It isn't about the money - it is about liability. If you got treated at Sloan, you would have a team. For an opinion you got a person. All the big centers have a "gate keeper" / evaluator that helps the people that come for opinions make decisions, but also evaluates if they could actually be helped by coming there. In many cases, that gatekeeper decides that your local treatment team's opinion - compared to what he/she knows of their own institution's protocols regarding similar cases, is similar enough to not warrant a move to their treatment facility. There is also a huge liability to recommending treatment protocols that are going to be administered by someone that you don't even know at another institution. That is why the reverse "have them contact me" approach.

The big institution systems have mandatory tumor boards, and no single doctor decides treatment, not only because it is best for the patient, but because it ensures that the institution, from a success standpoint, and a liability standpoint, is doing what they believe from multiple multidisciplinary experiences, to be the best possible treatment.

By the by, I am one of those people that traveled across the country to get treated because I didn't like the treatment plan, and reputation of my local facility. 8 weeks in another city, in an apartment. Since I was sleeping all the time from the radiation treatments beating me up, it passed rather quickly. The tough part was the next 5 months back at home after treatments when I was NED, but still suffering from the impacts of the treatments. Still on a PEG, still on morphine, still in pain, still emotionally fragile, still getting every bacterial and fungal infection that came around... those were the months when really needed my support team of friends.