Want to go from PPO to HMO but need a new PCP to authorize cancer treatment
I (39F) have been on a PPO HSA plan through my employer for years and rarely saw the doctor. I was diagnosed with breast cancer in June and have been undergoing treatment at a cancer hospital. At this point I’ve reached the out of pocket max ($7900), paid for by draining my HSA account.
Ahead of open enrollment, I’m researching switching to the only HMO plan offered by my company (Anthem Blue Cross HMO 10/0) because the OOP max is $1750 and the other PPO options have similar or greater OOP maxes. Obviously this switch comes with complications but it’s worth it, considering my treatment will continue for a while.
After making a few calls, I learned my current PCP’s medical group isn’t contracted with the cancer hospital so if I switch plans, I’d have to find a new PCP that IS contracted with them and get an authorization. I’m not attached to my PCP so I’m fine with switching – I don’t want to change my cancer hospital due to the ongoing care but also because it’s the best in California and is a one stop shop.
I’m thinking that, while I have the PPO, I’ll switch to a PCP that’s contracted with the cancer hospital, explain the situation to them, and see if they’ll give me an authorization for treatment asap in Jan 2025 to prevent interruptions to my treatments. Is this reasonable/wise/realistic? Any advice or experience is appreciated – thank you!
submitted by /u/redditforthisjelly
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