I know how much of the visit will be covered? Is a Sports Medicine doctor treated just like another specialist M.D. like a gastroenterologist? Or would it be considered an elective visit?

I know I can call the insurance agency and ask, but I'm not entirely sure how to phrase what I'm asking, so giving me a hand with that would help.
posted by griphus to Health & Fitness (7 answers total)
 
Do you need a sports medicine doctor or a physical therapist? Doctors who do sports medicine usually perform surgery.

If you're looking for a physical therapist, I've had a good experience with SPEAR Physical Therapy, which has a bunch of locations in Manhattan.
posted by dfriedman at 8:34 AM on March 5


You pretty much have the phrasing right. Once you find a provider, I would call your insurance to confirm that he'll be considered in-network, and then to ask how much your plan would generally cover for a specialist visit of that type. You might also check if you're going to need a referral or prior authorization.
posted by ThePinkSuperhero at 8:36 AM on March 5


Don't let the name scare you, because The Hospital for Special Surgery has great sports medicine doctors who can diagnose your problem- it's not a surgery mill. Lots of professional athletes I knew went there as a starting point to getting what often ended up being very conservative treatment.

(edited to add: I would call the center and ask what doctors, if any, are covered by your plan. That's what I did)
posted by stagewhisper at 9:45 AM on March 5


I had a good experience with the doctors at Riverside Orthopaedics last year when I broke my patella. I agree that you should try calling the office of whichever doctor you choose and get their impression of whether or not you'll be covered—there's a good chance they've worked with your insurance provider before and can give you an idea of whether you're covered and how you should proceed with getting your care paid for.
posted by aparrish at 10:27 AM on March 5


I'm not sure exactly what you mean about whether a visit to a sports medicine doc might be considered "elective", but sports medicine physicians are generally orthopedists who specialize in sports injuries. You have pain, so this would not be considered elective. In fact, this is precisely the sort of patient compaint they usually see.

I think you might be thinking about physicians who do procedures not covered by insurance because they are considered "not medically necessary". These are procedures like cosmetic plastic surgery or teeth whitening. Doctor visits stemming from an injury would be covered without question.
posted by citygirl at 12:20 PM on March 5 [1 favorite]


I saw Dr Friedman at Seaport Orthopedics (right off the Fulton stop) for my shoulder last year and he seemed competent/legit. He looked at it, had me do some movements, took an xray (inhouse; processed immediately), talked about what was going on and the treatment needed, and gave me a script for PT.

No idea if they're in-network for your insurance. Be aware of any deductible and/or co-insurance you may have. In any case, I think the total cost (after insurance discounts but before any payments from me or the insurance) was like $175, including the xrays.
posted by melissasaurus at 6:43 PM on March 5


What you need is a physiatrist. A good one is hard to find (mine retired so I can't recommend him.) There should be some on your insurance, but you might have to try a few out until you find one you like.
posted by Obscure Reference at 6:58 AM on March 6


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