jm's Adventure with Multiple Myeloma: Medical Insurance and 2nd Opinion Care - October 22 2012

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Monday, October 22, 2012

Medical Insurance and 2nd Opinion Care - October 22 2012

I have excellent health insurance (Anthem) and I've been very thankful for that in the last 15 months since I was diagnosed with high risk multiple myeloma. 

Last night, out of the blue, but timely, my health insurance nurse Case Manager called. I filled her in on my need for a 2nd Opinion with my current relapse to 60 % plasma cells in my bone marrow and told her I wanted to go to Boston. She explained that Boston's Dana Farber is OUT of MY NETWORK and I could only go there if my doctor first wrote the insurance company doctors a letter of medical necessity explaining that Boston provides care that no one IN MY NETWORK could provide. After the insurance company receives the letter, it takes at least a week for the insurance company doctors to rule and it is not a given that they would rule in my favor. This doesn't mean I couldn't go to Boston, just a lot of hoops and a possible denial. 

My Insurance Case Manager explained that the Mayo Clinic, Scottsdale, Arizona is IN MY NETWORK and was one of the places my University of Colorado Hospital oncologist, Dr. Clay Smith had suggested last week for the 2nd Opinion. In addition, because Mayo is IN MY NETWORK, they will help me with the expenses involved in travel there (airfare, rental car, and hotel).

So, I called Jani and we decided it would be best to seek the 2nd Opinion at the Mayo Clinic, Scottsdale vs Boston. I emailed my nurse Transplant Coordinator at the University of Colorado Hospital and explained all of this. Unfortunately, they had already started the ball rolling at Boston, but Dr. Clay Smith was willing to change gears and contacted Rafeal Fonseca, MD at the Mayo Clinic for me. In addition, my Transplant Coordinator contacted the Mayo Clinic, Scottsdale, Arizona and let me know that that she has already started to fax my records there.

I am grateful to Clay Smith, MD and Lindsey McMenimen, RN, my University of Colorado Hospital doctor and Transplant Coordinator for their timely and hard work on my behalf. It helps to have people in your corner!

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