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Health Information
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Saturday, September 06, 2008
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Managing Insurance
Issues
What You Can Expect
- If you are like
most cancer survivors, the costs of initial treatment and
continuing care are a major concern. What happens to insurance
coverage and costs after you've had treatment for cancer?
- In general, people
who had life and health insurance before treatment are able
to keep it, although costs and benefits may changes. Those
who change jobs or apply for new policies, however, often
face problems.
- The stories of
the following cancer survivors show common post-treatment
insurance experiences.
- "I'm grateful
my insurance benefits are safe at my company. I only wish
my job had more going for it. I'm working hard to find something
that pays better and offers more growth. But along with finding
the right job, I'm also looking for a good benefits package
that is fully open to a cancer survivor. So far, the two haven't
come together."-Ron L.
- "I never even
thought about life insurance before I got cancer. My wife
and I are young, and we had enough expenses. But after my
diagnosis, I felt like I should get some insurance for my
wife's sake. It turned out to be harder than I'd expected.
Several companies refused to accept me at all. I have coverage
now, but the policy has an 'exclusion' for cancer, and it
pays nothing if cancer is the cause of death. My doctor says
it's very unlikely that my cancer will recur. But I'm still
looking for another policy where having had cancer doesn't
hurt me."-Burt W.
- "I knew I had
health insurance, but I had no idea what it covered. And when
I went into the hospital, the last thing on my mind was the
cost of the treatment. When the bills started coming in, I
was shocked that my company's insurance policy didn't cover
everything. At first, I felt like everything about my health
had gone out of my control, but I started to take charge again
by learning about the claims process and pleading my own case."-Bill
G.
- "My insurance
company paid for all of my cancer care, but my radiation treatment
made me unable to father a child. When my wife and I looked
into artificial insemination, we found that insurance would
not cover the cost of donor sperm. We decided to adopt a child
instead."-Brian K.
- "When my health
insurance company canceled my individual policy after my cancer
treatment, I started checking into other options. My best
bet turned out to be joining my new company's group policy,
even though employees have to pay all their own premiums.
The benefits are pretty good, and they accepted me despite
the cancer history. But I had to fill out a health history
and have a physical exam that none of my coworkers had to
complete. There was also a 5-year 'waiting period' before
I could submit any bills for cancer care. Luckily, I got through
5 years with no major expenses."-Jean T.
- "I had been covered
under my husband's health insurance policy, and we had no
problems until he changed jobs. When the new company saw my
cancer history, they denied him family coverage. I was finally
able to get insurance through my state health insurance pool."-Laura
S.
- "My health insurance
after cancer treatment worked pretty much like my car insurance:
After I had an accident, my rates went up." -Barbara K.
Briefs
- States That
Provide Health Insurance Coverage for the Hard-To-Insure
- A number of states
currently sell comprehensive health insurance to state residents
with serious medical conditions who can't find a company to
insure them. Listed below are states and the companies that
run their programs. (Several other states have programs planned
that are not yet operational.)
If your state isn't
listed, you may want to contact the State Department of Insurance
to find out if such programs are available in your state. Call
directory assistance in your state capital for contact information.
Arizona
- Arizona Department
of Insurance
- 2910 North 44th
Street
- Suite 210
- Emil Barberich
(Hotline Monitor)
- Phoenix, AZ 85018
- (800) 544-9208
- (602) 912-8450
California:
- California Major
Risk Medical
- Insurance Program
c/o Blue Cross of California
- P.O. Box 9044
- Oxnard, CA 93031-9044
- (800) 289-6574
Colorado:
- Colorado Uninsurable
Health Insurance Plan
- Philadelphia American
Life Insurance
- 3121 Buffalo Speedway
- Houston, TX 77098
- (303) 863-1960
- (800) 67-CUHIP
Connecticut:
- Health Reinsurance
Association of Connecticut
- Travelers' Insurance
Company
- One Tower Square
- 9MS
- Hartford, CT 06183-2937
- (800) 842-0004
- Florida:
- Plan currently
closed to new enrollment; for information on when legislature
may approve reopening of plan, contact:
Florida Comprehensive Health Association
971 E. Tennessee Street
Tallahassee, FL 32308
(800) 766-3242
- Georgia:
- Program not
yet operational. For information on startup, contact:
Georgia Insurance Department
#2 Martin Luther King Drive, SE
Atlanta, GA 30334
(404) 656-6054
- Hawaii:
- Current program
provides very limited benefits (basic preventive care); as
of July 1, 1994, plan will change to provide more comprehensive
coverage.
