Making headway for a second opinion referral
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Linda,
I am also in an HMO (with Blue Cross Blue Shield). Right on my insurance card it says “no out of network coverage”. I had one or two different doctors appealing my case for a referral (previously denied). In the meantime an appointment was made for me at Mayo Clinic by the local referral coordinator at the doctor’s office. My appointment was on a Tues and they were going to let me know by Friday. BCBS called me at almost 5pm on Monday evening before my Tuesday appointment to let met know the referral was accepted. BCBS has been fantastic at covering my expenses. The lady from BCBS told me that if I had not previously gone to an in-network provider it would not have been approved. The in-network provider only saw 2-3 cases a year with bile duct cancer and Mayo Clinic (according to their web site) sees 100-200 new patients a year.
Kathy
Well, news is good. Basically I was having difficulty getting my medical group to give me a referral to another medical facility. I didn’t like the last diagnosis of just doing nothing for now, from the University of Chicago.
I eventually asked my medical group for a list of drs. in-network. They didn’t have a list, so they were going to check with my gastro. dr. He said I should definitely have a 2nd opinion from an oncologist and his suggestions were Northwestern Memorial Hospital and Mayo Clinic. However I was told the medical group didn’t refer to Mayo, and Northwestern was out of their network. My question was then why did the dr. suggest it?
I finally got the med. group to look up in-network facilities, and was told there was only one other in our network, Loyola Medical in Maywood, IL. There is also a cancer center there, so that was at least a viable option. And thank you all for your suggestions, that I will be keeping for futher reference.
In the meantime, I had a meeting with my HR dept. at work about my benefits. She told me to make an appt. with my dr. (gastro. or primary care dr.) and ask him for the referral to Mayo. Since the one dr. already suggested Mayo, she thought he might also give me a referral. HR also told me that others that I work with that have HMO have received referrals to Mayo and gone there with ins. paying for it. HR’s suggestion was also that if one dr. didn’t give me the referral, go to the other dr. If that still doesn’t work, change medical groups until I get a dr. to make the referral.
That’s promising to me. At least that gives me a plan of attack to get to Mayo or anywhere else that I WANT to go to. And because this cancer is more unusual, that helps getting me to where I want to go.
So for now, I have a plan. I’ll start Monday to see what appointments I can make.
Linda
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