Recently, we discussed that obtaining a second opinion for a diagnosis of mesothelioma is a personal decision. Today, we turn our attention to the process of getting in that the second opinion. Unfortunately, in this age of insurance bureaucracy, it may be more difficult to get a second opinion from an outside vendor of your insurance plan. Many HMO regulations require the insured to be treated in their provider network. The problem? There are very few doctors or surgeons have the expertise to treat pleural or peritoneal mesothelioma.
Let me tell you about some of the challenges of two mesothelioma patients had to overcome before they can get a second opinion.
A gentleman I'll call Jimmy, noticed that during the months he had been putting on weight around her stomach. Like most middle-aged men, he attributed his weight gain to overeating and lack of exercise. He took it upon himself to start a strict diet and vigorous exercise regime. Nothing worked starvation diet and eventually placed him in the emergency room. After numerous tests and exploratory surgery, Jimmy was diagnosed peritoneal mesothelioma. He sought treatment from an oncologist within its insurance scheme to be told by the oncologist that he had no expertise in the treatment of mesothelioma.
Jimmy returned to his primary care physician, who arranged for him to see a specialist mesothelioma. A consultation has been approved by the insurance company, and a meeting was planned. However, the consultation was canceled after the specialist learned that Jimmy had peritoneal mesothelioma. You see, the specialist was a thoracic surgeon who limits his practice to that of pleural mesothelioma.
With the help of the Foundation for Applied Research mesothelioma, Jimmy found a surgeon who was trained in the treatment of peritoneal mesothelioma. Before Jimmy could meet the surgeon, he was required to file a prior authorization provision with its insurer. He got the necessary reference from the first oncologist and assumed it was approved. Should an appointment with the surgeon and sent his medical records.
However, Jimmy faces another setback when his insurer rejected the request because it did not respond to the first consultation on the outside. This was clearly a lack of understanding by the insurance carrier on the complexity of Jimmy cancer.
Jimmy said he could file a grievance would be heard on an expedited basis if it could prove that the hearing process of settling grievances standard of 30 days would be detrimental to his health. With the help of new staff surgeon, information about peritoneal mesothelioma and the surgeon's treatment protocol was provided to the insurance company.
Thanks to the diligence and determination, Jimmy took his insurance company and won!
Hazel was faced with another problem. It took doctors in the HMO over a year to his diagnosis of pleural mesothelioma. When she was finally diagnosed, her insurance company refused to allow him to obtain a second opinion. The carrier insisted she uses one of their thoracic surgeons licensed to practice exploratory surgery. Hazel met the surgeon who honestly says that he never performed surgery on a patient with mesothelioma.
issues Disgusted with his insurance company, she took into her own hands. She gathered all her medical records and using the applied Mesothelioma Research Foundation is a thoracic surgeon with expertise in the treatment of patients with mesothelioma. After undergoing all diagnostic tests, Hazel learned she was a candidate for surgery. Again, she contacted her insurer requesting service coverage "off plan". Again, she was denied.
Fortunately, Hazel had money available to get the best treatment and went ahead with the surgery.
Unlike Hazel Maryanne has not the resources to insist on a second opinion. It blindly, without knowledge and understanding of his disease has its treatment in the hands of a local oncologist.
The chemotherapy regimen was not effective, and Maryanne suffered serious side effects. A few months later, his son stepped in to take control. Together they went to the Mayo Clinic in Rochester, M.D. Anderson in Houston, University of Colorado Cancer Center, University of Chicago Cancer Center and New York for second opinion, third, fourth and fifth.
Unfortunately, all said Maryanne and her son the same dismal diagnosis. Maryanne had waited too long. The cancer had metastasized to his liver and there was nothing that could be done
The point of sharing these stories is as follows :. If you have questions or concerns about the care you receive, use all available resources and all means necessary to get second and third opinions about your treatment. It is your life, not the insurance company
- Make your primary care physician and staff your ally ;.
- Enlist their help to all references and laboratory tests;
- Understand the terms of your insurance coverage;
- Scour the Internet for new protocols and providers near your home;
- Contact Mesothelioma Applied Research Foundation and other nonprofit organizations to help locate medical professionals and put you in contact with other mesothelioma patients;
- Rely on your family. Give each task or responsibility to help you get the best treatment, and ;.
- Believe in yourself
Fortunately, soon there will be significant changes in the insurance industry to allow people the ability to search the best care available, even if it is outside of their insurance plan.
