INSURANCE

  1. IF YOU HAVE INSURANCE:
    1. Contact your insurance company to review your coverage for cancer treatment.
    2. Every doctor's office will ask if you have insurance. Always have your insurance card available. Before the procedure, have the doctor's office confirm with your insurance company that you will be covered.
    3. Many times, an insurance company will deny a claim because they feel the cost of the procedure is not "customary and reasonable". This should not be an issue if the doctor is a "preferred provider" (i.e., an approved provider listed under your PPO or HMO). However, if the doctor is not a preferred provider, it will be necessary for you to negotiate a payment standard with the doctor's office that both the doctor and the insurance company acknowledge to be "reasonable and customary".
    4. Dealing with the insurance company is one of the most stressful issues you will confront when going through treatment. If you have a spouse, relative, or friend who will take on the burden, it will be of great assistance. Once you begin treatment, you may not be able to handle these types of matters.
    5. Claims should be submitted promptly.
    6. Often claims are denied because of incorrect coding or information is missing from the doctor.
    7. Try to postpone payment to the medical provider until the claim is resolved by your insurance company.
    8. If the claim is denied, resubmit it along with a request for review.
    9. To reverse a decision, ask to speak to a supervisor who may have the authority to do so.
    10. If necessary, obtain a letter of medical necessity from your doctor regarding treatment.
    11. If the claim continues to be denied, seek assistance from the consumer services division of your state's insurance department.
    12. If all else fails, consider legal action.
    13. Ask your insurance agent if you have disability insurance coverage. If so, review the requirements for obtaining the benefit. It may be advisable to have an attorney process your disability claim.
  2. IF YOU ARE NOT INSURED:
    1. Speak with your doctor to determine if the charges can be reduced.
    2. Contact the resources noted under the FINANCIAL ASSISTANCE section.
    3. If you are over 65, you may qualify for Medicare.
    4. If your cancer is disabling, you are under 65, and have been employed, you may qualify for Social Security Disability benefits. Once approved for Social Security Disability benefits, you also qualify for Medicare Insurance two years later, even if you are under the age of 65.
    5. Every state or county may have programs for which you qualify if you are low income or unemployed.