ENT recs non-network surgeon for tonsil cancer - will ins help?

Posted by sj19850810 @sj19850810, 6 days ago

Husband (63) just dx'd with stage 1 SQUAMOUS CELL CARCINOMA, P16 POSITIVE from biopsy. ENT recommended a surgeon from Univ Hosp to consult. This doc is not part of our insurance (we're retired, with ACA HMO, with high deductible). At first glance it appears as though since this doc is out of network nothing will be covered by our insurance. I have calls into the ENT's office as well as our insurance for clarification and suggestions as to how to proceed.

Has anyone else done this out of network and gotten it covered? I'm concerned the cost will put us in the poorhouse!
Where should I go for help maneuvering this insurance?
Thank you!
Susan

Interested in more discussions like this? Go to the Head & Neck Cancer Support Group.

mrsfootdoc | @mrsfootdoc | 6 days ago

What insurance does your husband have? He should be eligible for Medicare. I am not familiar with this plan. Does he have an advantage plan or Medicare replacement plan? Julie

sj19850810 | @sj19850810 | 6 days ago

Anthem pathways. We are too young for Medicare. We purchased this through the Affordable Care Act.

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