Anyone able to get a second opinion with an HMO plan?
Hello, I was recently diagnosed with Invasive duct carcinoma. And that's as far as it got. My primary knows nothing about it except it's cancer and sent in a referral for a surgeon. Because I have an HMO plan (I live in CA) they assigned a "general surgeon" that I met with today. He's like its only X centimeters so lets do a lumpectomy, I'll check nodes. Then we'll refer you to an oncologist and they can do radiation. I mean when he talks like that it sounds like we'll just change the tires on the car type thing. But because of my insurance, and I looked, there are no Oncologist Surgeons, and no breast specialists. There is a Cancer Center at the hospital that apparently has this, but with my plan I don't think I'm able to see them. And I don't have means to pay cash out of pocket for medical procedures. How can I get a second opinion from a breast doctor when it doesn't appear that they even have one in my group? And even if I can find a way to take out a loan should I try and find a doctor anyhow for one?
Comments
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Hi debbie92284,
Do you have Kaiser per chance? I do and am now into 10 years at stage IV with no progression. The short answer, if you have Kaiser, is no. If you go anywhere outside the Kaiser system then it’s self pay. As far as I know, for mastectomies and lumpectomies they use general surgeons but you can ask about their experience with these procedures. No oncology surgeons either as far as I know. That being said, I personally never felt that there was any lack of expertise. The oncology department at my campus has some sort of NCCN (?) recognition. That being said, I did go to Stanford twice for second opinions (my brother generously paid) and they completely concurred with Kaiser’s treatment plan. Take care.
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My surgeon is a general surgeon but she specializes in breast cancer and benign breast conditions. She is listed in my HMO provider directory under "general surgeon", not "breast surgeon", but her offices are in the breast center.
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Thank you for that info.
No, I have Blue Shield HMO. It was the only plan offered to us as the nearest Kaiser centers/drs were more than 35 miles away and they said we couldn't choose them.
Which doesn't seem to matter anyhow as with the Blue Shield the Hospital and drs are 32 miles away.
Its just so confusing.
I'll go back now and look to see if there were general surgeons that state anything breast related.
The one from today does hernias and gallbladders as his specialty....so I'm kinda worried.
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I think I forgot to mention that there is no board certification for breast surgeon. Read this link:
https://www.breastsurgeons.org/management/patient/breast_surgeon
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Yeah, I would not want a gall bladder guy for breast cancer surgery. How about calling your Insurance and asking them to help you find a breast cancer specialist? Also you could call the biggest hospital on your plan and ask them.
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Where do you get your mammograms done? Who do they refer people to? Where I go, it's a one-stop breast center for mammograms, ultrasounds, biopsies, and surgeon's office visits. Or ask your gynecologist's office for a suggestion.
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As I mentioned above , there is no board certification for breast surgeon.However, you can look for surgeons who have a lot of experience and an interest in breast surgery and belong to the organization I linked above. TBH, the surgeon was the person I had the most fleeting relationship with. After he removed the drains (10 days post surgery) I never saw him again. My plastic surgeon followed up on reconstruction and my mo developed the post surgical txplan. I know some folks feel a “breast surgeon" is very important but since no board certification clearly defines who is a breast surgeon, finding a surgeon with a lot of experience doing breast surgery might be something to consider. Just my two cents FWIW 😊
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Another word in support of "general surgeons." I also go to a "general surgeon" who performs myriad surgeries for myriad conditions. However, she is also a top-notch breast cancer surgeon. In addition to providing guidance on bc surgery and performing my lumpectomy, she is also the one who ordered my genetics test, my oncotype, my blood tests, my liver enzyme tests, my DEXA scan, made sure care was coordinated with an MO and RO...Heck, she even personally gave me a ride home after my lumpectomy. She is a "general surgeon" but she is a ROCK STAR. I realize that is not always the case, but I think it's worth asking more questions before deciding that a general surgeon won't be able to provide adequate care for bc patient. (I also have an HMO in CA so likely wouldn't have had a whole lot of choice in who provided my care; but if I could choose, I would still definitely choose her.)
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Actually, there is a board certification in complex general surgical oncology which is given by the American Board of Surgery. The candidates must have completed an accredited fellowship in surgical oncology, must pass an exam and maintain continuing education in the field of surgical oncology. Although there is not a specific 'breast' surgeon, these surgeons are skilled in all facets of surgical oncology. They will generally then practice in settings in their preferred areas of expertise. So, although my own surgeon only does breast and thoracic surgeries, others might do colon, adrenal, etc.
Debbie, where are you located? if you look at your list of Blue Shield surgeons, delve deeper into their education. Their choice of fellowship will tell you what they prefer to specialize in. If they don't list a fellowship, they are general surgeons only. It is not rocket science to remove a breast or a lump but there is definitely a bit of finesse required to seek and find all areas of cancer, repair the defect caused by the surgery and give you the best quality of life possible. Finally, you can consult with an oncologist near to your area (again, look at your HMO list of oncologists) and that individual can give you a referral to a surgeon he/she works with.
https://www.absurgery.org/default.jsp?examoffered_...
Good luck,
Jane
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Here is the Blue Shield qualifying second opinion rules:
https://www.blueshieldca.com/bsca/bsc/public/commo...
Here is a good article on cancer second opinions from the LA Cancer Network:
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Thanks jhl. Yes, there are fellowships and certifications that surgeons can complete if they have an interest in a particular area of surgery (not just breast) but there is no specific “breast surgeon” as you mentioned. Complex surgical oncology certification is not specific to breasts.Looking at a surgeons experience , including fellowships can be helpful and you certainly do want someone with extensive experience in breast surgery but I wouldn’t get too hung up on a title IMO. However, if that is important to you, follow some of the suggestions that have been made.
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Thank you so much EVERYONE!
After reading all the posts and checking out all the websites you’ve sent I’m not feeling so bad. I was under the impression that surgery on a specific part took a specific doctor. (This is obviously all new stuff for me to learn). I do think I’d feel more comfortable with a female doctor but again that’s not available (yes I checked). So for now I’ll take a deep breath and try to work with what I’ve got.
It sounds like the surgery will be the easier part of this ordeal and I should probably focus more on who they’ll give me for an Oncologist.
Thank you again, you’ve all been very helpful and this forum has been a blessing to me
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