Navigating Insurance After Cancer Diagnosis


Learning that you have cancer is difficult enough without having to deal with insurance headaches.  If you have health insurance at the time of your diagnosis you may have a variety of questions.  Will my health insurance cover treatment?  How much coverage will I get and are their limits to coverage?  How much will this cost me out of pocket?  Will my premiums skyrocket?  Am I going to have to constantly be on the phone with insurance throughout my treatment process?  After a diagnosis the most important thing to focus on is getting healthy and health insurance should not be a distraction but, for many, navigating the health insurance world with a cancer diagnosis can be tricky and frustrating.

Coverage varies significantly between providers and individual plans but health insurance will cover treatment to varying degrees.  Even with an incredible health insurance plan with optimal coverage, there will likely be out-of-pocket costs associated with your care.  Once you have been diagnosed the first thing you need to do is make sure you have a physical copy and/or an electronic copy of your up-to-date health insurance plan and coverage.  .  This will provide you important information about your coverage as well as contact information.  The key to navigating insurance after a diagnosis is being well-informed.  The more information you have about what your insurance allows and covers, the more comfortable you will be with making decisions without fretting. For example – does your insurance cover a second opinion?  What are your copays?  Do you have an out-of-pocket-maximum?  These are the sort of questions to educate yourself on right away.  If your health insurance is through your employer make an appointment to discuss coverage with your Human Resources representative because the can also be a wealth of information and assistance when navigating insurance after a diagnosis.

When you call your insurance company to discuss your care with them, ask to be assigned a case manager who you can speak to each time you call so that you do not have to constantly explain your situation but rather can deal with someone who is, at least vaguely, familiar with your situation.  When you ask questions write down answers in a notebook and keep good records, along with the name of who you spoke with so that, should the need arise in the future, you can reference your notes for answers.  When speaking with your insurance company, do not be afraid to ask the same question multiple times until you feel you understand the answer well.  If you are having a hard time getting answers or feel uncomfortable with the insurance representative you are speaking, ask to speak to someone else or a manager.  While being polite can go a long way in life, you should never sacrifice getting answers for being polite.  It is incredibly important to get answers about coverage right away and you need to speak to whoever is necessary to get your answers.  Additionally, find out about prescription coverage because there are frequently prescriptions involved in cancer treatment and some may be quite expensive.  It is also important to discuss dates and clarify coverage – are you covered for the calendar year or does the insurance company use a different schedule for your year of coverage?  If something is denied that you believe should be covered file an appeal.  If your appeal is denied and you still believe you are correct seek legal counsel immediately because there are lawyers who specialize in understanding health insurance coverage and dealing with insurance companies.  While doctors and their staff deal with insurance companies on a daily basis there is no way for them to be familiar with each individual plan so it is best to not rely on them for information but rather arm yourself with information so that you can have peace of mind about your coverage and get the treatment you.

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