HEALTH INSURANCE FOR CANCER PATIENTS (Page 1)

(www.cancerandcareers.org)

Health insurance for cancer patients can be a battle. Women with cancer must often wage two battles: They fight to regain their health and to get what they deserve from their insurance plan. Here, advice from cancer organizations, advocacy groups and survivors about how to get the most out of your coverage so you'll be assured the best possible medical care.

Know Your Insurance Plan

The moments and days after you hear a cancer diagnosis are understandably filled with anxiety and uncertainty. As soon as you feel able, however, it's a good idea to sit down and read your health plan. It's not exciting reading, but looking through the health plan now can reduce the likelihood of misunderstandings and glitches later on. Carefully examine your policy, says Beth Darnley, special projects director of the Patient Advocate Foundation (800-532-5274, "www.patientadvocate.org", a nonprofit group based in Newport News, Virginia. "See how you need to go about handling your care."

Whether you have traditional ("fee-for-service") health insurance or a managed care plan, such as a health maintenance organization (HMO) or a preferred provider organization (PPO), be sure you know what you need to do to get the most out of your coverage.

Among the questions you need to know how to answer:

  • How do I go about getting a second opinion?
  • May I go out of the network or plan [for managed care subscribers] to obtain care, and is it covered?
  • Must treatment be pre-authorized and if so, when?
  • What exactly is covered (e.g., doctor's office visits, hospitalizations, chemotherapy treatments), and to what extent?
  • May I choose my own specialists?
  • If I change my mind and want to go to another doctor, is it possible to switch?
  • Is there a specific representative I can always call on for help, or is there a toll-free number, or both?

Be Your Own Manager

If record-keeping is not your forte, now is the time to learn.

Among the ways you can become better at maintaining health care-related paperwork:

  • Keep an informational journal. "After every conversation with your doctor, your employer, your human resource person, make notes," suggests Beth Darnley, special projects director of the Patient Advocate Foundation (800-532-5274), www.patientadvocate.org, a nonprofit group based in Newport News, Virginia. After every interaction with your health care provider, "describe the conversation topic, the date, the time." Then, as the conversations accumulate, it will be easier to keep them straight. Having all these details might also swing some coverage decisions in your favor.
  • Don't discard a shred of paper received from your insurance provider. One woman with cancer had thrown away an insurer's denial of treatment letter, then needed it when she decided to appeal. She had to request a duplicate letter, slowing down her appeals process.
  • Get everything your insurance plan representative promises you or explains to you about coverage in writing.
  • Download our insurance template (see the "Taking Charge" section), which can make it easier to organize information.

Lobby for Yourself

While you will likely have help from family, friends, co-workers, support group members, your doctors and your insurance representative, you will always be your own best advocate.

To be sure you're doing the best job possible, follow these tips:

  • When you find out the name of the insurance representative to call for questions, telephone him or her and introduce yourself. Ask for their title and work hours and the best time of day to call. Be friendly, pleasant and appreciative, and you will likely have another person in your corner.
  • Before you call your representative for the first time, vow to maintain a friendly, professional attitude, difficult as it might be. It's not always easy to lay aside that "insurers are the enemy" mindset, but it usually helps to do so, says Donna Doneski, a spokeswoman for the National Coalition for Cancer Survivorship (877-622-7937, (www.canceradvocacy.org), a Silver Spring, Maryland advocacy group.
  • Stay positive. You might be surprised to find out the problem can be resolved with one brief conversation. For instance, a university researcher diagnosed with breast cancer received a hospital bill that stated she owed $13,000. Her PPO plan covered hospitalization, so she called the insurance company to question why she was sent a bill. Sure enough, someone had miscoded the charge, and the $13,000 bill was quickly cleared up. From this experience, she learned: "Begin these conversations by taking a deep breath. Don't assume what comes in the mail is correct."
  • Brush up on your negotiating and assertiveness skills, if necessary. The National Coalition for Cancer Survivorship (www.canceradvocacy.org) distributes the Cancer Survival Toolbox, a free audio tape program aimed at helping patients communicate with their insurer, make decisions about treatment, negotiate and fight for their rights.

Troubleshoot for Yourself

What problem areas in insurance coverage can you expect?

Here are the most common complaints heard from patients, and what advocacy groups recommend doing about them:

  • Complaint: Denial of a treatment, a drug or a second opinion.

    Action: You can always appeal -- and then appeal again if you are denied again. Enlisting your doctor's help can speed the process. (See "When Your Insurer Says No, Take Action," below.)

  • Complaint: Continuity of care problems. The oncologist who has been your source of both great treatment and emotional support leaves the insurance plan. Or your radiation provider has left the plan, but you have several treatments yet to finish.

    Action: Lobby your insurance agency to allow you to continue your care with the same physician.

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