insurance and doctor????????????????????????????

[AN?]

Hi:
I am in NY area and I have been diagnosed AN recently.

 I am now kind of a fix. from this forum I came to know that the doctors in this area , who are very famous, in AN operations are Dr. Selesnick at Weill cornell and Dr. Post at Mt. Sinai.

Dr. Selesnick does not take my insurance and Dr. Post is not with any network porvider. I am now completely confused, did you all paid your surgery and took the heavy finanical burden along with the post-op? I just can't think of that situation.

Please help!

Anamika

[Road Trip Dale]

Anamika,

Basically, here is what I would do....I would talk with person in the Doctor's offices who handles all insurance claims and get their opinion as to how to deal with the problem.  Then I would talk with my insurance company and ask them how to handle getting this procedure (surgery) accomplished.  Then, as hard as it may be to do, I would look at other doctor alternatives.  I can assure you that flying to House in California would be a lot cheaper than paying the bill out of pocket.  I had mine done in Kansas City by a couple of wonderful doctor's who did a terrific job, and if I'd had to pay out of pocket it would have been close to $40,000.  There are few of us who can afford that kind of hit in the pocketbook.

Just my humble opinion, but its what I'd try first...especially, checking with your insurance company and see what they recommend.  Although we tend to think of them as bloodsuckers (which they are I suppose), its in their best interest that you get quality care so they don't have to pay out more for followups and second surgerys, etc.,

Good luck on your quest.

[Battyp]

Hi Anamika,
  You need to start with your insurance company to see what the  procedure is for out of net work providers and see what you can do to cut a deal.  My surgery all total was 100K and no I could not have afforded that out of pocket so I went with my in network provider.  I was lucky to find one who had extensive experience that I was comfortable with.  Like Dale said it might be cheaper to travel to house or another place that has experience with AN surgeries that might be an in network provider.  I know Duke, Charolette, Atlanta, all have some good doctors from others posting on this site.
good luck!
Michelle

[Captain Deb]

Anamika,
Have you gotten a second opinion whether you even need surgery? Radiation could be an option depending on the size of your tumor.  My ENT didn't seem to know this little fact at all.  Seeing you have made it to this forum, I assume you are exploring your options already!
Any major surgery like this requires a thing called "pre-certification" from your insurance company, so hopefully you will havre time to look around--NY probably has several centers of excellence.  Check out the section here called "physicians"
Capt Deb

[Kilroy1976]

I was really impressed with the way that my insurance treated me. There was red tape of course, but they accomodated my request for an out-of-network procedure with very little resistance. Give your insurance a call; you might be pleasantly surprised to find that they don't want to make life any more hellish for a person with a brain tumor. Best of luck!

[AN?]

Thank you all  for the info and such detailed responses.

 I have found out my out of network option. which is expensive but doable. And Dr. Post has overwhelmingly accepted my urge (since I also work in Mt. Sinai a scientist and unfortunately I understand what's going on in my head molecular and cell level!!! believe me that's more scary. sometimes ignorance is bliss) and we found out that there is a way by which I can have consulatation of Dr. post within the insurance rules.

I most probably don;t have to go for surgery soon as my AN is small, my age is 37 and I have exceptional hearing now but the question is when? and that's where my previous doctors were confused.

I have thought of House many times but flying crosscountry after surgery is something I still don't know if it is manageable or not.

[Captain Deb]

House Ear clinic is great and many of us have flown across country to have treatment without a hitch.  The airlines are accomodating, too, providing wheelchairs and special treatment.  There is a guest center at House that will let you and a friend or family member stay there for  a few days till a few weeks post op--like a high end Holiday Inn attatched to the hosp and $35 a night.
Capt Deb

[Jim Scott]

Hi:
I am in NY area and I have been diagnosed AN recently.

 I am now kind of a fix. from this forum I came to know that the doctors in this area , who are very famous, in AN operations are Dr. Selesnick at Weill cornell and Dr. Post at Mt. Sinai.

Dr. Selesnick does not take my insurance and Dr. Post is not with any network porvider. I am now completely confused, did you all paid your surgery and took the heavy finanical burden along with the post-op? I just can't think of that situation.

Please help!

Anamika

I recommend looking into New Haven instead of New York as the site for for your AN operation as it's more economical. 

I'm not an insurance expert but  my surgeon told me not to be concerned with the cost of the surgery (we have Blue Cross) and that I could pay off any remainder of his fee not covered by my insurance for as long as it would take...he would not ask me for money.  Not all doctors are that generous, I know.

Most hospitals will allow you to pay down your bill over time as long as you set up a payment plan with them that you can honestly afford.  Press your insurance company and 'use' the very real fact that you have a life-threatening brain tumor that has to come out  and that you have a right to choose your own surgeon.  Do not incur any major personal expenses...that is what insurance is for!

[HeadCase2]

Anamika,
  Look around on this forum.  I remember a few posts where a patient was able to get the insurance carrier to cover AN treatment out-of-network at in-network rates,  They did this by talking to the insurance carrier and telling them that non-provider (non-network) treatment was needed by experienced experts at treating AN, since that expertise was not readily available "in network."  And that having a positive outcome depended on it.
Regards,
 Rob

[nipanddale]

Hi Amamika,

My husband and I have been dealing with the same thing and we spoke to the neuro surgeon who would be "out of network" and he said that he was willing to waive the difference of the costs. That all we had to do was write a letter of financial need and then he would waive it. You might want to talk to the doctors and see if they are willing to do this for you.

Good Luck,

norma