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[Robot Parade Leader]

I know I am not the only person dealing with these and there are much smarter people out there than me. There was also a bit of a derail in another thread about these issues. So, here:

I have an ingrown toenail. It's not fun. I treat it by soaking it and putting antibiotic Neosporin on it after soaking it. I also tried lifting the nail a little bit (because it was growing into my toe (side) a bit.

Part of the nail seems to have broken off, like the purple part of the nail by the side of the toe. I'm not a doctor but I think I might be seeing a little bit of the nail bed when I zoom in?
It seemed to have gotten infected, no pus but some nice throbbing and redness. My doctor prescribed a 10 day antibiotic course without seeing me or the toe (since I had just seen him recently).
It was actually another doctor from his office that wrote the prescription and that doctor said "You might want to see the foot doctor/podiatrist." (not having seen it).

I freely admit I don't know a lot about this. I still have 9 days of antibiotic left. I don't know what happens after that. I don't want to be the moron who screws this up more than I already may have..

Do I schedule a podiatry appointment with a foot doctor?

[Robot Parade Leader]

Update. I was told to schedule an appointment with a podiatrist (Foot doctor), because the nail is broken. Like it is actually broken in the part you don't want it to be broken and you can see the nail bed under it by the edge near the border with the toe's skin.

I have never been to a foot doctor before. Not sure what the heck to expect. I'm hoping the missing part of my toenail (not the part you usually trim but the one under that) grows back.

[nenjin]

It probably will. My brother dealt with ingrown toenails in his teens and they'd cut away a part of it. However it may not grow back fully/healthy. You may end up with a thin veneer of nail over the top and it may be subject to unpleasantness like getting gross when it gets/stays wet for too long.

[Robot Parade Leader]

Thanks for letting me know / commenting. Nobody talks about any of this and it should probably be common health knowledge but it just isn't. Especially, I don't think I'm diabetic but if anyone out there is, it can be a huge concern for them. 

I wouldn't mind keeping it dry or whatever works either. It never occurred to me that part of the actual nail (not the part you trim) would break off. Very grateful I have an oral antibiotic, because otherwise I am pretty sure this would just be infected bad. $1.68 for 10 days and having to drink a lot of water because of the antibiotic is way better for everyone than an urgent care visit costing literally 100 times that.

[nenjin]

Mostly it comes up as an issue if you have sweaty feet. If you find your feet are sweaty and that's causing the regrown part of the nail to get soft and the whole thing gets gooey (which can lead to another infection) you can use foot powder to keep your toes dry. Or wear open toed sandals in the appropriate weather as an alternative.

[Robot Parade Leader]

Thank you.

I also got some info from an anonymous person who showed me the possible costs for these things in my area from information I did not know existed. They said as long as it was never traced back to them and I knew it wasn't set in stone/only an estimate.

Of the last four numbers the first (leftmost) is the standard gross charge, 2nd is discounted cash, 3rd is standard minimum, 4th (rightmost) is standard maximum

HC TRIM NAIL(S) ANY NUMBER   CDM   11719   CPT   761   214   74.9           56.28   188.32
HC DEBRIDE NAIL 1-5           CDM   11720   CPT   761   303   106.05   79.69   266.64
HC DEBRIDE NAIL 6 OR MORE   CDM   11721   CPT   761   303   106.05   79.69   266.64
HC REMOVAL OF NAIL PLATE   CDM   11730   CPT   761   515   180.25   135.44   453.2
HC REMOVE NAIL PLATE ADD-ONCDM   11732   CPT   761   303   106.05   79.69   266.64
HC DRAIN BLOOD  UNDER NAIL CDM   11740   CPT   761   242   84.7          63.65   212.96
HC REMOVAL OF NAIL BED      CDM   11750   CPT   761   1413 494.55   371.62   1243.44
HC REPAIR OF NAIL BED      CDM   11760   CPT   761   706   247.1   185.68   621.28
HC EXCISION OF NAIL FOLD TOECDM   11765   CPT   761   634   221.9   166.74   557.92

I guess podiatry care can be expensive. Hope my insurance covers it and if not that they can give me the "discounted cash" price.

[nenjin]

That reads like an item list for fully excising the entire nail. Hopefully they don't have to go that far.

