How does cancer treatment out of state work with standard health insurance plans?

[LNC]

If you were diagnosed with a really rare cancer and the major treatment center for surgery was Sloan Kettering in NY and you lived in the SE - would your insurance cover you to have surgery and care up there? Is it out of network? So, 20% or so instead of the 10% in network? How does it work?

[lisamarie]

You call your insurance company and beg them to accept it as in-network. You jump through hoops. If they refuse, then you pay the out-of-network portion. But you definitely want to call and talk to your insurance company first.

[prairiewindmomma]

We didn't have any problems; our insurance was through one of the bigger national insurance companies. The care providers were still in network for us.....even the smaller ones like when we needed to switch out oxygen tanks during a cross-country trip to the hospital.

 

My daughter and I flew cross-country monthly for a year. Even when she was seen "locally", it was at a children's hospital across the state line since our local hospitals don't do pediatric cancer.

 

And, frankly, if you are being treated for cancer, typically you are going to hit catastrophic coverage pretty quickly....most policies do away with a % split once you hit the catastrophic amount in care. My dd's chemo was $10,000 a vial.

 

One thing to check....if you end up getting onto drug trials, often they will cover treatment at the site but if you need weekly labs at home, those are NOT covered by the drug trial.

[3browneyedboys4me]

The best advice is to call your healthcare provider. They are the only one's that can truly advise you on what they will do. It's better safe than sorry. They should be able to discuss coverage, deductibles, and providers in and out of network.

 

Hope that is helpful!:grouphug:

[Twilight Woods]

I would contact SK and they would be able to provide you with more information. SK could even contact case management of the health insurance and they would probably negotiate a rate sutuable to in network rates since it is a rare cancer and SK is the only place to have the surgery.

[LNC]

Thanks everyone - this is a hypothetical by the way.... I'm having tests done and thinking about worst case scenarios for sarcoma...

[prairiewindmomma]

FWIW, Duke and MD Anderson (TX) are a bit closer to home and have good sarcoma centers as well. I'm sorry you're having to worst case scenario plan....but I totally understand. :grouphug:

 

In our experience, the other bit of helpful advice I have is to get copies of all labs and scans now to keep in your master file and to look online to see when their tumor review board is. Sometimes you just go directly through scheduling at a hospital, but other times your file goes through a review committee that meets weekly before they confirm diagnosis and take you on.

 

My dd had a very rare type of brain tumor...I think you are wise to travel to a hospital that deals with a higher volume of your type of cancer cases if you end up with a diagnosis.

[J-rap]

I'm glad it's only hypothetical. You would need to call your insurance company. We chose to go out of state for four months for my husband's stroke therapy, because we found an amazing rehab program in Chicago. It was covered 100%.

[KirstenH]

My local specialist referred me to an out-of-state specialist for my cancer surgery and it wasn't a problem; insurance still paid everything. I'd just call and ask.