Chemotherapy (cont.)
Paying for chemotherapy
The cost of chemotherapy varies with the kinds and doses of drugs used, how
long and how often they are given, and whether you get them at home, in a clinic
or office, or in the hospital. Most health insurance policies cover at least
part of the cost of many kinds of chemotherapy. There are also organizations who
will help with the cost of chemotherapy and with transportation costs. Ask your
nurse or social worker about these organizations. Finding the answers to the
questions below will help avoid problems in receiving payment later on.
What Questions Should I Be Able to Answer About My Insurance?
- What are the benefits of my insurance plan?
- What cancer treatments/care does it cover?
- Do I have a primary care provider? Can I use only certain "preferred
providers" under my plan?
- Am I entitled to a yearly checkup or does my plan only cover office
visits when I am sick?
- What are the benefits if I go outside of my health plan to obtain
care?
- What are the rules of my insurance plan?
- Do I need a referral from a primary care provider?
- Do I need a written referral form?
- Do I need to get approval from my health plan (pre-certification)
before seeing a specialist, obtaining treatment, tests, and medical
equipment or physical therapy services or going to the emergency room or
a hospital?
- Does my lab work, including blood work, or pap smear need to go to a
special lab?
- Do I have to pay a certain amount (co-pay) at the time of my visit?
- Do I have an amount that I must pay for medical expenses (annual
deductible) before the insurance pays for services?
- Do I have a lifetime or annual limit on how much is covered for medical
expenses?
- Is there a special pharmacy where I need to get my medications?
- Are all tests and procedures covered both as an in-patient and
out-patient?
Getting Maximum Coverage of Clinical Trials Costs
Many clinical trials (treatment studies) offer some part of care free of
charge. But some insurers will not cover certain costs when a new treatment is
under study. Your doctor can work with you to try to help you. If you are taking
part in or considering a clinical trial:
- Ask your doctor about other patients in the trial. Have their insurers
paid for their care? Have there been any consistent problems?
- Talk to your doctor about the paperwork he or she submits to your
insurer. Often the way the doctor describes a treatment can help or hurt
your chances of insurance coverage.
- Find out what is in your policy. Check to see if there is a specific
exclusion for "experimental treatment."
Many insurance companies handle new treatments on a case-by-case basis,
rather than having a blanket policy. You can always ask about their coverage of
specific therapies. However, some patients say that their questions may have
hurt their chances for coverage by raising a red flag. A call from your nurse or
social worker to your insurance company about specific coverage may be helpful.
Getting the most from your insurance
- Get a copy of your insurance policies before treatment and find out
exactly what your coverage includes.
- Keep careful records of all your covered expenses and claims.
- File claims for all covered costs.
- Get help in filing a claim if you need it. If friends or family cannot
help you, ask a social worker for help. Private companies and some community
organizations offer insurance-filing aid.
- If your claim is turned down, file again and inquire about the reasons.
Ask your doctor to explain to the company why the services meet the
requirements for coverage under your policy. If you are turned down again,
find out if the company has an appeals process.
In some states, Medicaid (which makes health care services available for
people with financial need) may help pay for certain treatments. Contact the
office that handles social services in your city or county to find out whether
you are eligible for Medicaid and whether your chemotherapy is a covered
expense.
For more information on paying for chemotherapy, see
Facing Forward: Life After Cancer Treatment.
SOURCE: National Cancer Institute (www.cancer.gov)
Last Editorial Review: 8/8/2006
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