[Truean]

Please do not quote:

Not representing anyone. Not legal advice, if anyone takes legal advice from anyone online, then they are stupid. If you need a lawyer find one licensed near you as appropriate.

Agreed. it is a menu of costs for the most common procedures that could occur. Of course, it depends on what the physician says, but I imagine it is unlikely it would get to that point of the whole thing. Trimming and perhaps debridement would be most likely from a wide statistical standpoint, but again it depends on what the doctor says is wrong. Simply most would not have the whole nail removed, but someone could if things were bad. Hopefully just looking at one of those + initial visit cost. (Note different hospitals have different charges).

***** Primarily the point was to show some price differences, particularly if it ends up being self pay. Big difference for nail trim of $214 gross standard charge v. $74.90 for self pay/denial, right? Although I've gotten it lower before, though not easily.

[rant]
Very complicated and a major problem in the US. So basically, most insurance in the US does not cover foot care except in the event of metabolic (e.g. diabetic) or peripheral vascular disease, etc. If you don't have one of those magical qualifying diagnosis(es), then they deny you and don't care. One of the many things I have done is settle amounts with billing departments (who do not want to give you a lesser charge because they are in it to make money). Showing up with an attorney and basically challenging the cost/liability/(and coding in my case) can yield massively lower bills. I'm not exactly happy that multiple hospital administrators just groan when I show up at treatment facilities for this reason/doing my job. The facts that a.) Most bankruptcies in the US have a significant medical debt component and b.) most people (yes even many lawyers, but most also don't practice healthcare law) cannot read medical records, are tragic.

I did several types of law including personal injury law the right way, while others got more business because they are flashy. I am not flashy and am that disabled one with a nose in a book. Even far too many personal injury lawyers I have seen don't do things right, because they can't read medical records. Yes, I've fought them on this, yes they hate me for it, and I dislike most of humanity right back. I have three letters for them (MSP: Medicare Secondary Payer). By disputing the actual hospital, rehab and treatment billing and coding, the cost gets lowered. If the cost gets lowered, the amount Medicare takes out of the settlement or verdict goes down. Same goes for other payment sources like Medicaid, etc., etc. Yes, Medicare (remember, for the aged and disabled....) can take back money it paid for treatment from lawsuit funds.... Far too many lawyers would consider this not the practice of law and I would tell them they are lazy,  don't know how to read medical records, cost their clients money, are missing an opportunity to bill for very reasonable and quite economically viable (for client and lawyer) services, and enriching the large corporate hospitals at their clients' expense, but they sure look good doing it. [rant]

TL;DR (We need more literacy focus in society): Keep careful tabs on medical treatment and cost stuff and your medical records. Get copies of things. It will cost you in the long run if you don't. I do not do this sort of thing anymore though and am not presently in a position to do so.

Practically:
Perhaps consider taking a picture of your toe with your phone every day, perhaps zoomed in. Create a timeline for your doctor to see that you can swipe for your physician so they can observe the progression of the area as relates to healing and possible infection. I have found physicians appreciate the few seconds of photographic evidence of an infected wound so they can see it progressing and apply their expertise, rather than rely upon only verbal descriptions of "It's red and swollen." How red? How swollen? O, it's right there in the picture for the doctor to see... The ones I have talked to have told me it is a useful tool.

Please do not quote:

[Robot Parade Leader]

First of all you are a freaking legend and have my gratitude, again. Kind of amazed anyone knows this stuff.

Just got back from the podiatrist. His assistant gave me "CPT" codes

11730 (He called this one the temporary procedure) or

11750 (He called this one the permanent procedure where that part of the nail doesn't grow back ever)

Those look familiar:
HC REMOVAL OF NAIL PLATE   CDM  11730   CPT   761   515   180.25   135.44   453.2
HC REMOVAL OF NAIL BED      CDM   11750   CPT   761   1413 494.55   371.62   1243.44

So if I'm reading that right, the total cost of the first one 11730 would be $515 gross under insurance or $180.25 without?
Second one would be $1,413 gross under insurance and $494.55 without?

But that's only if their billing department agrees to it?

Those are not small differences, especially the second one. I mean and that's just a bad ingrown toenail. Do I wanna know how much something way more serious is like a surgery for someone in a car wreck or a heart thing or something?