State Health Insurance Program
1000 Bishop Street, Room 908
Honolulu, HI 96813
(808) 586-4141
- Illinois:
- Illinois Comprehensive
Health Insurance Plan
- Blue Cross and
Blue Shield of Illinois
- P.O. Box 2401
- ICHIP Administrative
Unit, 18th Floor
- Chicago, IL 60690
- (800) 367-6410
- Indiana:
Indiana Comprehensive Health
- Insurance Association
9525 Delegates Row
- P.O. Box 40438
- Indianapolis,
IN 46240-0438
- (800) 552-7921
- (317) 581-1005
- Iowa:
Iowa Comprehensive Health Association
P.O. Box 40699
Indianapolis, IN 46240-0699
(800) 877-5156
Kansas:
- Program not
yet operational. For information on startup, contact:
- Kansas Health
Insurance Association
c/o LaHood and Associates
P.O. Box 12170
Overland Park, KS 66282-2170
(913) 362-0040
(800) 255-6065
- Louisiana:
- Louisiana Health
Insurance Association
- 7904 Wrenwood,
Suite D
- Baton Rouge, LA
70809
- (504) 926-6245
- Maine:
- Maine has a
guaranteed issue requirement; premiums may not differ based
on gender, health status, claims experience, or policy duration.
Individuals who had no coverage during the three months before
their new coverage takes effect may be subject to a pre-existing
exclusion of up to 12 months. For further information on this
law, which went into effect December 1, 1993, contact:
- Maine Bureau of
Insurance
- State House Station
34
- Augusta, ME 04333
- (207) 582-8707
- Minnesota:
- Minnesota Comprehensive
Health Association
- P.O. Box 64560
- St. Paul, MN 55164
- (800) 382-2000
- Mississippi:
- Mississippi Comprehensive
Health Insurance
Risk Pool Association
P.O. Box 13748
Jackson, MS 39236
(601) 362-0799
- Missouri:
Missouri Health Insurance Pool
1831 Chestnut Street
- St. Louis, MO
63103
- (800) 843-6447
- Montana:
- Montana Comprehensive
Health Association
404 Fuller Avenue
- Helena, MT 59601
- (800) 447-7828
- (406) 444-8200
- Nebraska:
- Nebraska Comprehensive
Health Insurance Pool
- Blue Cross and
Blue Shield of Nebraska
- P.O. Box 3248
- Main Post Office
Station
- Omaha, NE 68180-0001
- (800) 356-3485
- New Mexico:
New Mexico Comprehensive HealthInsurance Pool
Blue Cross and Blue Shield of New Mexico
- PO. Box 27630
Albuquerque, NM 87125-7630
- (800) 432-0750
- North Dakota:
- Comprehensive
Health Association of North Dakota
- 4510 13th Avenue,
SW
- Fargo, ND 58121
- (701) 282-1100
- (800) 737-0016
- Oregon:
- Oregon Medical
Insurance Pool
- 796 Winter Street,
NE
- Salem, OR 97310
- (800) 848-7280
- South Carolina:
- South Carolina
Health Insurance Pool
- PO. Box 61153
- Columbia, SC 29260
- (800) 868-2500
- (803) 736-0043
- Tennessee:
- Tennessee Comprehensive
Health Insurance Pool
- P.O. Box 6249
- Chattanooga, TN
37401-6249
- (800) 533-9892
- (615) 755-5918
- Utah:
- Utah Comprehensive
HealthInsurance Pool
- P.O. Box 27797
- Salt Lake City,
UT 84127
- (800) 624-6519
(in Utah)
- (800) 662-0876
(out of state)
- (801)481-6063
- Washington:
- Washington State
Health Insurance Pool
- PO. Box 31726
- Omaha, NE 68131
- (800) 228-4044
- Wisconsin:
- Wisconsin Health
Insurance Risk Sharing Plan
- Blue Cross Blue
Shield United of Wisconsin
- 1515 North River
Center Drive
- Milwaukee, Wl
53212
- (800) 828-4777
- Wyoming:
- Wyoming Health
Insurance Pool
- P.O. Box 2419
- Cheyenne, WY 82003
- (800) 438-5768
The following states have Blue Cross and Blue Shield plans that
offer some policy year-round or at a designated time period or
the hard-to-insure. Many states have restrictions/waiting periods
based on the individual's medical history.
