Special thanks to the support group member tips on this subject.
Please know that
for people without medical insurance, or adequate coverage there is help,
and that this help is deserved and you should not hesitate to
ask for it.
"Don't forget the local chapter of the American Cancer
Society. Most, but not all, offices have funds available for the following:
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reimbursement of travel expenses up to $50 per trip; |
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provide transportation by supplying driver and vehicle to transport patient to and from doctor's appointments, office visits, etc. |
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arrange for free or discounted motel/hotel
accommodations for out-of-town treatment; |
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provide a volunteer to assist with filling out applications for welfare, social security, or disability. |
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"Unfortunately, most patients will not ask for help. The patient must speak with the local office and fill out a request form to be processed. Some branches have more funds than others. The laws that protect patient privacy apply to this application process."
- Jama Beasley
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Re: Denied SS Disability
"It took two years, but only with the help of a disability lawyer did
we get
disability. Once we signed on with one, it did not take much time at
all." - RL (cyberfamily)
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"You know the big "C word" keeps you out of
many things. It's not suppose to but it does -- they call it discrimination.
So if you have already been diagnosed, your in for a real fight to obtain
any insurance other than Social Security, Medicare A, and B"
- Keith
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Success Story:
"I was told by the social worker at Stanford that small or mixed follicular NHL was a slam dunk for disability given I was undergoing a bone marrow transplant. I followed her advice and have been on Social Security benefits for over a year. However, my application was bounced back twice for more information. It includes a multitude of questions about previous employment and experience which looks like they're looking to see what else you could be doing if your disability precludes you from doing what you're currently doing.
For instance, I'm a landscaper, but have been in sales. I stated emphatically that designing and building landscapes is what I do, and the fact that I'd done other things without passion and sometimes not very well, was irrelevant. Process took three months but benefits were retroactive. I believe you have to have not worked for 6 months before you're eligible, and that's the point the benefits begin accruing.
Reading the accounts on the Lymphomation site made me think you might get discouraged and not try, so I wanted you to know it's possible. The money's not huge, $1,700/mo, but my two sons both get $400 each too, so it's covering the mortgage and their future college or whatever. Definitely worth the fight, in my mind."
- Mark (CA) NHL-follic
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To
treat cancer effectively you need an accurate diagnosis, access to experts,
and state of the art medicines, which are costly and not always readily available to all who need them.
If your insurer denies payment for your treatment, don't
give up. Most people do get payment eventually.
"If you have purchased your own
insurance in the individual market, you are protected by state law. For
example, many states have instituted a patients' bill of rights. For
details on your protections for obtaining and retaining health coverage,
check out information for
Your
State." -
Health
Insurance Info.net
In the News
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Social Security's Compassionate Allowances Program Means
So Much To People In Time Of Need
http://bit.ly/oW0YMo |
Tips to receive insurance coverage for
treatments
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Be well informed and familiar with your health insurance
policy. |
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Prior to treatment, verify that your doctors, the
healthcare facility , and the type of treatment you are receiving are
all covered in your plan. |
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Ask your medical team for a referral to a therapist or social worker who specializes in
helping cancer patients with their finances. These specialists are a wonderful resource and will be able to help you cut through the red tape.
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What to Do If Your Claim Is Not Paid?
Insurance companies may deny claims because they know there's a good
chance the consumer won't appeal the decision.
FIRST, inform your health care team if you have been denied payment.
ASK your doctors for Help and to tweak and resubmit the claim: They can consult with your insurer and help answer
questions about the treatment.
BE PERSISTENT: Do not take a denial as final, many times they are
not.
GET LEGAL HELP, if necessary ... initiating this action alone can change
the decision.
OFF-LABEL USE? Ask your health care team or hospital staff to provide insurance companies with
studies showing that a particular drug is effective for your type of cancer.
These actions are often sufficient.
What Else?
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Contact The
Patient Advocate Foundation
patientadvocate.org
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Contact the
pharmaceutical company for drug you received, and ask for information about reimbursement specialist
hotlines . |
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As noted, if necessary, sue the insurance company to get payment
for your treatment. Courts often side with patients and order insurance companies to pay for treatment. |
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Contact the State Commissioner
of Insurance for Your State. See next item. |
Contact the State Commissioner of Insurance for Your State
One of the roles of the State Commissioner is
to "facilitate the fair and equitable treatment of insurance
consumers"
You can write or call the commissioner to report policies that you feel
are unfair.
