Cancer, Insurance, and You
Last updated: May 2023
Did you cringe when you read the title of this article? I did when I wrote it. Dealing with insurance is one of the things I hate most about being sick. I want to share some tips that might make this odious task a little easier.
1. It isn't as simple as just picking one plan over another one
There are so many things to consider when choosing an insurance plan. We don't simply see one specialist. Most of us have a medical oncologist, possibly a radiation oncologist, a surgeon, a pulmonologist, radiologists to read our scans, internists, and the list goes on. And, even if they all work in the same hospital or clinic complex, they may not all take the same insurance plans.
I heard this phenomenon described like this. Think about your favorite shopping mall. There are many stores all under the same roof. But, each of the stores has its own set of products and prices. What one store charges for its products and the types of payments accepted has nothing to do with what the one right next door charges.
The same may be true at your clinic. You may stay within its walls, but visit any number of different specialists, each of which is likely to be considered an independent business. One may accept your insurance, while another may be considered out-of-network.
Specialists you will need that may be out-of-network or balance billed include anesthesiologists, pathologists, hospitalists (doctors who specialize in hospitalized patients), radiologists, and ambulance services. It is important to know before you choose your insurance plan if the doctors you use most often are in-network.
2. Choosing your plan
When choosing your plan, you should consider:
- monthly premiums
- out of pocket expenses
- out of pocket maximums
- in-network vs out-of-network costs
Before you make your final choice, consider sitting down with financial counselors at your clinic. Ask for their advice about the insurance companies with whom they prefer working or that cover most of the available services.
3. Supplemental health plans
If you are still working, there are a variety of supplemental health plans that may be offered through your employer during your annual open enrollment period. These include long- and short-term disability plans, cancer policies, and long-term insurance.
While these policies may have been an excellent idea before you were diagnosed with cancer, they may not be such a good idea now. They can (and usually will) deny you coverage for pre-existing conditions. Before you sign up for one of them, be sure to carefully read all of the fine print so that you don't pay for a policy that will not cover you.
4. Use a checklist
It is so confusing when trying to decide which insurance plan to choose. You can help organize and drive your decisions by using the Cancer Insurance Checklist. This checklist is specifically designed to help you when shopping for insurance on your state’s Health Insurance Marketplace. It allows you to evaluate insurance plans online and helps guide discussions with your navigator and/or marketplace/exchange representative.
5. Ask for a case manager
Once you choose a plan, ask for a case manager to be assigned to your case. This person, who works for your insurance company, will be your go-to person every time you have a question or a problem. This individual will help ensure that you are receiving quality care in the most efficient and economical way possible.
Dealing with insurance is a necessary evil, especially for those of us with cancer or other long-term diseases. I hope some of these tips will make your journey easier.
Beside manner matters! What has your experience been?