Navigating the Insurance Maze

To get the most out of your coverage, you’ll need to keep 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 manage your insurance information during your cancer care.

Start here:
Read your insurance policy before chemotherapy and try to determine what your plan will cover. Discuss costs with your oncologist—often there will be several effective treatment options that may vary in costs and what your insurance may cover.

  • 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 him or her 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 treatments.
  • Contact your Medicaid office prior to receiving treatments to see if you are 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, and they can help you resolve a multitude of frustrating issues. Some of their good deeds: They can locate interpreters, explain confusing consent forms, describe how to get assistance with high copays or the cost of expensive drugs, and even show you the layout of the hospital so you’re less likely to get lost!

You can also reach out to organizations that help with healthcare issues like insurance denials and medical debt. CoPatient and Patient Advocate Foundation are two such organizations.

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