Keeping Up with Health Insurance During Cancer Treatment

It’s very important for anyone with cancer to have a health insurance plan that covers the costs of cancer care. And it’s key to keep your health insurance up to date with no coverage gaps.

Managing health insurance

If you or someone in your family has cancer, it’s important to know these things about health insurance.

• Do NOT let your health insurance lapse.
• Pay your health insurance premiums and other costs on time. New insurance can be hard to get.
• If you are changing insurance plans, don’t let one policy run out until the new one starts. This includes when you are switching to Medicare.
• When possible, call the insurer before planned medical service (such as surgery, procedures, or treatments) to see if you need  prior authorization.
• If your finances are limited, ask  your cancer care team for help from a caseworker, financial counselor, or social worker. Often, health care facilities can work with you to set up a payment plan.
• Check each medical bill to make sure it looks correct. If something doesn’t look right, call your insurance provider. You can ask for an itemized bill and dispute any charges that don’t seem correct.
• Find out what you need to do to submit requests for reimbursement to your insurance company. And find out what costs can be reimbursed.
• Submit requests for reimbursement as you get them. You will likely need to submit requests by a certain time, such as 90 days after the service was provided.
• If you have trouble keeping up with bills and expenses, get help from a trusted family member, caregiver or friend. For extra help, reach out to support organizations, such as the American Cancer Society.

Understanding your medical bill

Your policy and medical bills will include information on what services are covered and what costs you owe. Here are some definitions of the most common out-of-pocket insurance expenses.

Understanding out-of-pocket costs before service

Health care facilities, health care providers, and health insurance companies are required to give people information on costs before services are given.

If you have health coverage, you can get this information from your health insurance providers. If you don’t have health coverage, you can get an estimate from your health care providers before you receive services. To learn more, visit www.cms.gov/nosurprises.

Many health care facilities offer cash pricing (a discount) if paid upfront. And remember, it is best to negotiate before the services when possible.

How does billing work?

When you see a provider, get a test, or other service, their office will send a bill to your insurance company.

 If your doctor accepts your insurance, their office will often bill the insurance company for you, and then send you a bill for the amount your insurance didn’t cover. If they don’t take your insurance, you might have to pay your bill yourself and then fill out forms and send them to your insurer to get paid back (reimbursement).

Before you get a bill, you should get an Explanation of Benefits (EOB). It’s important to review this so that if there are any issues, you can look into them before you get a bill. Do not pay a bill until you receive the EOB and make sure it is correct.

 The EOB will include the services you got, the amount your insurance will pay, and the amount you will owe (when you get your bill). Here is an example of what an EOB usually looks like.

Create a system to keep track of your expenses and payments

Keeping track of medical expenses is a good idea for anyone. But it’s even more important if you have cancer. You may see more than one health care provider and get services at more than one facility. You’ll likely be prescribed medicines that you haven’t taken before. And after treatment, you will probably have some kind of follow-up or long-term care plan.

Keeping a careful record of medical bills, insurance claims, and payments helps people with cancer and their caregivers manage their money. It’s also helpful if questions come up about errors in billing or whether correct payments were made.

• Decide who can help you keep track of your records. Many people ask a family member, caregiver or friend to help with this.
• Keep  all paperwork related to your claims, such as letters of medical necessity, explanations of benefits (EOBs), bills, receipts, requests for sick leave or family medical leave (FMLA), prescriptions, and correspondence with insurance companies.
• Some people choose to keep paper copies of the paperwork in a secure place. Other people choose to scan the documents and keep them in e-files. There may be online tracking and other tools that are available from your insurance company or employer.
• Find out what’s tax-deductible and be sure to keep the originals of those records, such as travel, meal and lodging expenses during treatment.

Need more information?

Triage Cancer
Phone number: 424-258-4628
Website: www.triagecancer.org

Provides free education and resources related to health insurance, medical bills, employment, and disability.

Cancer Support Community
Toll-free number: 1-888-793-9355
Website: www.cancersupportcommunity.org

 Has a section about managing the cost of cancer treatment.

Livestrong
Toll-free number: 1-855-220-7777
Website: www.livestrong.org

 Includes a section about health and disability insurance.

State Health Care Marketplaces – US Department of Health and Human Services
Toll-free number: 1-800-318-2596 (also in Spanish)
TTY: 1-855-889-4325
Website: www.healthcare.gov

Provides information on the new insurance law, takes you through the steps of finding insurance, and much more. If you don’t have Internet access, the phone number will connect you with your state’s marketplace.

Medicaid – US Department of Health and Human Services
Toll-free number: 1-877-696-6775
Website: www.medicaid.gov

Your state social service or human service agency can give you the best answers to questions about your benefits, eligibility, and fraud.

Medicare – US Department of Health and Human Services
Toll-free number: 1-800-633-4227
TTY: 1-877-486-2048
Website: www.medicare.gov

Answers questions, provides literature, and gives referrals to state Medicare offices and local HMO’s with Medicare contracts.

Department of Veterans Affairs
Toll-free number: 1-800-827-1000
Website: www.va.gov

For information on veteran’s medical benefits and whether you qualify for them

Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA)
Toll-free number: 1-800-733-8387
Website:   www.va.gov/health-care/family-caregiver-benefits/champva/

For information on coverage of eligible families and survivors of veterans and military service members. The program is administered by the Chief Business Office Purchased Care (CBOPC) in Denver, Colorado.

US Department of Labor, Employee Benefits, Security Administration (EBSA)
Toll- free number: 1-866-444-3272
Website: https://www.dol.gov/agencies/ebsa

Information on employee benefit laws, including COBRA, FMLA, and HIPAA requirements of employer-based health coverage and self-insured health plans. Also has information on recent changes in health care laws.

Information for military reservists who must leave their private employers for active duty can be found at: https://webapps.dol.gov/elaws/vets/userra/mainmenu.asp

National Association of Insurance Commissioners
Toll-free Number: 1-866-470-6242
Website: https://naic.org/state_web_map.htm

Offers contact information for your state insurance commission (also called state insurance department). You can contact your state insurance commission for insurance information.