Consult with “world expert” and insurance

[Kwilson]

Hello Everyone,

My husband was recently diagnosed CLL probably stage 0- no symptoms. We are reading that many have traveled to seek specialist advice at Mayo Clinic or OSU. Wondering about insurance coverage favor this out of network. Has anyone sought exceptions, single case agreement or other method for getting 100% coverage? I am wondering if we can make a case since we have not found this caliber of expert in our area?

[cll2013]

I went to OSU for consultation as they absolutely understand CLL better than most oncologists. I have since called with questions and they have been very helpful. I'm on Medicare and a medigap policy and that covered my visit. I understand that Mayo does not accept Medicare.

[Grieb in reply to cll2013]

My wife was treated 2 1/2 years ago by Dr. Jeff Sharman at the Willamette Valley Cancer Institute in Eugene Oregon--a 750 mile commute for us. I can not overstate Dr. Sharman's qualifications. My wife was 80 years old, at the time, her defective B-cells did not have any of the more troublesome mutations (such as 17p) and her immunoglobulin-g was mutated. Dr. Sharman, therefor, recommended treatment with Gazyva. Gazyva requires and extended (5-6 hour) initial IV. My wife's peripheral blood vessels are deep, thin and hard walled. In addition, they tend to collapse before anyone can get even a small blood sample. I didn't think it would be possible for ANYONE to maintain an IV, in a peripheral blood vessel, for 6 hours and she was, at that time, unwilling to have a surgically- implanted IV line. However, Dr. Sharman's IV nurses are magicians and they had no problem. By prior agreement, the subsequent 5 monthly IV's were administered by our local CLL specialist who interned at OSU. The subsequent IV's required surgical installation of an access line and, because of improvement from the initial IV, my wife acquiesced.

I made the initial appointment with Dr, Sharman (no referral). We have a Medicare Advantage Plan with Pacific Source and the plan covered costs as advertised.

My wife's blood counts have been and remain within the normal range since the first Gazyva IV. Likely of equal importance, her immune system does not seem to be compromised--since treatment, she hasn't had the flu or the colds that circulate thorough our community.

I encourage you to review Dr. Sharman's credentials, visit his website and have an extensive conversation with Dr. Sharman's nurses before you make any decisions.

[lankisterguy Volunteer]

Can you advise what type of insurance? And is the patient over 65?

Len

[Kwilson]

Thank you all for your replies. I was very surprised and pleased to find out today that my insurance Blue Cross Blue Shield will cover 100% cost of out of state consult with Dr at OSU The James.