Navigating the Insurance Maze

Managing the bills for your cancer treatment doesn't have to be overwhelming. Just follow our step-by-step plan.

By
Health Monitor Staff

Whether you have metastatic cancer, or another stage of cancer, getting the most out of your coverage means keeping track of all the paperwork, as well as the conversations and transactions that take place between you and your insurance provider. This convenient checklist can be used to help you or your caregiver manage your insurance information during your cancer care.

Start here:
Read your insurance policy before treatment and try to determine what your plan will cover. Discuss costs with your doctor—often you’ll have several effective treatment options that may vary in costs and what your insurance may cover. If you're considering participating in a clinical trial, find out what your insurance company will cover as some carriers won't pay for these expenses.

  • Open, review and file bills and insurance notices immediately.
  • If you have COBRA coverage, pay premiums in full and on time.
  • Create a system for recording your expenses and claims by filing things under categories like “submitted” and “paid.”
  • Pay by check so you have a record, and attach any canceled checks to the related bill and file them.
  • See if your insurance company has assigned you a case manager. If so, keep them informed about your treatment.

If your claim is denied:

  • Resubmit it.
  • Make copies of any paperwork you send to your provider.
  • Record names, dates and conversations you have with your insurance company in a notebook.
  • Enlist the help of your doctor’s billing office to deal with claims or disputes.
  • Call a social worker or nurse on your healthcare team to discuss unresolved problems. Ask one of them or a family member to contact your insurer.
  • Request that your doctor, hospital and/or cancer treatment center provide scientific studies to your insurance company to demonstrate the effectiveness of your metastatic cancer treatments.
  • Contact your Medicaid office prior to receiving treatments to see if you’re eligible for reimbursements, or check with pharmaceutical companies to see if there’s a reimbursement specialist who can help you.

Confused?
Then ask to speak to a nurse navigator, social worker or financial advocate. Every hospital has at least one of these pros available who can help you resolve various issues. Some of their good deeds: locating interpreters, explaining consent forms, describing how to get assistance with copays or the cost of drugs, and even showing you the layout of the hospital so you’re less likely to get lost!

For more information on navigating the insurance maze, visit SurvivorshipAtoZ.org.

Published
October 2012