It's not that they won't necessarily pay for it. But - they won't if I don't get it pre-authorized and to do that requires a letter from a physician stating why I need to go to this particular facility in favor of a local one. The RO at the CCC doesn't feel comfortable writing it - since he hasn't yet seen me (although he does already have my entire cancer history through all the medical forms, evaluations etc that were faxed to him), and I haven't asked my ENT to write one since he said I didn't need the radiation anyway.

I rescheduled the appt at OSU for next week when we thought that I could get the letter - then they called and said the RO wouldn't write one. I haven't cancelled that appt yet - and I can still go - but risk having to pay for it. The initial appointment is going to be around $500, and though I could pay for that, and file an after the fact claim- there is a good chance they'd stil deny it and thus deny any treatments there as well. I don't know if the RO would write a letter after the appointment to get the pre-authorization at that point.

I understand why HMO's suck. My physician filed a surgical bill that was close to $9000 for the surgery which took 4 hours and two ENTs working togther from the same practice. I had triple endoscopy, resection and bilateral neck dissection. They have denied his claims for payment for everything other than $414!!! Yes - $414 for 4 hours of surgery for 2 surgeons! He has refiled and they have denied him a second time. At one point a few years ago (when I was seeing one of these physicians for only my allergy / asthma), they actually dropped my insurance from what they would accept. They did pick it back up before my next appointment - so I didn't end up having to switch, but now I know why.

If anyone has the name of a good RO in Cinci that may have treated several of these cancers - please pm me with the information. I might be limited to staying local. There is a medical school at the University of Cincinnati that is very good and there is a cancer center called the Barrett Cancer Center also one at the hospital where I had the surgery - both equipped with IMRT I believe. They are just not CCC's. I just really don't want to be a guinea pig for some doc who has only treated a handful of these cases and will "fry the hell" out of my entire mouth and neck- "just to be safe". So, please let me know if you have the name of someone who might be worth calling.