Keeping Up With Health Insurance During Cancer Treatment

Keeping Up With Health Insurance During Cancer Treatment

Dr. Singhal Explains Why The Necessity Of Having A Good Health Insurance Plan Is Important During Cancer Treatment

It is very necessary for adults and children with cancer to possess a health coverage plan that covers required cancer treatments. It’s essential to keep the health insurance coverage with no conceivable gaps.

Proper Money Control

It's also significant to keep a meticulous record of medical checks, insurance applications, and payments to help families control their money correctly and reduce their stress levels. This is also really helpful when there are problems, such as disputes or inaccuracies in billing or recording installments.

Health Insurance Plan Is A Contract Between Patient And The Insurance Company

Health insurance is a contract. Protection policies are partly ruled by contract law. Patient or their business accepts to pay a set premium, partake in cost-sharing, such as salary write-offs, co-pays, and deductibles, and regard the contract guidelines. In return, patients’ health insurer grants to meet specific duties in their policy and those dictated by law. It’s helpful to think of insurance coverage as a contract because it enables patients to safer advocate for themselves and for suitable coverage. It also helps you set sensible coverage expectations. For instance, if patients’ health coverage policy says that radiation therapy for a certain period of time or level of care is met with no co-payment or unique allocation, then their insurer cannot come back and charge you for extra payments. But, if patients’ plan explicitly states that it does not cover a service, then that service may not be included except if it meets the standards for an exclusion. It is necessary to review the exclusions segment of the policy to be certain what the policy means. Also, Dr. Shyamali Singhal reminds patients to keep in mind that even services that are included under the policy usually ask for pre-authorization.

The Patient Protection And Affordable Care Act 

The Patient Protection and Affordable Care Act is a law about health care. Colloquially people call it “health care reform” or the "ACA." This law passed in March 2010, and it replaced several health insurance rules in the United States.

The Affordable Care Act says most U.S. citizens and legal citizens must have health insurance. Some states may impose charges to people who can sustain health insurance but do not buy it. If patients are uncertain about the laws in your state, they can review the ACA website.

Other things to know are:

• A patient can buy insurance from the health insurance marketplace. A different name for that is the “insurance exchange.” It encourages people and small businesses to acquire insurance.

• Patients can get help financing insurance if they make less than a specific amount. Right now, this is $47,080 or less for 1 person. For a family of 4, it is $97,000.

• A patient might be able to get Medicaid from their state. Some states give Medicaid to adults who earn $16,654 or less for 1 person or $32,252 for a family of 4.

Secondary Insurance

With a cancer diagnosis, patients may discover that the health coverage plan they have doesn’t include enough of their medical costs. It might be reasonable for patients to analyze changing to a plan that may have bigger premiums but will include more of their costs over the long run. If they’re covered through Medicare but never purchased any supplemental insurance, this also might be something to consider. Without secondary insurance, patients are responsible for 20% of treatment-related costs. Generally, patients would have to wait until an open enrollment period, which is the time of year that health plans accept new applicants. This can vary depending on whether patients are considering a job-based plan, a Medicare supplement, or an individual plan through the Health Insurance Marketplace.

Appealing Insurance Denials

It is not unusual for claims to be rejected or for insurers to say they will not cover a test, procedure or service that the doctor ordered. However, patients can appeal their health insurance company’s decision and they may be able to get the decision overturned.

Patients should check with their health care team to see if there is someone on staff who can help them out. If the appeal is for coverage of a specific medication, some producers may be able to help patients with their application. If patients choose to register the petition themselves, they should keep in mind that assistance will improve their chances of success. It is natural to be frustrated, annoyed or irritated that a request was rejected. However, how patients decide to deal with that difficulty may influence the success of the appeal.

If the appeal is rejected, patients still have other options. They can ask for a final decision in writing and then file an external appeal. But, if the matter is essential, patients don’t have to wait to get a final decision from their insurance society before planning an external request. An external appeal includes a revision of the previous claim by an independent organization outside of the patients’ insurance company. All private health insurance policies are now obligated to have external appeals processes.

Patients can also inquire about help from the state’s Consumer Assistance Program, state’s insurance agency or the Department of Labor if patients are insured with federal policy.

Health Policy Requirements Mandated By Law

Public policy overrides health insurance plan language. Due to the unique nature of health insurance, there are definite demands mandated by law that patients are allowed to, even if their health insurance policy states differently. For example, patients can examine “cancer treatment fairness,” or oral parity, which means that the insurance will include oral chemotherapy at the same level as intravenous (IV) chemotherapy. If state mandates coverage for oral parity, then it doesn’t matter if the policy particularly suspends oral parity because that clashes with the state law. In some examples, public policy can overrule plain language even if there is no law in place. For example, if the policy states an appeal must be posted within 180 days but if a patient was in a coma during this time, then they should still be permitted to submit their appeal within a fair time after waking from the coma, even if the deadline has passed.