I am going to do my best to make a long story short.
First, it looks highly likely that I have some kind of lymphoma. The oncologist I saw two weeks ago was using phrases you really do not want to hear like “definitely malignant.” When I asked if it could be anything else, he asked if I had ever had tuberculosis or bubonic plague. So I have a textbook presentation, plus the list of differential diagnoses is short and far-fetched. Unfortunately, everything I have read online just seems to confirm his opinion.
So, my thinking was just that I would have the biopsy done locally, then send the slides to a national cancer center for a second opinion before starting treatment. Unfortunately, I learned today that my supposedly really good health insurance does not cover second opinions at all. So, now I am thinking of simply starting at the cancer center (which is about 2 hours away from where we live) so I will have an expert opinion right off the bat.
Here is where it gets pretty complicated. Apparently, even if I go to the cancer center before I am diagnosed, this first consultation will still be billed as a second opinion (they bill every first visit as a second opinion no matter what), so I will have to pay for this first consultation out of pocket, although I will not need to pay for the expert reading of the biopsy slides. (If I had the biopsy locally and wanted an expert to interpret the slides, I would have to pay out of pocket not just for the interpretation, but also for the consultation just mentioned).
I am actually fine with paying between $500 and $1500 for the first visit at the cancer center (what the billing department quoted me). But I am concerned that there will be a bunch of extras that somehow find their way onto that bill. So I asked about that. I asked, so if I pay between $500 and $1500 for the visit, will this be it? Or are there ancillary charges? Might other things be added to the bill? And the billing department said: “Well, there is a fee for ordering your medical records and a fee for facility use and the doctors charge their own fee, plus the doctor might order other tests.” As of now I can’t seem to get any information on these other fees. They kept telling me they couldn’t tell me because I wasn’t a patient yet. I also called my insurance company back to ask if the tests my doctor orders at that first visit would be billed as part of the second opinion of whether they would indeed be covered by insurance (as everything after the second opinion is supposed to be). But I did not get a satisfactory answer from them.
I would just throw in the towel and go with the local oncologist I am already seeing, but I am feeling more and more uncomfortable with him and his office. I won’t go into everything here, but one issue is that it is part of a cancer treatment chain that is currently involved in a whistle-blower lawsuit for monopolistic practices, Medicare fraud, and unsafe medical practices. Also, I only googled them because I was already feeling uncomfortable about certain things.
I suppose I could just go with the cancer center, tell myself that all these first time charges probably won’t end up being more than we can afford, but really I would like as much transparency as possible ahead of time. For one thing, I would find it a lot less stressful not having to worry about “mystery bill.”