Orthopedic surgery FAQ

Search by specialty, city or state, and accepted insurance on AdvOrtho. Every listed provider holds an active NPI (National Provider Identifier) with an orthopedic surgery taxonomy code. For a specific condition or procedure, filter by subspecialty - knee replacement, sports medicine, spine surgery, hand and wrist, and foot and ankle specialists are all searchable separately.

Orthopedic surgeons complete medical school plus a 5-year residency in musculoskeletal surgery. Sports medicine physicians may be orthopedic surgeons who did an additional fellowship, or primary care doctors with sports medicine training who do not perform surgery. For injuries that may need surgery (ACL tears, rotator cuff tears, fractures), an orthopedic surgeon is the appropriate specialist. For overuse injuries, sprains, and performance issues that are unlikely to need surgery, a non-surgical sports medicine physician is often the right starting point.

It depends on your insurance plan. PPO plans generally allow direct access to specialists without a referral. HMO plans require a referral from your primary care physician first. Medicare (Original, not Medicare Advantage) does not require referrals for specialist visits. Call the number on the back of your insurance card to confirm your plan's referral requirements before scheduling.

Board certification in orthopedic surgery requires passing written and oral exams administered by the American Board of Orthopaedic Surgery (ABOS). You can verify certification at certificationmatters.org. Most orthopedic surgeons list their board certification status on their practice website and AdvOrtho profile. "Board eligible" means the surgeon completed training but has not yet passed the certification exams.

Bring insurance cards, a photo ID, any imaging you have had done (X-rays, MRI, CT scans - ideally on disc or with the imaging report), a list of current medications, and notes on when the problem started and what makes it better or worse. If you have had prior treatment (physical therapy, injections, prior surgeries), bring records or at least a summary. The more specific your symptom history, the more efficient the appointment.

Yes - all major commercial insurance plans and Medicare cover orthopedic procedures when medically necessary. "Medically necessary" means the condition is documented, conservative treatment has been tried when appropriate, and the surgical indication meets the insurer's clinical criteria. Prior authorization is required for most elective procedures including joint replacement, ACL reconstruction, rotator cuff repair, and spinal fusion. The specific prior auth requirements vary by insurance plan.

Prior authorization (prior auth) is a requirement that your insurance plan review and approve a procedure before it is performed. Your surgeon's office submits clinical documentation (diagnosis, imaging, treatment history) to the insurer, which reviews it against their coverage criteria. Approval typically takes 3-10 business days. If denied, you have the right to appeal. Most orthopedic denials are overturned when the surgeon requests a peer-to-peer review with the insurer's medical director.

With commercial insurance, patient out-of-pocket for major procedures typically ranges from $500 to $6,000 depending on your deductible and plan design. This assumes you use in-network providers. Out-of-network care can cost significantly more. Without insurance, hospital-billed charges for joint replacement often exceed $40,000-$60,000, though self-pay rates are usually much lower. See our costs section for procedure-specific estimates.

In-network means the surgeon and the facility (hospital or surgery center) have contracted rates with your insurance plan. Using in-network providers means you pay the contracted cost-sharing (copay or coinsurance) rather than the full billed charge. Critically, the surgeon AND the facility must both be in-network - a surgeon who is in-network but operates at an out-of-network facility can result in a surprise bill. Confirm both before scheduling.

For major elective procedures - total knee replacement, spinal fusion, hip replacement, rotator cuff repair - a second opinion is reasonable and often covered by insurance at a standard specialist copay. Surgical recommendations for the same condition can vary significantly between surgeons, particularly for spine surgery and knee arthroscopy. A second opinion is not about distrust; it is about confirmation and exploring whether conservative alternatives have been fully considered.

No reputable surgeon takes offense at a patient seeking a second opinion for major surgery. It is standard, expected, and endorsed by every major medical society. If a surgeon discourages you from seeking a second opinion, that itself is a red flag.

Yes. Most major commercial insurance plans cover second opinion visits at the standard specialist cost-sharing (copay or coinsurance). Some plans actively encourage second opinions for high-cost procedures like joint replacement and spinal surgery. Call your insurer to confirm, and when booking the appointment tell the office it is a second opinion visit so they code it correctly.

Recovery time varies significantly by procedure. Minor arthroscopic surgery (meniscus trim, carpal tunnel release) often allows return to desk work in 1-2 weeks. ACL reconstruction typically requires 6-9 months before return to sport. Total knee or hip replacement involves 2-3 months before most daily activities, and full recovery to maximum function takes up to a year. Use our recovery calculator for procedure-specific estimates adjusted for your age and activity level.

For most major procedures, yes - physical therapy is a required part of recovery, not optional. Skipping PT after joint replacement, ACL reconstruction, or rotator cuff repair significantly increases the risk of stiffness, weakness, and poor functional outcomes. Most insurance plans cover post-surgical PT with an annual visit limit. Ask your surgeon for a PT referral at the time of surgery scheduling so it is in place before you are discharged.

The general rule is that you should not drive while taking narcotic pain medication or while your reaction time or physical ability to operate the vehicle is impaired. For right-leg procedures (knee or hip), most surgeons clear patients for driving at 4-6 weeks when strength and control have returned. For upper extremity procedures or left-leg procedures in automatic-transmission vehicles, the timeline is shorter. Always get explicit clearance from your surgeon before driving.

Contact your surgeon promptly for: increasing redness, warmth, or swelling at the incision site; fever above 101 F; wound drainage that is cloudy, foul-smelling, or increasing; sudden severe pain not controlled by prescribed medication; calf pain, swelling, or redness (possible blood clot); chest pain or shortness of breath (seek emergency care immediately). Some swelling and bruising in the first 2-4 weeks is normal; the key is worsening symptoms rather than improving ones.

Yes. Searching the directory, viewing provider profiles, and accessing all patient education content is free. There is no account required to search. Surgeons pay to claim and enhance their profile with photos, a bio, and additional practice information.

Providers are listed based on NPI registry data, which is maintained by CMS and reflects active, licensed healthcare providers. We do not independently verify individual credentials beyond what the NPI registry contains. Board certification status, hospital affiliations, and malpractice history should be verified independently through your state medical board and certificationmatters.org.

Search AdvOrtho by insurance plan to filter for surgeons who list your plan as accepted. Because insurance networks change frequently, always call the surgeon's office directly to confirm in-network status before scheduling. Also confirm that the surgical facility (hospital or surgery center) the surgeon uses is also in-network under your specific plan.