Out of state surgery - problem solvers needed (medical, plan, hospital)

[WildSpark]

Currently a resident of Las Vegas, NV. I'm a caregiver and have Medicaid/Aetna. I am not able to use this HMO plan in another state.

- Diagnosed in May 2017 with a large tumor. Hated the doctor (wrote about her in another thread).

- Got a second opinion and learned my tumor is in a different spot than the first bad doctor diagnosed. MRI shows the tumor is growing. It's large (size of a large grapefruit/small melon) and has freaked out my second opinion doctor.

- 2nd opinion is pushing me off on an Oncologist/GYNO specialist to rule out cancer. He said she's more experienced with my situation than he is and commented, "gosh this tumor is big, have you named it yet?" (2nd opinion has a medical malpractice lawsuit on his license from 1991. I asked him what that was about and he admitted to killing a baby in his first year residency. Although he hasn't had any more suits since.)

- Third doctor has two, recent, disturbing malpractice lawsuits against her name according to the Nevada State Board of Medical Examiners. She also gets very bad ratings on HealthGrades.com and Yelp.com.

I am not comfortable with any of these doctors. I've asked around to friends and every doctor someone has referred me to has malpractice claims! or I cannot get in to see them for six months!

I'm currently shopping around for better insurance, even if it means taking out credit to handle the premiums.

Been on the phone several times with the Mayo Clinic in Phoenix. $5,000 out of pocket gets only a consult! Mayo also has a list of providers. Some require me to relocate to Phoenix, which is an option, as I despise Las Vegas for many other reasons beyond healthcare.

Mayo clinic also said there are some health carriers in Nevada (United Health Care) that might let me go out of state. Mayo said they get many patients who come from Las Vegas for this very reason. There's a saying said often in Vegas, "When in pain, get on a plane!"

I am worried I won't get coverage because I have a pre-existing condition. Any advice as to the wording I could use when calling the insurance companies?

Also, I've started a side business, it hasn't made any money, but I could form a quick LLC. Do you think I could get corporate insurance off of my own business to nullify a pre-existing condition? Would you move for better healthcare?
I'm trying to think of solutions from all angles. Thank you for thoughtful feedback.

[Flamingo13]

From my understanding - Medicaid (which is free to you?) - is rather limited.

[WildSpark]

Originally Posted by Flamingo13

From my understanding - Medicaid (which is free to you?) - is rather limited.

Obviously! Bottom of the barrel doctors. I explained that I'm looking for other insurance. Your comment is unhelpful and unnecessary for this thread.

[bigbear99]

You want someone with expertise, not cute bedside manners, so forget healthgrades and yelp.

Mayo Clinic is not worth going to for most people. It's as much a "brand" as a place to get good health care.

Your LLC idea won't work for reasons I won't bore you with.

Most docs have malpractice claims. Most are bogus and are brought because an outcome was not what the patient wanted.

You seem to be doc shopping. That's not good, because you don't have the expertise to know the good ones from the not so good. I'd stop futzing around and get on with it with someone. You won't get the bedside manner superstar because the star won't take medicaid - too busy already.

I have no advice on wording because it seems like you're trying to scam things already

[Ariadne22]

Generally, unless you have a qualifying life event, your opportunity to purchase different coverage effective January 2018 would begin November 1, 2017 through December 15, 2017.

Qualifying life events are described, here:

https://www.healthcare.gov/glossary/...ng-life-event/

Per the above link, the easiest way to purchase insurance before 2018 would be to change your residence. You can't be discriminated against for a preexisting condition if you meet the qualifying life event criteria.

Insurance through your LLC on the ACA SHOP exchange would require you have one employee in addition to yourself:

https://www.healthcare.gov/small-bus...p-marketplace/

[NSHL10]

Originally Posted by 7freak7

Obviously! Bottom of the barrel doctors. I explained that I'm looking for other insurance. Your comment is unhelpful and unnecessary for this thread.

Individual plans tend to have even more narrow networks than medicaid. In NY most of the better hospitals do not take "Obamacare" insurance.

[Angie682]

Originally Posted by NSHL10

Individual plans tend to have even more narrow networks than medicaid. In NY most of the better hospitals do not take "Obamacare" insurance.

Don't waste your money on short term policies or a an individual policy not through the marketplace. They still have pre-existing conditions and you would probably not even qualify based on your health history.

I would call Aetna if they administer your Medicaid.
Let them know you have tumor that is growing rapidly, one of your doctors wants to refer you to an oncologist and see if they can assign a Case Manager to you to help you navigate the system and get appropriate care. Sometimes they can make exceptions if providers are not available, etc.

Please get treatment soon. Sometimes time really is of the essence and delays can impact your health

[bigbear99]

Has the OP had a biopsy yet? That's the first step and you don't need Mayo Clinic level expertise to do one. If it turns out cancerous, then yes, an oncologist probably manage your case. There are many next steps for a cancerous tumor, not all of them surgery.

I doubt Aetna's network only has the "bad" doctors.

[WildSpark]

Originally Posted by bigbear99

Has the OP had a biopsy yet? That's the first step and you don't need Mayo Clinic level expertise to do one. If it turns out cancerous, then yes, an oncologist probably manage your case. There are many next steps for a cancerous tumor, not all of them surgery.

I doubt Aetna's network only has the "bad" doctors.

According to my doctor (2nd opinion) they don't biopsy a fibroid tumor. If it's cancerous and you cut into it, it'll spread. What they do is take surrounding endometrial tissue and test it. My doctor promised to call this other dr to discuss my case and that I'd hear from this oncologist this week. I've already called and left messages. It's Thursday already and no response. I just started with Aetna July 1st, so we'll see if they'll resolve this, but I have my doubts.

However, Las Vegas has the worst doctors I've ever experienced, having lived in five other states and 15 cities.

[WildSpark]

Originally Posted by Ariadne22

Generally, unless you have a qualifying life event, your opportunity to purchase different coverage effective January 2018 would begin November 1, 2017 through December 15, 2017.

Qualifying life events are described, here:

https://www.healthcare.gov/glossary/...ng-life-event/

Per the above link, the easiest way to purchase insurance before 2018 would be to change your residence. You can't be discriminated against for a preexisting condition if you meet the qualifying life event criteria.

Insurance through your LLC on the ACA SHOP exchange would require you have one employee in addition to yourself:

https://www.healthcare.gov/small-bus...p-marketplace/

This is insightful, thank you for the thoughtful comment.