What if you have insurance and lose
your job?
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The Consolidated Omnibus Reconciliation Act (COBRA), was
enacted to help.
"COBRA gives you the right to choose to temporarily keep the group
health insurance benefits that you would otherwise lose after you reduce
your working hours, quit your job, or lose your job. It also lets family
members choose to keep health insurance after your job loss or other qualifying
event that would normally cause them to lose the coverage they
have through your employer."
See COBRA
ACS
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What if you don't have insurance?
First, do not panic, because help is
available from many sources.
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NEW Healthcare.gov:
State by state health
insurance options for people with pre-existing conditions
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Contact your
hospital's social service
office, which may be able to direct you to other sources of help. |
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Contact
Patient Advocacy
Foundation:
800-532-5274
a national
non-profit organization that serves as an active liaison
between the patient
and their insurer, employer and/or creditors
to resolve insurance, job
retention and/or debt crisis matters
relative to their diagnosis through
case managers, doctors and
attorneys. |
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Contact
Medicaid: 877-267-2323
Web:
cms.hhs.gov
Medicaid makes health care services available for people with financial need. They may help pay for certain treatments.
Contact the social
service office in your city or county to find out if you are
eligible and if your treatment expense is a covered.
Begin early.
The Medicaid approval process can take a long time.
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Review the
free
drug program:
f the drug or company that makes the drug you need is on
the lists that follow, you probably can get assistance to pay for it with the
information provided here by NeedyMeds: Drug Index |
Drug
Company Index |
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Contact the National Cancer Institute and
inquire if you might be
eligible for a clinical trials, preferably,
perhaps, a study that is testing the standard of care against a
promising new protocol.
NCI's hotline (1-800-4-CANCER).
* Contact the an
NIH Cancer Research
Center:
Also Contact the Patient Recruitment and Public Liaison Office at:
1-800-411-1222, TTY 1-866-411-1010
Every patients is on a research protocol.
Every citizen and permanent resident is eligible.
Patients from other countries are also welcome.
No one is ever denied.
Travel is paid when needed, as is lodging.
Includes a Children's Inn.
Specializing in rare diseases, and other serious conditions,
such as cancers. |
Other types of financial help
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Free transportation or discounts for travel associated
with cancer
treatments PAL |
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Clinical Trials may provide treatment without cost,
especially studies sponsored by the NIH
PAL |
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Help with
payment for drugs PAL |
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Financial Assistance and Other Resources
for People With Cancer
cancer.gov
(highly recommended) |
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See also
Financial
resources below. |
Tips about gaining social security
disability insurance
SSA stands for Social Security
Administration
Note: State laws may vary
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Disability claims require documentation based upon the
medical records of the patient.
How We Decide If You Are Disabled? See socialsecurity.gov/
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There are often two disability programs -- state and
federal.
To apply for Federal, see: socialsecurity.gov
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In general, patients meet SSA standards for disability
claims when it's determined that the malignancy is inoperable or beyond
control of any other type of therapy. |
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You can plan on at least three rejections, but you
must go through the process for SS Disability. And plan on hiring an
Attorney to represent you in front of the administrative law Judge which
is the final process. The patient's doctor will be
instrumental in obtaining SSD. - Keith (patient) |
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I have found that knowing how to reach the
Commissioner of Insurance in my State to be an
asset in my favor. - Keith (patient)
See for Map to your State Commissioner of Insurance:
http://www.naic.org/state_web_map.htm
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Read the list of impairments for social security
disability. List every disability you have, and every
impairment, not just NHL.
See 2001bluebook.pdf
(PDF-Help) - Sue (Caregiver) |
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A disability application is no place for personal
pride. State your disability strongly It is no place to be
"optimistic" as to your current or future abilities. - Sue
(caregiver) |
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The SSA will consider side effects from cancer therapy. |
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If cases go to court, the judge is the arbiter of what
is a reasonable fee, and usually cut the fee back. Using an
EXPERIENCED Social Security lawyer is a good idea.
For SS cases the fee is ordinarily limited to 25% of retroactive
benefits. One would have to wage a four year successful case to
get that kind of a fee, though with our SS system, it's not unheard of.
- Toby
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I can tell you long term disability insurance is a
paper work nightmare and full time job for the patient, or
family member to keep up to date. So too are the redundant
mailings to maintain your disability once you get through the first year
and have received a favorable decision from the administrative law
judge. - Keith (patient) |
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