Stupid question, do Europeans and Canadians and anyone else with socialized medicine have to deal with anything like this?

Anyhow the podiatrist said it would be 3 to 5 days of discomfort after the numbness wore off and 3 to 4 months for that part of the nail to grow back. He said he would take 2 mm of nail from the side of the nail closest to the left side of the nail. $180 is way less than $500 and I'm spending more than that on doctor appointments, medication and other stuff. If I don't do anything he said it will just get worse after the antibiotic wears off, because the underlying problem is still there without a larger treatment, "It's like taking an antibiotic for an infected tooth. It works for a bit but eventually you have to do something with the tooth like pull it or a root canal. This doesn't hurt as much though."

He called it something like a "matrixectomy?" I don't know. I might do it. Should I? 

[nenjin]

If they're removing the nail bed, then they're removing the part that actually grows the nail. Between removing the nail plate (the grown part) and the nail bed (the part nearest the base of your toe where the nail grows from) that is more or less a full removal of the nail.

Mind you, when my brother had this done it was 25 years ago and under our mom's insurance. So I have no idea what it cost then, but healthcare costs being what they are, the cost for a simple procedure like this doesn't surprise me.

I'm guessing they're not going to remove all of the nail bed, but at least a portion of it. If they full removed the nail bed, they wouldn't be saying stuff like "some of it will grow back."

Do I wanna know how much something way more serious is like a surgery for someone in a car wreck or a heart thing or something?

You really don't. When I had sinus surgery it was $8k on insurance like 8 years ago. A friend just got what amounts to major back surgery, and her bill was easily $80k.

Healthcare in this country is a nightmare and it's being felt even at the lowest level of care. A simple doctor's visit on insurance is easily $175 for me right now.

[Truean]

Please do not quote

I pretty much always liked this guy.

Pretty solid points. I don't know but from what I'm hearing it doesn't sound like full nail bed removal for the whole toe? Probably just the part behind the ingrown/infected area? Can't tell from this, but when I see "2mm" I assume this is 2 millimeters? If so, surprised he didn't describe it in fractions of an inch too just for clarity.

Also yes, medical care in the US can be an expensive nightmare. Yeah, surgeries can get real expensive, real fast. Then rehab in a SNF (Skilled Nursing Facility) for a car accident where somebody gets hurt bad.... It can be a ton. Don't get me wrong, a lot of the people who work medical do hard work, and I am not saying things against them. A lot of the nurses and people like that don't get paid enough and that makes no sense considering how much everything costs. I'm just saying the average Joe or Jane Doe can't really afford it easily or perhaps at all, especially without insurance. As an understatement, this is quite sad.

Much appreciated. I don't really do things like this anymore because I've been burned too many times. Also not in a position to.

CPT is medical billing and coding stuff. Call your insurance company and ask if they cover those CPT codes for you. You might need a preapproval or something. Or there may be restrictions such as trying other treatments first for a certain amount of time under your physician's care or who knows. This is why you ask the insurance what it covers. If it doesn't cover, then you might want to know that upfront instead of after you get a big bill.

Also call the medical provider's billing department and see what they can do for you about costs, because it is complicated and costs are approximate at best with the limited information available. For example, they could do that code plus another code or something. Also they might charge you more/provide different care if you have diabetes or peripheral vascular disease so tell the billing department that too. You might be able to ask for an estimate upfront, again based upon those codes/what your doctor said. There really is a lot to it and it isn't simple, so exact answers are not practical here or really possible. However, you might ask them (the billing department of the medical provider) about those figures. They may also charge you with a visit (follow up, operative, etc). Medical things are not cheap, sadly.

Matrixectomy https://www.gentlefootdoctor.com/blog/what-is-a-matrixectomy-and-why-do-i-need-one
(obviously there's stuff about feet in there so fair warning but then again that's what the thread is so...).

Whether or not you do it is up to you and your physician (and honestly from a practical standpoint matters if your insurance covers it or not). I don't think it is necessarily appropriate for me to say one way or the other. I don't know if anyone out there has had one either or what their experience was.

