Health Insurance Question/ getting out of network care

Jade645

My mom was diagnosed with DCIS grade 3 multi focal and a mastectomy has been recommended. My mother lives in a smallish town and does not like her oncologist or her surgeon. They have come across as very cold, uncaring and at least from what I have heard second hand do not seem to be giving my mom adequate information each step along the way.

Just for example.. when the oncologist gave my mom the diagnosis she started crying (normal enough) he left the room and never came back. Sent the nurse in some minutes later to tell her what would be next and send her on her way... never followed up called checked in etc. At that point had very little information and was pretty sure she was going to die soon.. didn't let her know that DCIS was a very treatable cancer etc. give her any information about it..

Anyway she really wants to have the procedure done at another hospital/ other doctors etc. She was granted a second opinion at the hospital and with the staff that she asked... but the insurance made it sound unlikely they would allow the procedures there as it is out of network and not within 30 miles of her home (it is about 50 miles away and has a dedicated breast cancer center). WE are in California if that matters. Anyone have experience getting a different provider?

It just seems that having some confidence and rapport with medical staff is important. My mom has never had any surgery in her whole life and is of course very worried and this seems to be magnifying an already stressful situation.

gale1525

I am in California I was able to go out of network but it was a 18 month long fight (I had an HMO). IF you have an PPO you might be able to change groups to include the doctors or pay out of network costs. I was able to go to UCLA which is 38 miles away. This is open enrollment and she might try changing insurance. I just got a plan through Costco Assurant Health (PPO) and they use Aetna Signature Administrators PPO which is a large group of providers. It gives me a lot of choices.

DoggieBytes

I didn't like the Radiation oncologist I was sent to, at all.

I was able to switch to another RO who works for the same in network clinic though.

Usually there is more then one MD working at the hospitals/clinics that you can switch toand still be in network.

Is that a possibility for your mom?

Btw- I like my surgeon a lot, but in dealing with surgeons for my father's surgery, mother's surgery and now myself I've found they don't spend much time with patients to talk about anything outside of the scope of the surgery itself. I did find my Oncologist to be more compassionate in that regard but he too was some what reserved when I was in a fearful state. This doesn't excuse rude or unkind behavior but I was like your mom a newbie to the medical world and felt the same way.

I wish your mom and you all the best.