Seeking Advice Regarding Second Opinions, HMOs, Etc.

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Seeking Advice Regarding Second Opinions, HMOs, Etc.

Postby DenverCO » Sat Mar 26, 2005 4:52 pm

My insurance company is an HMO, and because I am single and self-employed I am essentially locked into it. During the years that my MS wasn't progressing very rapidly, my Neurologist and I got along fine. Over the past year, however, my functioning has declined noticeably. I have been on CRABS consistently for about 6 years, then did 2 months of Tysabri before it was withdrawn. At this point I want to do one of the chemotherapy treatments, but my neuro does not agree. He thinks that I am over-reacting to "normal disease progression." I have not been able to work for several months, and I know that things are getting rapidly and progressively worse. I'm not sure if his conservative stance is due to personal philosophy or HMO directive, but I know my body and I need to move forward.

Here is my question. If I find a neurologist outside of my HMO who agrees to a more agressive treatment plan, will they treat me knowing that I have another "official" neurologist whom I go through for my CRAB drug?
I am aware that I will have to pay out of pocket, but will they even treat me? Malpractice insurance is such a big issue with doctors that "Dr. B" might not be willing to assume the liability.

Also, does anyone know the approximate cost factor of the chemo drugs?

If you have gone out of your insurance network for actual treatment (not just a 2nd opinion) I would appreciate your insight.
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Re: Seeking Advice Regarding Second Opinions, HMOs, Etc.

Postby HarryZ » Sun Mar 27, 2005 1:10 pm


If you are going to see another Neuro, then I would tell him/her right up front that you are seeking a second opinion on your condition. This practice is done often in the medical community and the good docs will have no problem with this. Always remember that the doctor is working for you and not the other way around. Again, the good docs understand this.

As for the cost of the chemo drugs....I'm afraid they are very expensive. If this is the route you eventually go then ensure that you are told in advance about all the costs so you can make a final decision.

Whatever route you go, the best of luck.

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Postby DenverCO » Mon Mar 28, 2005 11:36 am

Thanks, Harry.

Between the limitations of an HMO and having a virtually uninsurable pre-existing condition, this brings some of our country's health care issues into clear focus.
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Postby amelia » Mon Mar 28, 2005 12:38 pm

As for chemo, I am sure it works for some. The people in our area that has been on it were VERY bad and it helped very little. They said it is some bad stuff. Just research good before you make a definite decision. As for the Doc, I believe that is the most important relationship outside your friends and family. That DR has to work for you. I told someone around here that had a DR that just wasn't in any hurry about treatment that some of the DR's don't understand what it is like to NOT be able to get in and out of your Mercedes with no effort.
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Postby OneEyeBlind » Thu Mar 31, 2005 8:07 am


I do not belong to an HMO but I can say that I had a Neuro I was not comfortable with as he was having trouble deciding wether or not to diagnose me. He sent me to a Neuro Specialist for a second opinion, and I ended up staying with the Specialist. It was my choice and I am very happy with the outcome. Again I do not have an HMO but its my body and I want to be content that I am getting the best treatment I can.

Why don't you call your HMO and see if they can refer you to another Neuro for a second opinion? It can't hurt and could save you some money.
Karen (OneEyeBlind) :wink:

* I don't suffer from insanity, I enjoy it!
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