I may get to change oncologists after all

lisa42
lisa42 Member Posts: 3,625 Member
edited March 2014 in Colorectal Cancer #1
For those of you who read my other posts on my frusrations of wanting to change oncologists to one who specializes in my cancer and is in a major cancer center, but was told by Aetna back in November and again this past week that "no Aetna HMO patients can change doctors while in the middle of treatment"... well things may work out for me after all.
I had actually started the appeals process on Friday against Aetna, which I was told I had to do before I could take it to the California Insurance board. I got a phone call this morning from someone who identified herself as my case manager from my medical group (which is the group my primary care Dr. and my current onc are affiliated with and they use many insurance companies for their patients). Anyhow, she said that she saw that I had put in for a referral for another consultation with this other onc. I want to go to and that they had denied it. She was calling to see if I wanted to actually change oncologists. I said, "what?! I was already told two different times that wasn't possible because he's not within our medical group." She replied "well, I don't know why you were told that, because he's also contracted with our medical group as a specializing oncologist. I think you absolutely could change to him." I couldn't believe it! It's all who you talk to, I guess, which is scary. Anyhow, it's not for sure yet and it may take a while if it does happen, but she's going to try make it happen for me and try to make it happen before the appt. I already have scheduled w/ this onc (Dr. Fanta) on June 17. The other good news is that I would not have to change away from my internist/primary care Dr. (whom I really like), because this woman was saying Dr. Fanta IS within our medical group. I've got hope here! It's so maddening though, then why was I told that it absolutely could not happen and they just "had to follow the rules". Now this woman is saying those aren't the rules!
I do believe someone "upstairs" is intervening on my behalf here!!!
I'll keep you posted!

Lisa

Comments

  • dorookie
    dorookie Member Posts: 1,731 Member
    #2
    Great News
    I was a bit worried myself, because we have the same insurances and I was thinking of changing or at least looking at getting a second opinion if the cancer should return (which I pray it wont). Thanks for the info and please keep me and us posted.

    Thanks Lisa
    God Bless
    Beth
  • VickiCO
    VickiCO Member Posts: 917
    #3
    Good news Lisa
    We'll keep the prayers and good thoughts going on this end that it all works out for you. Good for you to keep fighting them!

    Hugs, Vicki
  • kmygil
    kmygil Member Posts: 876 Member
    #4
    Wonderful!
    Lisa, I really hope that works out! It is maddening when you can't get a straight or consistent answer from your medical insurance provider! I am fortunate in that my insurance has been wonderful from the get-go, even to the point of nurses calling to see how I was doing. Yeah, at first I thought they were calling to see if I was dead yet so they could stop paying, but finally I accepted that they were actually checking to see if everything was going ok. So suspicious am I... Keep the faith and hang in there. If you don't like/trust your oncologist, you will have a harder time, so keep fighting.

    Hugs,
    Kirsten
  • lisa42
    lisa42 Member Posts: 3,625 Member
    #5
    update on 6/5
    More interesting news today from the case manager of my medical group... they will no longer be contracting with my current oncology group effective end of August. Their reason is that there "have been numerous complaints about ineffective care and negligence of care". Wow- it confirms I haven't been overreacting. Here, I'm told one day I can't change oncologists "while I'm still in treatment". Another day I'm now told that I WILL be changing in August. Although I may still pursue the appeal of getting to go to UCSD to the oncologist there, I was very impressed by what I've heard so far about the new oncology group my medical group is going to contract with. The San Diego Cancer Center actually has some ties with UCSD- some doctors from each place seem to work or cooperate together. The SD Cancer Center also incorporates some alternative treatments into the whole picture. In addition to the chemo, radiation, etc, they also offer things such as massage therapy, counseling, acupuncture, and nutrition counseling. I'm impressed! Now, they are a fairly small cancer center, but do participate in some research and clinical trials. I don't know a lot of firsthand info on the place yet, but I am highly encouraged in this situation of mine at this point. Perhaps when one door is closed, another gets opened. This may be true with this situation in my case. I've just requested from my primary care Dr. to put in a referral for a consultation with the onc at SD Cancer Center who specializes in colorectal cancer. My insurance and medical group might not actually let me switch over before end of August, but they should hopefully allow me a consultation w/ him to see if I feel comfortable there with him, or if I should still pursue the appeal to my insurance to get to go to UCSD.
    Just thought I'd give that update. Well, I'm off tomorrow to have fun with some friends from high school- it's been a long time!

    Blessings everyone-
    Lisa
  • Buzzard
    Buzzard Member Posts: 3,043 Member
    #6
    lisa42 said:

    update on 6/5
    More interesting news today from the case manager of my medical group... they will no longer be contracting with my current oncology group effective end of August. Their reason is that there "have been numerous complaints about ineffective care and negligence of care". Wow- it confirms I haven't been overreacting. Here, I'm told one day I can't change oncologists "while I'm still in treatment". Another day I'm now told that I WILL be changing in August. Although I may still pursue the appeal of getting to go to UCSD to the oncologist there, I was very impressed by what I've heard so far about the new oncology group my medical group is going to contract with. The San Diego Cancer Center actually has some ties with UCSD- some doctors from each place seem to work or cooperate together. The SD Cancer Center also incorporates some alternative treatments into the whole picture. In addition to the chemo, radiation, etc, they also offer things such as massage therapy, counseling, acupuncture, and nutrition counseling. I'm impressed! Now, they are a fairly small cancer center, but do participate in some research and clinical trials. I don't know a lot of firsthand info on the place yet, but I am highly encouraged in this situation of mine at this point. Perhaps when one door is closed, another gets opened. This may be true with this situation in my case. I've just requested from my primary care Dr. to put in a referral for a consultation with the onc at SD Cancer Center who specializes in colorectal cancer. My insurance and medical group might not actually let me switch over before end of August, but they should hopefully allow me a consultation w/ him to see if I feel comfortable there with him, or if I should still pursue the appeal to my insurance to get to go to UCSD.
    Just thought I'd give that update. Well, I'm off tomorrow to have fun with some friends from high school- it's been a long time!

    Blessings everyone-
    Lisa

    Great news Lisa
    It sounds like things are lining up for you...Good to hear and Im sure your tickled pink...Have fun with the high school buddies and forget everything for the weekend.....Have a good weekend........

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