Please do not quote

[Robot Parade Leader]

Wow. You two are basically dead on right with everything you're saying. Whole operation will cost about $550 before insurance because they're tacking on an operative visit and stuff like that. Hopefully insurance covers it.

Procedure scheduled this week. Hope it goes well.

1.) Odd question. So you have to soak your foot in a tub. I have a plastic one for it. Am I stupid or is there any way to clean it?
I mean, it's hot water and antibacterial dish soap that I put in there and sometimes some episom salt for the foot soak thing.
I feel like I'm being dumb or not getting something about how to clean this because I already put antibacterial soap in it generally.
Do I just do that to wash it again but not soak my foot in it to clean it? Knowing my luck not doing that would cause infection....
I just don't want to be the moron who screws this up and ends up with a secondary infection, especially after I have the podiatrist operate on it.

I know it sounds like a riddle or something. How do I clean a foot tub that always has antibacterial dish soap in it? With what?

2.) I don't think I'm diabetic but I've heard people say things about it here. Would that matter for the operation if someone was? Asking for the same reason as always, because someone else might go through this. No one told me anything growing up.... At least someone might benefit from asking and having it answered.

[nenjin]

Ah yes, I remember the foot soaking.

Pour the contaminated water out, wash the container again with anti-bacterial soap and a sponge, let it dry. Don't overthink it. Those instructions are written for the worst case scenario: people who literally don't wash it after using it. That can lead to the introduction of bacteria to the container, adhering to the sides, that just more water and anti-bacterial soap with no scrub might leave behind. While you soak your toe, you'll have some blood and fluid dissolve into the water. A scrub and rinse will be fine to get rid of any residue. Obviously, use a sponge specifically for cleaning it, rinse it out thoroughly after use and throw it away when you're done. You won't need it too long.

2.) I don't think I'm diabetic but I've heard people say things about it here. Would that matter for the operation if someone was?

Shouldn't matter for the surgery itself, it's not a major surgery. Diabetes can present problems post-operation in terms of healing times and infections though. Hence the foot soak to continually clean dried blood and other substances out of the removal area.

[Truean]

Honestly, good job asking that question.

Seriously. I would rather you ask that than risk getting your foot infected after surgery.
Too many people today deny not knowing just everything (no matter what it is).
Things get called "simple" or "common sense." Wound care after surgery of any type is not simple. No, it is not.

I know from my experience, my parents didn't teach me practically anything. They just yelled. Growing up poor sucks. 
Looking back, it was just part of amazingly bad parenting on their part. If they did it today, they'd be in jail.
I was a kid and didn't know anything (See also, was a kid). Learned the hard way.... All they did was scream when I inevitably made
mistakes, because they didn't teach me when I was a kid. There was a time when I was told not to "waste anything," like that.
I could totally see my clueless parents yelling at me wasting soap and water on something that just got soap and water in it.... Ouch.
Washing things and sterilizing is important.

Because it is only one foot, ask about using a smaller, easier to wash and carry tub for one foot.

Please ask questions, preferably of your doctor / a nurse as well to avoid making some mistakes.

This is absolutely correct as far as I know.

Question: Are there instructions out there for aftercare? I feel like sometimes people just get thrown out there and expected to know things that practically speaking some of them just don't. Not about blame... just think the hospital or someone should throw that in there.

[Robot Parade Leader]

Thank you both for not making me feel dumb.

Yeah, my parents didn't really explain anything either and yelled a lot too. Addiction is like that I guess. I feel like I don't know things other people do sometimes. So yeah, any explanation on this is helpful. Because I feel like I should know things I don't. Now that I think of it, that's probably how I wound up where I am needing surgery. Nobody taught me anything about foot care growing up.

I feel like the podiatrist just looks at it as normal to him, because he deals with this every day as his job. I've never done this before.

Right now I got a new tub thing and am washing it with paper towels and lots of antibacterial soap like a big dish or a pan or something. I can get a sponge for it I guess.

Another question, I keep a band aid on it until surgery is performed. Should I let that breath at night (sleep without the band aid) or just change it once a day? I was told to put neosporin (over the counter antibiotic) on it. I don't even know how I'm going to deal with surgical dressing after the procedure and am going to have to really ask about that and hopefully get it in writing.

Thank you. I guess I don't know what I'm doing. But yeah, at least I can say it.