by Bobbi Christensen-Meins, Community Program manager from Cancer Lifeline
Probably the second most paralyzing thought after you have been given a cancer diagnosis is "How am I going to pay for all of this?" Following are some questions and answers about insurance and cancer, as well as some helpful resources.
Q: My insurance company denied my claim for part of my treatment. What should I do?
A: One of the most important points for cancer patients concerning paying for treatment is never to accept the word "no." You will have to spend time preparing and filing appeals, but you may be able change a "no" to a "yes" and get the procedure covered. Check your plan benefits. If you think a procedure should be covered but your insurance company denied it, appeal in writing and ask them to reconsider. Include with your appeal a letter from your doctor explaining why the procedure was necessary.
Q: Can my new employer's group health plan deny me or impose a waiting period if I have been treated for cancer in the past?
A: If you have had continuous health insurance for at least 63 days before switching to the new plan, your new insurance cannot deny you or impose a waiting period for any pre-existing conditions, such as cancer. If you have had a gap in coverage, your new insurer can make you wait before it will cover care for pre-existing conditions.
The following organizations can provide you with more information:
SHIBA (Statewide Health Insurance Benefits Advisors)
For information about and assistance with insurance.
Senior Services of King County/Seattle
Not just for seniors! Cancer patients may qualify assistance with a variety of issues.
A 24-hour resource that provides information, emotional support and referral to other cancer services.
Q. Where I can turn for help and information about my rights and responsibilities concerning health insurance?
It is always best to first ask your insurance company or your employer for help answering your questions or solving your insurance problems. If this does not work, though, there are other resources.
Your state insurance commissioner's office is always a good place to turn for help in understanding state laws and programs; in additional, personnel may be able to direct you to other sources of assistance. They also can help you determine whether your plan is one that is under their jurisdiction. The Washington State Office of the Insurance Commissioner can be reached via the following:
Washington Office of the Insurance Commissioner
P.O. Box 40256
Olympia, WA 98504-0256
Phone: (800) 562-6900 (in state)
Fax: (360) 407-0186
The United States Department of Labor regulates health plans offered by many large employers. For more information try www.dol.gov.
The Centers for Medicare & Medicaid Services (CMS) runs the Medicare program and works with states on Medicaid programs. The CMS web page can be found at www.cms.gov.
Finally, many consumer groups such as the National Coalition for Cancer Survivorship may offer assistance. For very complicated problems, you may need to consult a lawyer or another expert for professional advice and help. Or you may want to ask a friend to help you make some of these calls, gather information, and keep track of the paperwork. If a professional is needed, make sure he or she has expertise in health insurance (not all lawyers or accountants do). Health insurance can be complicated and frustrating, but you are not alone. Be persistent and take advantage of the help that is available to you.
What Cancer Survivors Need to Know About Health Insurance, by Kimberly J. Calder, MPS and Karen Pollitz, MPP. Published by the National Coalition for Cancer Survivorship. (2006), 34 pages.