Hello. I understand your plight to find the right care. My wife has a grade 2, stage 4 pancreatic Net diagnosed in April this year. We live in Georgia where there is good support for surgical NET treatment but no comprehensive NET program. The approach we took was to meet with a local medical oncologist who specializes in NET (30% of his practice) We then flew to NY for a consultation at Sloan Kettering. Dr. Reidy reviewed her CT, Pet dotatate, labs and conducted a thorough history and physical exam. She recommended a treatment approach that would not have been available as first line in Georgia. Her local oncologist was happy to implement that protocol and has coordinated nicely with Reidy. This approach may work for you at significantly lower cost than going fully out of network.