Resources for Patients and their Families

Health Insurance Planning

Health Insurance Planning

When you’re diagnosed with cancer, including mesothelioma, one of the first concerns you may have is whether or not your health insurance will cover the cost of treatment including the primary medical costs and secondary costs that are involved in treating mesothelioma cancer. It can be a frightening scenario, especially when you’re faced with costs that are have the potential to soar into the hundreds of thousands of dollars.

It is important to have a solid understanding of the treatment coverage you have under your primary health insurance as well as other supplemental types of insurance such as Medicare, Medicaid, VA benefits and Social Security. Every policy is different and should indicate what is and is not covered. In many cases, however, there are gray areas. If you are unsure about any aspect of your coverage please contact the carrier, your benefits representative, or your insurance salesperson so they can clarify any confusing areas.

It is also essential to remember that dealing with insurance companies often requires time and energy. If communicating with them directly is something you – the patient – is not up to, or if you feel as if you don’t understand your policy fully enough to ask the right questions, ask for help from a trusted family member or friend. It can sometimes take hours on the phone to straighten things out, so please don’t hesitate to seek help from others if needed.

Questions to Ask

Indeed, cancer care can be complicated, especially when there are numerous specialists and other medical professionals involved. The bills come in regularly and can often become overwhelming. However, if you stop and ask some questions before the whole process begins, things may proceed more smoothly. Consider asking these questions:

  • What is covered and to what extent? (i.e. mesothelioma doctor visits, treatments, hospitalization)
  • What are the co-pays? (if any)
  • Must visits to specialists, treatments, or hospital stays be pre-authorized by my insurance company?
  • May I choose the specialists I see?
  • If I’m not pleased with a particular doctor may I make a change?
  • Am I permitted to go out of my network for care, especially if there is a top specialist for my disease who is not in my network?
  • What treatment scenarios (home health, physician’s office, hospital setting) are best suited to the kind of coverage I have?

Types of Insurance

Provided below are the types of insurance that may be available to help pay for your medical costs:

Primary Health Insurance

If you have a managed care plan (MCO) type of insurance coverage, you have one of three kinds: HMO – health maintenance organization; PPO – preferred provider organization; or POS – a point-of-service PPO. They all work a little differently but there are some constant threads. With MCOs, you will most likely have to choose specialists from a network of pre-approved providers. Very often, there may be some sort of penalty for going outside of your network to seek care from an individual who is an expert in the treatment of your disease. For example, because mesothelioma disease is a rare form of cancer, patients may have to travel a distance to find a specialist who can treat them properly. In this case, your MCO may demand that you get pre-approval for a non-network specialist or, in the case of some POS policies, pay higher co-pays if you choose a specialist outside the network.

These policies sometimes restrict the types of services and treatments to which you have access, so it’s necessary to gather all information about your treatment protocol before moving ahead. For example, they may not approve the use of certain anti-cancer drugs, may not cover expensive scans, or may restrict the use of non-FDA approved drugs including participation in clinical trials.

Medicare / Medicaid

If you have government funded insurance, like Medicare or Medicaid, you’ll want to contact the source of the policy to get specifics. Be aware that these programs cover millions of cancer patients each year, so don’t be concerned, even if you don’t have a supplemental program. In addition, there are many government programs available for underinsured cancer patients. You may also be able to purchase a “Medigap” policy that covers the gap in your health care.

Medicaid many be a different story. Often, many office-based mesothelioma clinics will not take Medicaid patients or will not accept the coverage as secondary insurance for mesothelioma chemotherapy and radiation treatments. If Medicaid is your only source of coverage, be sure to obtain help from a social worker or government Medicaid employee in researching the specifics before you begin treatment.

VA Benefits

Veterans may receive treatment at a VA hospital or be able to obtain some of their prescription drugs at their local veteran medical center.

Social Security

Victims of mesothelioma are frequently no longer able to work. As a result they experience a loss of income that can result in financial hardship making it even more difficult to keep up with medical bills. Social Security disability benefits can help fill that gap.

Be an Advocate

Remember, above all, that sometimes you’ll have to fight the insurers. It’s often necessary for patients or their family members to become advocates and argue for their rights, often for days at a time and via a number of different channels. If an insurer turns down payment for a certain drug or treatment, for example, call them on it and find out why and what you can do to change that. Insurance carriers do change their rules from time to time. It pays to be persistent.

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