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HMO/IPA Frustration

HMO/IPA Frustration

Last month my brother was diagnosed with Pancreatic cancer. He has a managed care plan (Health Net through Medi-Cal). Our hope is to get him to either USC or City of Hope as he lives in Los Angeles county and they both accept his insurance. His current IPA will not refer him out of the network which I expected. There is no specialized cancer unit in the only hospital his IPA contracts with and he was even told by one of the doctors at the hospital where he is to receive his radiation that their equipment is not up to par with what is needed to treat his cancer. We are fully aware of the grim prognosis linked to his diagnosis as we lost our mom to the disease as well and feel strongly that he will receive better care if he can be seen at a comprehensive cancer center. Our plan seemed easy---change his IPA to Molina as they are contracted with his insurance and the City of Hope. Health Net agreed that this could easily be done.I was shocked when I received word later that day that the director of the Medical Group he needed to switch to will not allow him to be transferred to their group as they will not assume the costs of his treatment now that he has a confirmed diagnosis. I spoke with Health Net and Medi-Cal who confirmed that this would more than likely happen with any IPA he tried to switch to. Our only other hope was to try to get him into straight Medi-Cal (dis-enrolled from Managed Care).Unfortunately, he only meets 2 of the 4 criteria needed to make that happen. We are heartbroken and frustrated beyond words.His insurance is gladly accepted at the best institutions that he can possibly go to, but he just can't get there due to the prior choice of IPA. Does anyone know of any route I haven't yet explored? I've tried Medi-Cal, Medi-Cal Ombudsman, Health Net, Preferred Healthcare, Molina Healthcare, the City of Hope, USC, the Department of Managed Health Care and The American Cancer Society. We're racing against the clock and any help is appreciated.
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