How to deal with insurance for 3rd opinion??

hsnmp1978
hsnmp1978 Member Posts: 44
in Head and Neck Cancer #1

After week long emotional roller-coaster ride and when you see all hope and faith is fading away.

Well we are thinking to get 3rd opinion at M. D. Anderson Cancer Center in TX.

The question for all of you is you have experience dealing with insurance on this is…

How we can get approval from insurance to get out of network service?

We lie in Chicago and thinking to go to TX!!

We have BlueCross blue shield HMO insurance.

Thanks for you all help everyone.

Hetal

Comments

  • phrannie51
    phrannie51 Member Posts: 4,716
    #2
    Do you have your actual insurance policy in hand?

    Or...can you call and actually talk to an agent?  When I first started treatment, unknowingly to me, my Ocologist was out of network...my work place told me he was in network, but I guess he'd dropped out.  I thought that when they were out of network it was going to cost me 40% for all the chemo and extras you get from an Onc. so was going to have to go to another Onc.  But I found out it was just an extra $1000 out of pocket, and that was it, not 40% of everything forever more.

    My insurance is a PPO tho, rather than a HMO.....I don't know what the differences are......but calling them, or if it's from work....calling the Human Resources office will get you the answers you need.

    p 

  • TracyLynn72
    TracyLynn72 Member Posts: 839
    #3
    I'd call for sure!

    I'd definitely call and keep asking for someone until you get a person with some compassion and who will listen!  I had NO insurance so I'm not having to go back and see if Medicaid will help with any of it.  So far, they are helping with my large expenses.  I just had to apply (7 months ago) and prove the NEED for help.  I wish you well..

  • Ladylacy
    Ladylacy Member Posts: 773 Member
    #4
    HMO vs PPO

    When I had an HMO I had to go to the doctors on their list or it wasn't covered and you had to have a referral from your primary care doctor to see a specialist or another doctor.  PPO if you use the doctors on their list you can use any doctor without a referral.  If you go off the PPO's list, then you have a co-pay after your meet your deductible.

    I would definitely call your insurance yourself to find out and not rely on anyone else to do it.  Remember not all insurances are in all states and each insurance company has different coverages in the different states they are in.  In order words if you have say Blue Cross/Blue Shield in say Florida and then go to Georgia or Texas for treatment, what is covered and at what price is different.  I know that even the premiums are different in each state. 

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