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cosmo254 Asked January 2014

The health insurance I joined doesn't accept the cancer center my husband uses for cancer treatment. Any advice?

The health insurance I joined doesn't accept the cancer center my husband receives treatment from. When I checked before enrolling it said the center and oncologist were in their network but when he went for chemo Friday I was told they don't accept that insurance. I called the health plan and they said they didn't cover the center or oncologist. I called my last health insurance and they said I could get back on but it will be about 72 hours to show up. I'm worried about the medicare part as the plan I'm getting out of was a medicare advantage plan so even if my old plan is in effect by Friday if the new health insurance says they can't dis enroll us untill the end of Jan what will happen when Medicare is suppose to be the Primary carrier when we go for treatment on Friday?

igloo572 Jan 2014
Cosmo - this is a perfect story for the "action reporter" or other consumer affairs reporter on the local news station. Especially with you doing a screen shot. Nothing like bad PR to get things moving along….

vegaslady Jan 2014
You can get another provider (annoying, awkward and time consuming), or try to get some type of special authorization to continue through that course of treatment. The provider is probably best equipped to navigate that problem for you, or the insurance company probably has an appeals process or an ombudsman. My husband was always able to keep his same psychiatrist through some plan changes. Also, in this case, is it possible to consider the doctor "out of network" and pay something extra to continue with him?

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Countrymouse Jan 2014
So how does that work? - especially if you've already started an (insured) course of treatment with a provider who is subsequently removed from the insurer's approved list of suppliers?

vegaslady Jan 2014
Every insurance plan I've seen always say not to count on it continuing to have the provider (doctor, etc), you want, but to make your decision on what to purchase based on the insurance plan itself....what it covers, not the provider.

cosmo254 Jan 2014
Thank you all for the quick answers. This is how I got the misinformation. First I went to the Medicare compare plans page, then picked Blue Shield 65 Plus, Then went to their webpage (which just got updated on Dec. 31, 2013) and checked for facilities (Doctors Medical Center was included at the time) and physicians (Doctor Irwin was included at the time). Our primary doctor wasn't on the list but that was OK as we had only been with her a short time. I called my husband's dietician from Doctors Medical Center and told him I was changing to Blue Shield and asked him if he could recommend a doctor in our area who was with Blue Shield and told him both the Cancer Center (Doctors Medical Center) and Doctor Irwin would still be with us. When I check now on Blue Shield 65 Plus for facilities and physicians neither are listed so I Googled Blue Shield's 2013 list and found both medical center and doctor listed on their site and took a photo of each to save to my computer as proof that I didn't make it up when I made my choice last November. I think I'll now try the medicare ombudsman to see if they can help us. My husband is already late for his 5th chemo treatment, which was rescheduled for this coming Friday and he has another one for the end of the month. His cancer is very aggressive and he can't go much longer without having treatment to keep it under control so I'm really praying that I can find some help with the insurance as just one treatment of Alimta has a charge of $52,000 before Medicare knocks it down to a more reasonable cost. Thank you all for your help.

themomblackhole Jan 2014
try contacting your state's department of managed care and/or a medicare ombudsman to advocate for you or lodge a complaint.

Countrymouse Jan 2014
Who did you check with before enrolling? I'd love to get back to that person/web page and see what he/she/the site controllers have to say for themselves.

So, your husband has already undergone one round of chemo and has another scheduled at this uninsured cancer treatment centre, is that right? I think you need to call whichever organisation you see as the prime mover here, insist on speaking to a person with some authority to use initiative, and argue. They got you into this pickle, they can help you get out. Best of luck.

pamstegma Jan 2014
Don't go for Friday treatment unless it is covered. You'll have a real nightmare on your hands. Medicare will still be the primary coverage no matter who you have. I would like to know the name of the company that screwed up so badly so I can avoid them.

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