It's important to resolve financial issues before they become a source of increased stress or limit your access to needed treatments, prescription medications or support services. Therefore, discuss payment options with members of your healthcare team or the treatment centers' patient financial services department. Patients and providers can work together to devise ways to reduce costs without compromising treatment. Ask your providers about:
- Switching from a brand name drug to the generic
- Reviewing a medication list to see whether you're taking nonessential drugs
- Enrolling in a Prescription Assistance Program (PAP)
- Referring you to a public agency or a social worker
Social workers and caseworkers can:
- Help you better understand your insurance coverage
- Submit claims
- Refer you to assistance programs to help meet the cost of remaining bill
- Offer guidance on submitting the necessary paperwork for Medicare or Medicaid
To better manage your health finances and get the most from your insurance coverage:
- Check that the personal information on your policy is correct.
- Review the policy's summary of benefits, noting any coverage exclusions or limits. Don't overlook riders or endorsement forms.
- Keep a copy of all claims and related paperwork, such as letters of medical necessity, bills, receipts and requests for sick leave.
- Keep a written record of phone conversations with insurers.
- Check your health policy often to determine what services and medications are covered.
- Obtain proof of previous health insurance coverage, called a certificate of creditable coverage, from former employers and insurers.
- Pay premiums on time and in full to avoid a lapse in coverage.
- Plan ahead for procedues or treatments that need a pre-authorization or pre-certification.
- Learn what to do if a claim is denied.
- Keep track of all unreimbursed medical expenses. You may be able to claim these for tax purposes.
- Know the laws designed to protect patients and provide continuation of medical coverage (for example, COBRA, HIPAA, Family and Medical Leave Act, Americans with Disabilities Act).
If a Claim Is Denied
If your insurance company denies payment for a recommended treatment, you may be able to get a decision overturned by filing an appeal. Ask your insurer the following questions when appealing a denial:
- Can you send me a copy of the denial letter?
- What is the specific reason the claim was denied? (This information should be included in the denial letter.)
- How can I get a current copy of the plan document and plan's Summary of Benefits Coverage (SBC)? (You may need to request these documents in writing.)
- Whom can I contact at the insurance company to discuss the denial?
- How can I request a doctor peer review? (A peer review provides the chance for your doctor to discuss your treatment in detail with other doctors, usually within the same geographic area and medical specialty.)
- Can I speak with anyone else if I have questions about the appeals process?
- If a particular drug isn't on the prescription plan's covered drug list (formulary), what is the process for requesting an exception? Can my doctor submit a letter explaining why the drug is needed?
Record the date and time of each call to the insurance company, and the name, phone number and extension of the representative you speak with. Remain courteous, honor deadlines for obtaining key documents and submit all necessary paperwork.
Use these worksheets to help you stay organized: Click Here
Getting Help from Family and Friends
Delegate time-sensitive tasks to reliable family members or friends who can be counted on to be thorough and meet deadlines. Ask them to help with:
- Setting up a record-keeping system to track bills and submitted, pending and paid insurance claims
- Calling public and private agencies to determine eligibility for financial assistance, entitlement programs and other benefits and services
- Gathering documents to support insurance claims and appeals
- Following up with the insurance company
- Organizing fundraising efforts
Getting Help from Professionals
The professional counselors who staff national organizations that support people with cancer can give you expert advice on how to:
- Preserve your assets
- Reduce your debt
- Access community resources
- Handle employment issues
- Reduce insurance problems
- Use legal remedies, if and when necessary
This type of guidance can be invaluable in helping patients advocate for themselves more effectively. Organizations that can help you navigate the healthcare system include:
- CancerCare. CancerCare is a national nonprofit agency that provides free services, support, information and practical help to anyone affected by cancer. The organization offers guidance on financial issues and gives financial assistance to help with some costs. Visit the CancerCare website or call (800) 813-HOPE (4673).
- Patient Advocate Foundation. Patient Advocate Foundation (PAF) draws upon the expertise of case managers, attorneys and doctors who work with patients and their insurers, employers and creditors to resolve insurance problems, job discrimination issues and debt crisis matters. The PAF website features a comprehensive state-by-state directory of financial resources for housing, utilities, food, transportation, medical treatment and children's needs. Visit the Patient Advocate Foundation website or call (866) 512-3861.
We're Here to Help
Call The Leukemia & Lymphoma Society (LLS) at (800) 955-4572 to talk with an Information Specialist for help with the challenges of your diagnosis. LLS also provides information to healthcare professionals involved in the care of patients with these diseases.
For information about financial support, click here.
Below are resources and organizations that may be able to help you with concerns about managing insurance and expenses:
- Healthcare.gov. This government-maintained Web site includes information about the healthcare changes happening as a result of the Patient Protection and Affordable Care Act of 2010 (ACA), also called Obamacare. The site has information about insurance options in your state; compared quality of care in hospitals, home healthcare agencies and nursing homes; an overview of the healthcare law; and healthcare options for different groups of people (ie, families with children, individuals, people with disabilities, seniors, young adults and employers).Visit www.HealthCare.gov.
- The United States Department of Labor (DOL). The DOL's Employee Benefits Security Administration (EBSA) regulates health plans offered by most employers and ensures that employees eligible for COBRA get the benefits to which they are entitled. Call (866) 4-USA-DOL for live assistance in English or Spanish. Visit the EBSA website for more information.
- Foundation for Health Coverage Education (FHCE). FHCE educates callers about free or low-cost insurance in their home state. FHCE has developed a customized matrix for every state that details insurance opportunities, and has provided this matrix to each state’s insurance professionals. The foundation offers downloadable information about each state’s public and private healthcare options and locates resources and applications for health coverage programs by state. Visit www.CoverageForAll.org.
- The Centers for Medicare & Medicaid Services (CMS). CMS manages the Medicare program and works with states on Medicaid programs. Even if you are working you may be eligible for Medicaid. Visit the CMS website for more information. Even if you are working you may be eligible for Medicaid. For more information about Medicaid for the Working Disabled, click here.
- Triage Cancer. Triage Cancer is a national, nonprofit organization that provides education and resources on the entire continuum of cancer survivorship issues for survivors, caregivers, and healthcare professionals. Triage Cancer created an on-line toolkit for navigating finances after a cancer diagnosis. Visit the TriageCancer website.
For even more resources, visit the Financial Resources section of our Other Helpful Organizations directory.
Source: Cancer and Your Finances. Reviewed by Monica Fawzy Bryant, Esq.
- Insurance Coverage
- Use these worksheets to help you stay organized: Click Here
- Public Programs
- The Affordable Care Act
- Financial Support
- Download or order The Leukemia & Lymphoma Society’s free booklet, Cancer and Your Finances.