- Alaska:
Short-term program that provides six-month coverage.
- Blue Cross of
Washington and Alaska
2550 Denali Street, Suite 600
- Anchorage, AK
99503
- (907) 258-5065
- District of
Columbia:
- Plan available
to residents of the Washington, DC metropolitan area: the
District of Columbia (DC), Montgomery and Prince George's
County in Maryland (MD), and most of Northern Virginia (VA),
Enrollment is available in spring and fall for MD/DC residents,
year-round for VA residents.
- Blue Cross and
Blue Shield of the
- National Capital
Area
550 12th Street, SW
- Washington, DC
20065
- (202) 484-9100
- Maryland:
- Enrollment
available in the spring and fall each year.
- Blue Cross and
Blue Shield Open
- Enrollment Policy
10455 Mill Run Circle
- Owings Mills,
MD 21117
- (800) 544-8703
- Massachusetts:
Year-round enrollment available.
- Blue Cross and
Blue Shield of Massachusetts
- Non-Group Coverage
- PO. Box 9140
- North Quincy,
MA 02171-9140
- (800) 822-2700
- (617) 956-3934
- Michigan:
- Year-round
enrollment available.
- Blue Cross and
Blue Shield of Michigan
600 East Lafayette
Department B613
Detroit, Ml 48226
(800) 637-2227
(517) 322-9470
- New Hampshire:
- Year-round
enrollment available.
- Blue Cross and
Blue Shield of New Hampshire
- 2 Pillsbury Street
- Concord, NH 03306
- (800) 225-2666
- New Jersey:
- Year-round
enrollment available.
- Blue Cross and
Blue Shield of New Jersey
3 Penn Plaza
Newark, NJ 07105
(201) 491-2729
- New York:
- Year-round
enrollment available.
- Empire Blue Cross
and Blue Shield
- Tradition Plus
- 622 Third Avenue
- New York, NY 10017
- (212) 476-7111
- North Carolina:
- Year-round
enrollment available.
- Blue Cross and
Blue Shield of North Carolina
- Access Plan
- P.O. Box 2291
Durham, NC 27707
- (919) 490-3829
- Pennsylvania:
- Year-round
enrollment available.
- Independence Blue
Cross and Pennsylvania Blue Shield
- 1901 Market Street
- Philadelphia,
PA 19103-1480
- (800) 453-2566
- (215) 568-8204
- Rhode Island:
- Enrollment
available one month of the year.
- Blue Cross and
Blue Shield of Rhode Island
444 Westminister Street
- Providence, RI
02903
- (800) 527-7290
- (401) 831-7300
- Vermont:
- Year-round
enrollment available.
- Blue Cross and
Blue Shield of Vermont
- P.O. Box 186
- Montpelier, VT
05601
- (800) 247-2583
(existing insured)
- (800) 272-3674
(newcomers)
- (802) 223-6131
- Virginia:
- Year-round
enrollment available.
- Blue Cross and
Blue Shield of Virginia
- P.O. Box 13047
- Roanoke, VA 24045
- (800) 334-7676
The following states
have coverage only for employees eligible under Small Employer
Group Health Reform.
- Alabama:
Alabama Insurance Department
- P.O. Box 303351
- Montgomery, Al
36130-3351
- (205) 269-3550
- Delaware:
- Plan will be operational
by summer 1994.
- Delaware Insurance
Department
841 Silver Lake Boulevard
Dover, DE 19901
(302) 739-4251
- Idaho:
Plan will be operational April 11, 1994.
