Navigating health insurance can be complex, especially during cancer treatment. Find resources to help you understand your options, appeal denials, and access disability benefits.
Information about Social Security Disability Insurance (SSDI) and Compassionate Allowances
Medicare and Medicaid questions, long term care, your State Health Insurance Assistance Program (SHIP) provides free counseling on all these issues:
A reminder of helpful information about Social Security Disability guidance
If you have been contributing to Social Security long enough and recently enough, if your disability makes it impossible for you to work, and if the disability looks like it will last for a year or longer, you can qualify for Social Security Disability. Your doctor will have to write a statement describing your disability for Social Security.
If you have not worked long enough to qualify for SSDI, and if your assets are low, you might qualify for Supplemental Security Income instead. SSI provides immediate eligibility for Medicaid. You can return to work if you feel able; just let SSI know.
The Social Security Administration has the official word. There are answers to just about any question a person has. It's actually pretty understandable, but it's very spread out over page after page of specific answers for specific situations.
If you do not have health insurance, below are some options that might be available to you.
Marketplaces provide one location for people to learn about private and some public health insurance plans available to them.
Visit HealthCare.govA federal health insurance program for individuals 65+ or those with disabilities.
Visit Medicare.govA federal health insurance program with eligibility criteria and benefits that vary from state to state.
Visit Medicaid.govIf you have health insurance coverage through your employer or a spouse's employer, COBRA may allow you to maintain that coverage.
Consult your benefits manager for details.
ACS Health Insurance Assistance Service: 1-800-ACS-2345
Visit Triage CancerIf you have health insurance, it's important to learn about the specifics of your policy, including:
A good place to start is with your health insurance card. Your insurance card will have numbers you can call to learn more about your policy. Many health insurance companies offer insurance case managers to assist insured individuals diagnosed with cancer. These trained individuals (often registered nurses or licensed social workers) will follow your case closely, helping to coordinate care and insurance benefits.
Contact your insurance company to ask if they will assign you a case manager. Learning more about what your policy does and does not cover will help you better work with your insurer to make sure you receive all the benefits and coverage to which you are entitled. You will also be better prepared to deal with any questions or disputes you may encounter.
It is not unusual for claims to be denied or for insurers to say they will not cover a test, procedure or service that your doctor ordered. However, you can appeal your health insurance company's decision and you may be able to get the decision overturned.
See if there is someone on staff who can help you with the appeal process.
If the appeal is for coverage of a specific medication, some manufacturers may be able to help you with your appeal.
If you choose to file the appeal yourself, remember that courtesy and a cool head will increase your chances of success.
If your appeal is denied, you can ask for a final decision in writing and then file an external appeal with an independent organization.
You can request help from your state's Consumer Assistance Program, your state's insurance agency, or the Department of Labor.
Helpful guidance for patients/caregivers: Watch Video
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:
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 coverage.
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.
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.
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. You can also reach out to organizations that help with health care issues like insurance denials and medical debt. CoPatient and Patient Advocate Foundation are two such organizations.