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Question about Second Opinions and Insurance.

Mr. D
Posts: 6
Joined: Jul 2015

Hi Everyone

So as I posted in another thread my right kidney has a complex cyst with septation measuring 3.2cm X 2.9cm and a second cyst measuring 3.5cm X 2.3cm, not sure if this second cyst is complex with septation. Also my left kidney has an inferior cyst measuring 2.9cm X 2.2cm.

My initial urologist appt. is scheduled for 14 Aug that I’m guessing will be nothing more than a meet and greet with him telling me I need a CT Scan with contrast before we can talk further.

Anyway I’m hoping for the best but planning for the worst by educating myself. I have read a lot here about second opinions and for sure will be exploring that option if this goes sideways on me.  

I’m retired US Navy and have TRICARE Prime along with a Primary Care Manager (PCM) who referred me out to the urologist.

Questions;

1. I’m assuming that I would have to go back to my PCM to get another referral to a different urologist for a second opinion?

2. What’s the best source for finding a good urologist that is worthy of a second opinion?

This will be my first time using TRICARE Prime for anything other than normal Doctor appointments so I guess it’s going to be a learning experience for me.

I live in Huntsville, AL which is not a large city but does seem to provide good healthcare.

My current doctor àJames A. Flatt, M.D. received his undergraduate degree in Chemistry from Vanderbilt University, graduating summa *** laude.  He received his medical degree from Vanderbilt University School of Medicine in 1985.  He completed his Surgical and Urologic residencies at Duke University in 1991, where he served as Teaching Scholar in Urologic Surgery.  He is a Fellow of the American College of Surgeons, and is certified by the American Board of Urology. Dr. Flatt has served as the Chief of the Division of Urology of the Huntsville Hospitals, and as Chief of Staff of Crestwood Medical Center.  He is active in his church and in Scouting, and is married with two children.

 

Positive_Mental_Attitude's picture
Positive_Mental...
Posts: 454
Joined: Jul 2014

As I learned the hard way, the best way to find out what you need to do with insurance is to read your policy. And read it closely.  Also, most insurance companies let you go online and will tell you if someone is in your network, and may tell you if you need to go to your primary care physician.

 

What I also found out is that what the insurance company reps who answer the phone tell you can be incorrect, and if you act on that information, they can sometimes reverse course on you after they gave you permission to do something under your plan. 

 

I was caught in an unfortunate series of phone calls where I was told I could get a second opinion from a doctor in NY, got set up for surgery, and 7-8 weeks into the process and 2 weeks prior to surgery, they told me that I could not go to a doctor/hospital in NY under my plan.  I had documentation to show their website indicated this doctor/hospital were in my plan.  I fought hard, and they would not relent.  I ultimately had an assemblywoman from my State call my insurance company, and they finally gave in.

Read your policy, and get whatever information you can online.  With that information in hand, call your insurance company for any requierd pre-approvals.

Mr. D
Posts: 6
Joined: Jul 2015

You, your primary care manager (PCM) or your regional contractor may request a second opinion. Active duty service members and TRICARE Prime beneficiaries should request their second opinion through their PCM.

 

OK so it looks like my PCM can refer me back out for a second apimion.

 

Now to break the code on who that second opinion will come from.

Positive_Mental_Attitude's picture
Positive_Mental...
Posts: 454
Joined: Jul 2014

Mr. D., I did some Google searching for urologist-oncologists in Huntsville.  One name that came up was Joseph A. Pettus, MD.  Here is a link to his office:

http://www.northalaurology.com/about-us/urology-doctors-physicians.php

 

His bio says he specializes in minimally invasive cancer surgery.  Do a Google search on him and his reviews.  I don't know if you can go outside of Alabama, that that would let you cast a wider net for specialists.  I decided to do that to find my specialist in NYC.

In my experience,I would not not go solely on the recommnendation of my primary care physician.  There is a lot of information on the internet, and we can be our own advocates.

todd121's picture
todd121
Posts: 1425
Joined: Dec 2012

If I were you, I'd look for nearby contacts for people involved in RCC studies and contact them for the name of a urologic oncologist. You can go to

www.clinicaltrials.gov

There you can search for studies in kidney cancer near you. They will list the "principal investigator". This contact might be an oncologist or it might be a urologist/urologic oncologist. For sure it will be someone very interested and connected to kidney cancer.

There will be a contact for them. You can google them to find out more about them, or you can call their office and ask for a referral to a urologic oncologist. You're probably going to get someone that does a lot of surgery on kidney cancer patients.

Medical schools and national cancer hospitals are good places to look. You can also just look for the head of urology at the nearest medical school (or go check out their urology department staff listings).

I did  a search and came up with this name in Birmingham Alabama. Not sure that's close to you, but you could call the number and find out what his specialty is. If he's a urologic oncologist, you could see him. If not, you could ask for referrals. If you need a few, get a few. Cross reference the names you get with your insurance.

Birmingham

University of Alabama at Birmingham Cancer Center

Guru P. Sonpavde
Principal Investigator

Hope this helps!

Todd

Positive_Mental_Attitude's picture
Positive_Mental...
Posts: 454
Joined: Jul 2014

If you can find someone involved in studies, I agree with what Todd said.  I was looking at a bio of Dr. Pettus when he practiced at Wake Forest and it said:

 

"Kader and Pettus are active in several national and international clinical trials on the management and outcome of urologic cancers, including prostate, bladder and kidney. They perform robotic, laparoscopic, and open surgery for urologic malignancies. Kader and Pettus are both assistant professors specializing in urologic oncology.. . . .
Pettus came to Wake Forest Baptist from Memorial Sloan Kettering Cancer Center in New York City. He received his medical degree from the University of Alabama at Birmingham School of Medicine and completed an internship in general surgery and a residency in urology at the University of Utah. He completed a urologic oncology fellowship at Memorial Sloan Kettering Cancer Center. His research interests include bladder and renal tumors." 

 

His current bio says" I am a native of Huntsville, Alabama. I went to Auburn University and graduated with a degree in Chemical Engineering in 1995. Following that, I went to the University of Alabama at Birmingham for medical school. I trained in General Urology at the University of Utah in Salt Lake City before doing a Urologic Oncology fellowship at Memorial Sloan Kettering Cancer Center in New York City. I spent three years as Assistant Professor of Urology at Wake Forest University before moving home and joining North Alabama Urology. Here, I specialize in minimally invasive cancer surgery as well as general urology. My cancer care philosophy is geared toward a multidisciplinary approach with a clear understanding that treatment must be tailored to the individual patient.  I am certified by the American Board of Urology."

Mr. D
Posts: 6
Joined: Jul 2015

Thanks Todd and PM, good information. There does seem to be several good urologists here in the Huntsville Al area.

Thay also all seem to embrace the da Vinci Surgical System which is a bonus.

icemantoo's picture
icemantoo
Posts: 3215
Joined: Jan 2010

Mr. D,

 

Dr. Flatt as well as his 3 associates seem to have excellent backgrounds in Urologic surgery. If it does turn out that you have bilateral kidney cancer I would also seek a second opinion at a major University teaching hospital such as UAB, Duke, Wake Forest, Vanderbilt  or Emory.

 

Let us know how things progress.

 

Icemantoo

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