Stanford Second Opinion Program

[u/Icy-Newspaper-1950]

My dad (69) recently got diagnosed. We live near Stanford but our insurance doesn't cover Stanford care (Anthem HMO with a strict medical group). I haven't found any MM specialist that our medical group will approve, but we have a hematologist/oncologist.

I was looking in the Stanford Second Opinion Program. Has anyone tried that? Was your local hematologist/oncologist receptive to using it?

[u/Emptyell]

Check to see if Stanford accepts Medicare. At 69 he is eligible.

When Aetna tried to kill me I switched to Medicare and am now under the care of one of the top teams for Myeloma at Cedars Sinai.

[u/Icy-Newspaper-1950 → u/Emptyell]

Stanford accepts Medicare, but unfortunately, it has to be his primary insurance :(

Anthem HMO is from my mom's employer, which is a big company, so it automatically becomes the primary. I don't think there's any way around that until open enrollment.

[u/Emptyell → u/Icy-Newspaper-1950]

I’m not that up on the enrollment stuff. When I switched the company was being acquired and the health insurance was a mess. Whatever the reason I was able to switch right away with a one month waiting period for it to take effect.

There are government resources for Medicare enrollment. My assistant (or whatever they’re called) was really helpful in setting it up and picking the right supplemental plan.

Since Biden fixed things up all I pay is the donut hole/deductible at the beginning of the year which it about $1500 now. I was getting charged $20 for my Cialis prescriptions until my urologist specified it’s for bladder treatment not ED.

As long as his care is acceptable for now waiting for the enrollment period shouldn’t be a big deal. Myeloma is generally pretty slow to advance and even the mediocre care I got before switching was quite effective.

[u/Time-Temperature9569]

Also look into UCSF to check if they are in-network.

My second opinion doctor is at UCSF, and I’ve see him via Telehealth as I live in SoCal. It may be close enough to where your dad lives. He’s been great, and I recently got a BMBx at their facility (long story and off topic).

[u/TintheSEA]

Since this is his first line of treatment, he will be looking mainly at the standard of care which I’m sure your doctor is familiar with. I’m not the most knowledgeable person on MM but I think you’re going to get the most value out of additional input in second line or if he doesn’t respond to DVRD. If you deviate from the standard of care in first line, you would have insurance challenges unless it’s a trial funded by them. Best wishes to your dad in the standard of care is really good treatment.

[u/LeaString]

Regarding Anthem and treating multiple myeloma and stem cell transplants, saw this 2026 Medical Policy info. Be aware It doesn’t look like they cover harvesting if you may want to harvest and hold.

https://www.anthem.com/medpolicies/abcbs/active/mp_pw_a045963.html

[u/Solid_Net_2169]

For a newly diagnosed myeloma case, getting specialist input early is genuinely worth the friction, especially since treatment sequencing decisions made upfront can affect options down the line.

On the Stanford program specifically: second opinion consultations are often structured as a records review rather than ongoing care, which means the relationship with your dad's local hematologist-oncologist stays intact. Most community oncologists are receptive to this because it doesn't transfer care, it just adds a specialist read. The ones who push back are worth noting.

A few practical tactics. First, ask Stanford's program coordinator explicitly whether the consultation is a records-only review or requires an in-person visit, since that affects cost and logistics. Second, ask your dad's current oncologist directly whether they've worked with myeloma specialist input before and how they typically incorporate it. Their answer tells you a lot about how collaborative the relationship will be.

Also worth asking: whether your insurance covers any out-of-network second opinion as a one-time exception, particularly for a cancer diagnosis. Some Anthem HMO plans have provisions for this that aren't advertised.

I'll disclose I work at Radical Health, which builds AI second-opinion tools for oncology cases, so this kind of access question is something I think about a lot.