Breast Cancer - HMO Care

Zion
Zion Member Posts: 3
edited March 2014 in Breast Cancer #1
I have received what I think is conflicting information from my HMO (Kaiser Permanente) regarding surgery options, specialties of doctors,etc.

I was informed that because of the location of the breast cancer, It would be best if I have a Mastectomy. I requested a second opinion but that was also an HMO doctor who agreed with the first doctor. Also, the Plastic Surgeon that I'm assigned to is listed as a "hand" specialist.

I looked into obtaining a second opinion from UCLA but the cost was too prohibitive.

Does anyone have any experience or suggestions that you'd like to share or experience with this HMO? I'd certainly appreciate any information that you can give me.

Thanks,

Comments

  • Akiss4me
    Akiss4me Member Posts: 2,188
    #2
    Zion...
    Sorry to hear about your delima. I am not familiar with your HMO. I am in the process of switching Insurance companies myself starting the 1st. I am leaving an HMO (had difficulty with them as well) and going to a different type Insurance. I would appeal the Board of Doctors for the HMO and explain you have a right to be treated by a Breast Surgeon. Call them or look in your handbook for the process on appeal. I wish you the best of luck and hope it all works out for you. :) Pammy
  • CR1954
    CR1954 Member Posts: 1,390 Member
    #3
    I don't.....
    I don't have that insurance, so I really can't help you out there. But I wanted to say hello and welcome you to the board.

    I hope you get some answers...

    CR
  • cats_toy
    cats_toy Member Posts: 1,462 Member
    #4
    welcome zion
    I don't have kaiser either, but my doc was an oncology surgeon, and he told me I had the choice of which option I wanted. Sorry to be of no help, but someone will probably post soon that has the same type of insurance.

    =^..^=
  • fauxma
    fauxma Member Posts: 3,577 Member
    #5
    cats_toy said:

    welcome zion
    I don't have kaiser either, but my doc was an oncology surgeon, and he told me I had the choice of which option I wanted. Sorry to be of no help, but someone will probably post soon that has the same type of insurance.

    =^..^=

    I have Kaiser and my surgeon
    I have Kaiser and my surgeon and I sat down and discussed lumpectomy vs. mastectomy. I originally wanted to have bi lateral mastectomies. She pointed out that only the right had cancer and it was a small lump. The other was pre cancerous. She suggested lumpectomies for both. She felt that lumpectomy was the best option. I had complete trust in her and she said that if I really wanted the bi lateral mastectomy she would do it. I went with her suggestion and I have no regrets. The left had no sign of cancer. I had rads on the right side and am doing hormone therapy. She was a general surgeon but I was fine with that. I do see a oncologist for the hormones and they had me do the rads at one of the great local hospitals. It is outside the plan, but I only paid $30 for all my treatments. My surgery was $150. My total expediture with all my doctors visits, tests etc. has been under $500. Now money is certainly not the prime concern but I had a great team and have total faith in them. When I had uterine cancer I was sent to the Sacramento Gyn Oncology department and had a gyn oncology surgeon. He was great also but I honestly didn't see any difference in dealing with one over the other. They had be do my rads at Mercy General in Sacramento because it does a high volume of radiation and was considered a top choice. I know that the 2nd opinions are within the HMO but that doesn't mean that they just agree because they are both part of Kaiser. I had a 2nd opinion on my bladder cancer follow up and there were two very different opinions. One was after the cancer was removed to do some kind of chemo introduced into the bladder and the other was to just do regular follow ups and do the chemo if I had a return of the cancer. I chose the later and I have had no recurrence in 7 years. The treatment is harsh and frankly I didn't want to do it. So I am not sure it is necessary to go outside Kaiser but of course that is up to you. I have had several surgeries including one to reattach the tendons and nerves in my finger (I severed it with a knife while trying to remove a plastic tiedown on a package) followed by months of rehabilitation to regain the use of the finger. And that too went smoothly. I think the most important thing is to feel confident with your surgeon, oncologist and all the others on your team. All the decisions are tough and we all second guess and worry that we are making the right choices. My heart is with you and know that you will get through this.
    Stef
  • Moopy23
    Moopy23 Member Posts: 1,751 Member
    #6
    HMO
    Zion, I am not with Kaiser but do have an HMO plan with a national insurer.

    I was able to get an out of network opinion through referral by my PCP. I don't know that doctors can be divided into HMO and not HMO doctors. Or that doctors accepting HMO insurance are less competent. The doctors I see at a major cancer center all accept my insurance (again, I got referrals and the docs provided the necessary medical paperwork to my HMO).

    The ACS has an advocate service. You might contact them and ask for assistance. Also, some employers offer an advocacy service. So, you might ask your HR office if your employer has any programs that could help. Definitely, though, I would call the ACS.

    Good luck to you, Zion. I hope that you are able to get the referral you need, and/or that the ACS can advocate on your behalf. Please keep in touch.
  • Jeanne D
    Jeanne D Member Posts: 1,867
    #7
    cats_toy said:

    welcome zion
    I don't have kaiser either, but my doc was an oncology surgeon, and he told me I had the choice of which option I wanted. Sorry to be of no help, but someone will probably post soon that has the same type of insurance.

    =^..^=

    Welcome Zion!
    I don't have that insurance either. I had a plastic surgeon explain my

    surgery to me. I am so sorry for the problem you are having. I wish you good luck!

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