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
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
- 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
Among the ways you can become better at maintaining health
- 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
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
To be sure you're doing the best job possible, follow these
- 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
- 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
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
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,"
- 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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