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An unfortunate lingering effect for many cancer survivors is difficulty with health insurers. If you already have health insurance, you may face reduced coverage options and higher rates after your cancer treatment. If you are uninsured, your past medical history could keep you from obtaining health insurance.
Research studies have found that survivors are much less likely to have health insurance, and are more likely to face difficulties in obtaining insurance than similar people without cancer in their past. Yet health insurance is essential for survivors who may need follow-up care, including care for late effects of their treatment.
Health insurance issues can vary with your age, your employer, and your past insurance record. Some claim denials stem from administrative errors, incorrect billing codes and errors on forms. Always check to see if any of those apply. If there is a more substantive reason for the denial, proceed through the internal appeals process, which can take time and energy but could be worth the hassle. Ask for patient navigation assistance or someone close to you for help.
If you still aren’t getting the answer you want, you can move to the external medical review process, which is supposed to provide an independent review of your request. Many states have had external medical review for a number of years. Under health care reform, all states should now have an external appeals process. It can be worth going through the external appeal, since this decision is generally binding on the insurance company. For more information contact your state’s insurance agency.
Johns Hopkins is on the case
Representatives from Johns Hopkins’ Cancer Survivorship Programs have begun talking to several health insurer executives to discuss some of the issues and difficulties that need recognition. These include the need for cancer survivors, after their active treatment, to be covered for care related to lingering side effects, such as rehabilitation therapy for fatigue or psychotherapy services for depression or posttraumatic stress disorder. They also have suggested that nurses working as case managers for insurers take a more active role in the pre-certification process for patient treatment. This section will be updated as more information becomes available.
Resources to get insurance coverage or resolve disputes
If you already have insurance and are facing problems with your coverage, it’s always a good idea to speak with your employer or insurer first to see what can be done to restore your coverage or lower your rates. If you have been denied coverage by health insurance companies due to your survivor status, or if you are have trouble resolving a dispute with your current insurer, the following nonprofit agencies might be able to help:
CancerCare offers a Reading Room with information on insurance for cancer survivors, and some financial assistance programs for survivors.
Patient Advocate Foundation can help survivors work with insurers and employers on coverage appeals and bill payments.
The Kaiser Family Foundation offers a free guide to handling insurance disputes with your health care plan or employer, including a checklist for understanding your coverage and the details of appealing a coverage decision.
The Cancer Legal Resource Center, a program of the Disability Rights Legal Center, offers free information and resources on cancer related legal issues for patients, caregivers, healthcare professionals and employers. You can contact them directly at 1-866-THE-CLRC or firstname.lastname@example.org for more information.
Cancer and Careers has free charts available for download to track health insurance claims payments and interactions with health insurers.
The National Coalition for Cancer Survivorship has a section on understanding your insurance.