- Idaho Insurance
Department
700 W. State Street
Boise, ID 83720
(208) 334-2250
- Ohio:
Ohio Insurance Department
- 2100 Stella Court
- Columbus, OH 43266-0566
- (614) 644-2651
- Texas:
Texas Insurance Department
- Mail Code 106-A
- P.O. Box 149104
- Austin, TX 78714-9104
- (512) 322-3415
Tips
for Making the Most of Your Insurance
- Get all the
benefits your policy provides.
- Get a copy of
your insurance policies and find out exactly what your coverage
includes.
- Keep careful records
of all your covered expenses and claims.
- File claims for
all covered costs. Surprisingly, many cancer survivors don't
take full advantage of their insurance, either because they
don't know about a benefit or are confused or put off by the
paperwork.
- Get help in filing
a claim if you need it. If friends or family can't assist,
ask a social worker for help. Private companies and some community
organizations also offer insurance filing aid.
- If your claim
is turned down, file again. 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.
- Keep insurance
needs in mind when you are changing job status.
- Don't leave a
job with insurance benefits until you have a new job with
good coverage or you have made other plans for insurance.
This is also an important thing for your spouse to keep in
mind if you are covered under his or her policy.
- Look at the differences
in insurance coverage and other benefits offered by various
employers. You may be better off taking a new job with a lower
salary that has better insurance coverage.
Consider continuing to take part in your current company's
group plan after you leave. If a new job does not work out,
you could be left with no coverage. Federal law (Public Law
99-272), the Consolidated Omnibus Budget Reconciliation Act
(COBRA), requires many employers to allow employees who quit,
are let go, or whose hours are reduced to pay their own premiums
for the company's group plan. This protection lasts 18 months
for employees (up to 29 months if they lose their jobs due
to disability and are eligible for Social Security disability
benefits at the time they leave the job) and 36 months for
their dependents. If an employee leaves a company and takes
a new job, continuation coverage by the former company can
be kept for up to 18 months if the new company's coverage
is limited or excludes a pre-existing condition, such as cancer.
(COBRA applies to employers with 20 or more workers who already
offer group health insurance.) Contact your personnel department
to enroll. In addition, you can contact your state insurance
commissioner to learn if your state has continuation-of-benefits
laws. They may help you receive additional insurance rights
protection.
- Take advantage
of your right in some company group policies to convert to
an individual policy when you leave the company or retire.
Typically, a cancer survivor can obtain coverage for about
a year under a converted policy. Premiums for individual policies,
however, may be considerably higher and less comprehensive.
You may want to check around with different companies for
the best coverage at the lowest rates because each may have
a different system for assessing premiums.
- Look for work
in a large company, whose group insurance plans rarely exclude
employees with a history of illness.
- Work with your
doctors to get 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. If you are taking part in
or considering a clinical trial:
- Ask your doctor
about the experience of 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.
- Be sure you know
what's in your policy. Check it to see if there's a specific
exclusion for "experimental treatment."
Many companies handle new treatments on a case-by-case basis,
rather than having a blanket policy. You always can 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.
Find ways to supplement your insurance.
- Take all the Federal
income tax deductions for health care costs that you are allowed.
Examples include gas mileage for trips to and from medical
appointments, out-of-pocket costs for prescription drugs and
equipment, and meals during lengthy medical visits.
- What Your Health
Insurance Coverage Should Include
- When looking into
a new health insurance plan, it's a good idea to make sure
that the coverage provided suits your health care needs. Health
insurance for the cancer survivor should provide, at the very
least, the following:
- Benefits.
Inpatient hospital care, physician services, laboratory and
x ray services, prenatal care, inpatient psychiatric care,
outpatient services, and nursing home care. Prescription drug
coverage may be important if you will be taking a medicine
for a long time.
- Financial protection.
The insurer should pay at least 80 percent of the covered
services, except for inpatient psychiatric care, which may
require that the policyholder pay more than 20 percent of
expenses. In addition, the insurer should pay at least $250,000
for catastrophic illness coverage, with the patient paying
no more than 30 percent of his or her income toward these
expenses.
Confirm conversations with insurance representatives in writing.
If you think the representative is wrong, ask to speak with
his/her supervisor.
- Consider filing
an insurance complaint if you feel you have been treated unfairly.
