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Health Insurance for Cancer Care In America

CISN and many American’s now believe that access to health care, including quality cancer care, should be made available to everyone. With almost 50 million Americans without health insurance, and studies linking a lack of health insurance in America with increased death rates in cancer patients, health care reform is an urgent priority.

And even for those Americans with health insurance, coverage can be limited and expensive with high monthly premiums, deductibles, and other costs.

A study reported in the March/April 2006 Health Affairs shows about half of all filed personal bankruptcies in the United States cited medical causes as the reason. This study also found that 75.7 percent of those that filed bankruptcy had health insurance at the onset of illness.

Health Insurance and You

As you probably already know from your own experiences, cancer treatments, tests, doctors’ appointments, and follow up care are often a financial burden for patients and their families.

It is extremely important for patients to have health insurance that will offer the best medical coverage possible.

 

Because there are so many different types of health insurance plans, patients and their caregivers must understand the scope of their insurance coverage.

Your insurance company can provide answers to questions about your policy.

 
 

Tips For Choosing Health Care

There are steps you can take to help yourself with your health insurance and finances. The American Cancer Society (ACS) has a guide called “Choosing Health Insurance: Making an Informed Decision” with tips in the following areas.

  • Essential Questions to Ask any Health Plan you are Considering
  • 10-Key Cancer Related Components to a Quality Health Plan
  • Essential Cancer-Specific Health Plan Benefits that Should be Part of any Health Care Plan you are Considering
Please visit the ACS website for more information. http://www.cancer.org
 

 
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Health Insurance During & After Cancer

Once you have cancer, it may be more difficult and expensive to secure what you consider an ideal health insurance plan.

As an example, if you need to leave your job due to your health and therefore lose your group coverage, you may be forced to apply for individual coverage if you are an unmarried adult or your significant other does not have insurance. Health insurance companies may only provide a minimal, costly policy with high premiums due to your medical history.

It is very important to not let your health insurance expire. If you have a gap in your coverage, when you apply to a new health insurance company they can deny coverage for pre-existing conditions such as cancer.

Health Insurance Tips: ACS has compiled these tips.
 
  • Get a copy of your health insurance policy and find out what it covers, especially related to your cancer and treatment.

  • If you have a job with health insurance benefits, keep it until you have a new job with the coverage you need.

  • Keep your insurance needs in mind when you look at getting a new job.
 
  • Do not let your health insurance expire.
  • If you are unable to work for a time, talk with your employer about ways to keep your health insurance. For instance, the Family and Medical Leave Act (FMLA), paid or unpaid time off, or temporary disability benefits may be helpful.
  • Keep careful records of all your health care expenses and claims. If your health insurance requires claims, send in claims for all covered costs.
  • Get help in filing a claim if you need it.
  • Work with your doctor’s office staff or billing department to get the most coverage you can.
  • Follow up with your insurance company with questions about filed claims.
  • If a claim is denied, submit it again.
  • Keep complete records of all claims submitted, pending, and paid.
  • Find out if your insurance company has assigned a case manager to you. Get to know this person and keep him or her informed of what's happening with your treatment. This person can help you through many of the health insurance issues that may come up.
  • Consider filing an insurance complaint if you feel you have been treated unfairly.
  • Look for other options for getting insurance after cancer treatment, such as joining your state’s “high risk” health insurance pool for people who cannot get regular health coverage; using Medicare or Medicaid; getting dependent coverage under your spouse's insurance plan; joining your current company plan; getting coverage through an independent broker; or getting group insurance through an organization you’ve joined.

  • If your cancer care team has a social worker, talk with her or him about your insurance and job situation.
 
It will be helpful to keep organized records of the following:
 
  • Medical bills from all health care providers 
  • Claims filed

  • Reimbursements (payments from insurance companies) received and explanations of benefits (EOBs)
     
  • Dates, names, and outcomes of contacts made with insurers and others
 
  • Non-reimbursed or outstanding medical and related costs
     
  • Meals and lodging expenses
     
  • Travel (including gas and parking)
     
  • Long-distance telephone calls related to medical or other types of care, including psychosocial care

  • Admissions, clinic visits, lab work, diagnostic tests, procedures, treatments
     
  • Drugs given and prescriptions filled

Health Insurance Denials

Sometimes coverage is denied by health insurance plans. There is usually an opportunity to appeal the decision by making claims such as medical necessity. Even simple claims that were processed incorrectly may require several phone calls and letters to resolve, which takes time and energy. In these situations, it is especially worthwhile to have a loved one who can assist with insurance issues.


Health Insurance Advocates

You may want to ask a caregiver, family member, or close friend to help manage your health insurance. This can be time consuming and frustrating so don’t hesitate to ask for help.

 
This will allow you to stay focused
on your health!
 

For More Information about Financial Assistance:


For Direct Financial Assistance:

  • Pharmaceutical Manufacturers’ Association has information about patient assistance programs offering a free three-month's supply of medication
  • Partnership for Prescription Assistance manages access to more than 475 public, state, and private patient assistance programs, including more than 180 programs offered by pharmaceutical companies
  • Cancer Specific Organizations
    • Some non-profit organizations specializing in site-specific cancers offer financial assistance, as well as have publications about other resources for financial assistance
  • Health Insurance for High-Risk Individuals
    • Some states, like California, offer health insurance policies for high-risk individuals who have lost their insurance. These plans can be expensive and offer more limited benefits than other policies, but might offer your some protection.
    • The attorneys at the Cancer Legal Resource Center at Loyola Law School provide no-cost legal counseling to cancer patients with health insurance (and other) questions. Call 866-843-2572 or 213-736-1455.
  • Federal Screening and Treatment Programs
    • Free Screening and treatment for breast and cervical may be available for women through the Centers for Disease Control and Prevention (CDC). To find out if a program exists near you check with your doctor. These programs provide services for women within 250% of the poverty level. All health services - not just cancer treatment services - may be available for eligible women who are diagnosed through this screening program.
 
 
 
 
 
 
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