It’s normal to feel confused about what your health insurance covers and the details of your plan. But it’s important to understand your policy and to create an organized way to pay and follow up on health care bills. Dealing with insurance often takes time and effort and can be a large burden when going through cancer care. Ways to manage this include:
Call your health insurance company and talk with a benefits coordinator.
Have your policy in hand. Review which tests, treatments, and drugs are covered and which are not. Ask if your plan will cover any specialists your doctor might refer you to.
Ask about your co-pays, deductibles, coinsurance, and any other costs.
It’s important to know these costs when your care begins so you’re not surprised:
- a copay is the amount you pay for each healthcare service, such as a doctor's appointment or a prescription
- a deductible is the amount you pay for your medical care before your health insurance plan begins to pay
- coinsurance is the percentage of costs you pay for a service that your health insurance covers after you have paid your deductible; for example, you pay 20% and your insurance pays 80%
You may also want to ask if co-pays are due up front and how much they cost. Knowing these charges ahead of time will help you make plans for payment.
Be aware that the No Surprises Act bans surprise bills for emergency services and other care received from out-of-network providers in an in-network setting. Learn more about the No Surprises Act and how you’re protected from unexpected costs.
Ask how and when to make payments for your medical bills.
Find out how you should pay your balance. For example, do you file a claim? Does the insurance company pay first? Or do you pay the bill and then get reimbursed?
Understand your Explanation of Benefits (EOB) forms.
Your EOBs are the forms you get from your insurance company that list the cost of services and treatments you had and how much of the fee was paid for under your policy. EOBs are not bills.
Know the steps to take to get uncovered treatment approved.
Your doctor and hospital billing department will be able to help you with the steps you need to take to get your treatment covered. Most likely, if your doctor feels that you need a test or procedure that is not covered by your insurance policy, you will ask if they will write a letter stating why it is needed. You will then submit this letter to the insurance company. If the company does not agree to cover the treatment or procedure, you can go through its appeals process.
Request to have a case manager at the insurance company assigned to you.
This way you can talk with the same person each time you have a question or concern.
Contact Medicare.
For questions about Medicare coverage, go to Medicare.gov or call 1-800-MEDICARE. Medicare is government health insurance for people age 65 and older. Among other things, you can learn about the drugs that are covered in your plan, what to do if you have other insurance, and the claims and appeals processes. The State Health Insurance Assistance Program (SHIP) provides state specific information, referrals, and counseling to Medicare recipients and their caregivers.
Contact Medicaid.
For questions about Medicaid coverage, go to Medicaid.gov or call the Center for Medicare & Medicaid Services at 1-877-267-2323. Medicaid gives health benefits to people with a limited income and their families. The program is run by each state, and therefore states may differ in who is eligible and in what benefits they cover.
Review insurance guides from trusted organizations.
Look online for guides that explain how insurance plans work. Some examples are:
- Coverage to Care (C2C) from the Centers for Medicare & Medicaid Services
- Health Insurance from MedlinePlus
- Health Insurance: Understanding What It Covers from the American Academy of Family Physicians
If you don't have health insurance, visit HealthCare.gov. This is a database of healthcare coverage options provided by the U.S. Department of Health and Human Services. Consumers can search online for health insurance options specific to their life situation and local community.
If you can’t afford insurance and are not eligible for Medicaid or Medicare, ask about charity care and sliding-scale programs (in which fees are based on your income) at hospitals and clinics. Some hospitals are required to see patients who are uninsured. Contact your local department of public health or social services, or the business office of your hospital of choice for more information.