- If your insurer
is a private company (e.g., Blue Cross, Prudential), it is
regulated by your state department of Insurance.
- If your insurer
is a licensed health care service plan (e.g., Kaiser and other
HMOs), it is regulated by your state department of insurance.
- If your insurer
is a federal qualified Health Maintenance Organization, it
is regulated by the U.S. Health Care Financing Administration,
Office of Prepaid Health Care Operations and Oversight.
- If your insurer
is a private employer or union self-insurance or a self-financed
plan, it is regulated by the U.S. Department of Labor, Pension
& Welfare Benefits Administration.
- If your insurer
is Medicaid (sometimes called other names; e.g., in California
it's known as MediCal), it is regulated by your state department
of social services or medical assistance services.
- If your insurer
is Medicare, it is regulated by the U.S. Social Security Administration.
- If your insurer
is Supplemental Security Income, it is regulated by the U.S.
Social Security Administration.
- If your insurer
is Veterans Benefits, it is regulated by the Department of
Veterans Affairs, Veterans Assistance Service.
- If your insurer
is CHAMPUS, it is regulated by the Department of Veterans
Affairs, Veterans Assistance Service.
Options for Getting Insurance After
Cancer Treatment
- Obtain dependent
coverage under your spouse's insurance plan.
- Join your current
company plan.
- Join a health
maintenance organization. Look for open enrollment periods
when you may be accepted regardless of your health history.
- Request group
insurance through a professional, fraternal, membership, or
political organization to which you belong.
- Use Medicare.
It covers most people age 65 or older and those who are permanently
disabled.
- Use Medicaid or
other state or local benefits. Coverage and eligibility criteria
differ from state to state; check with your local office.
- Get coverage through
an independent broker.
- Join a state "high
risk" health insurance pool for people who cannot get conventional
coverage.
Resources
ADDITIONAL READING
- With so many issues
involved, cancer survivors may not be aware of their needs
for specific insurance coverage and benefits. Materials that
can help include:
- Comprehensive
Health Insurance for High Risk Individuals: A State-by-State
Analysis
- Communicating
for Agriculture
2626 East 82nd Street, Suite 325
Bloomington MN 55425
(800) 445-1525
There is a $24 charge for this product which includes shipping
and handling; prepayment is required.
- National Insurance
Consumer Organization (NICO)
P.O. Box 15492
Alexandria, VA 22309
(703) 549-8050
Offers general information only. For a list of NICO publications,
send a self-addressed, stamped envelope.
- Health Insurance:
Risk Pools
Pub.#HRD-88-66BR
U.S. General Accounting Office
P.O. Box 6015
Gaithersburg, MD 20884
(202) 512-6000 FAX
(301) 258-4066
ADDITIONAL RESOURCES
- Many people need
help paying for medical costs that aren't covered by their
insurance. For financial assistance, you may want to contact:
- Local Groups
- Local cancer support
organizations, which may provide referrals to community sources
for financial aid.
- Your local office
on aging, if you are an older adult.
- The county board
of assistance or welfare office.
- United States
Government
- The U. S. Government
has a number of programs designed to help people with low
incomes or disabilities pay their bills. For information,
call your local office of:
- Aid to Families
With Dependent Children (AFDC) and Food Stamps Programs. Look
for the numbers under the Local Government, Social Services,
section of your telephone book.
- Medicare/Medicaid
Information. Call your local Social Security Administration
office to receive an explanation of the medical costs covered
by these Federal health insurance programs. Note: For people
under age 65, Medicare coverage does not begin until 2 years
from the date they are declared disabled.
- Social Security
Administration. Call 1-800-772-1213 for general information
on Social Security benefits you may be eligible to receive.
- The Department
of Veterans Affairs. Request information about medical benefits
for veterans and their dependents.
- The Cancer Information
Service of the National Cancer Institute. Call 1-800-4 CANCER
to request information about drug companies with assistance
programs for cancer patients with low incomes.
- Your Hospital
- Financial help
may also be available within hospitals. To find out about
setting up monthly payment plans for hospital bills, contact
your:
- Hospital patient
advocate.
- Hospital financial
aid counselor.
- Hospital social
worker.
- Patient representative
in the hospital business office.
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