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Insurance
Last update: 05/10/2008
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INSURANCE
TOPICS
Tips
on Receiving Insurance Coverage | Win Social Security Disability Insurance
Other types of financial help
INSURANCE
RESOURCES
Medicare Resources | Coverage | Articles
| Insurance Info | Patient
Advocate Organizations
Bone Marrow Transplant | Managed
Care Terminology
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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
Tips to receive insurance coverage for
treatments
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To help alleviate some of the financial frustration that
can occur, 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?
Inform your health care team if you have been denied payment. They can consult with your insurer and help answer
questions about the treatment.
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 pharmaceutical company for drug you
received, and ask for information about
reimbursement specialist hotlines. |
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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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What if you have insurance and lose
your job?
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? |
Contact your hospital's social service
office, which may be able to direct you to other sources of help.
Contact Patient Advocacy Foundation:
800-532-5274
Contact Medicaid: 877-267-2323
http://cms.hhs.gov/medicaid/mover.asp
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
If the drug or company that makes the drug you need is on these
lists, you probably can get assistance to pay for it with the
information provided here by NeedyMeds Drug Index |
Drug
Company Index
Tips about wining social security
disability insurance
(SSA stands for Social Security Administration.
Note: State laws may vary.)
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There are often two disability programs -- state and
federal. |
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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. |
| 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) |
| I have found that knowing how to reach the
Commissioner of Insurance in my State to be an
asset in my favor. - Keith (patient) |
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Disability claims require documentation based upon the
medical records of the patient. |
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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) |
| 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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Other types of financial help
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Outreach programs provided by pharmaceutical companies
to pay for treatment PAL |
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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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| Resources
Coverage | Medicare
Resources | Articles | Insurance
Info |
Patient Advocacy Organizations | Bone
Marrow Transplant |
Coverage
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| A Consumer Guide to Handling Disputes with Your
Employer or Private Health Plan, 2003 Update www.kff.org
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Leukemia (CLL) and Social Security Disability
Claims By: Pitt
Dickey - Attorney seniormag.com
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Medicaid/Medicare Coverage Issues Manual CMS
Use the Search button on the CMS site to locate specific topics.
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State Insurance Department Web Sites naic.org
Click the map or links below to go to that state insurance department's web site.
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MEDICARE
RESOURCES
(provided by the Leukemia and Lymphoma Society) |
Social
Security Administration
Application for help with Medicare prescription drug plan
costs
Centers for Medicare and Medicaid Services
General information about the Medicare prescription drug
plan:
http://www.cms.hhs.gov/medicarereform/pdbma
"Outreach Toolkit" for the Medicare prescription
drug plan:
http://www.cms.hhs.gov/partnerships/tools/materials/medicaretraining/MPDCoutreachkit.asp
Help and information for those with limited income and
resources:
http://www.cms.hhs.gov/medicarereform/lir.asp
Health literacy - a guide to the best language to use when
communicating with beneficiaries:
http://www.cms.hhs.gov/partnerships/tools/materials/preferredterms.pdf
CMS' extensive Q&A resource:
Fact sheet link page for many of the subjects above:
http://www.cms.hhs.gov/medicarereform/factsheets.asp
Vignettes to help explain how coverage works with/affects
other types of health coverage
Site for beneficiaries to find a doctor, learn more about
the Medicare Modernization Act, deal with billing issues and learn about
Medicare Advantage and Drug Benefit plan options:
http://www.medicare.gov
To join CMS as an official partner to educate
beneficiaries, caregivers and others, write to:
partnershipwebsite@cms.hhs.gov |
Rating Insurance
companies
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Patient
Advocacy Organizations |
* Patient Advocate Foundation *
Headquarters
700 Thimble Shoal Blvd
Suite 200
Newport News, VA 23606
800-532-5274
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Patient Advocate Foundation is 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.
Patient Advocate Foundation seeks to
safeguard patients through effective mediation assuring access to care,
maintenance of employment and preservation of their financial stability.
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National Patient Advocate Foundation
National Patient Advocate Foundation seeks
to create avenues of access to insurance funding for evolving therapies,
therapeutic devices and agents through legislative and policy reform.
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National Headquarters:
725 15th St. NW
Suite 503
Washington, DC 20005
Phone: 202-347-8009
Fax: 202-347-5579
District Office
700 Thimble Shoals Blvd.
Suite 201
Newport News, VA 23606
Phone: 757-873-0438
Fax: 757-873-1082
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The Office of Patient Advocacy (OPA)
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Staff provide advice, support and access to
extensive resources and information.
To speak directly with a patient advocate, call
888-999-6743. Their "resources page" is the same as the one on NMDP's site.
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Financial
Assistance |
Contacts
Also see
Drug Payment Support
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Provides chemotherapy drugs to patients with financial need.
Adria Patient Assistance Plan
Adria Laboratories,
P.O. Box 16529, Columbus, OH 43216-6529
614-764-8100
Bristol-Myers Indigent Patient Assistance Program,
Bristol-Myers Onocology Division,
2404 West Pennsylvania Street, Evansville, IN47721 812-429-5000
Provides chemotherapy (Cytoxan) free of charge to patients with financial
need. Request must be made by the patient's physician.
American Association of Retired People (AARP)
Pharmacy Service.
Catalog Dept.,
Box 19229, Alexandria, VA 22320.
Members can use their nonprofit service to save on prescriptions delivered
by mail. Good for tamoxifen (Novaldex). Write for free catalog.
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American Cancer Society
800-ACS-2345 or local chapter
Provides free wigs, head coverings, financial referrals and
resources to patients in need.
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Bone
Marrow Transplants |
National BMT-Link
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National Foundation For Transplants
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1102 Brookfield - Suite 202
Memphis, TN 38119
email: nftp@aol.com
Assists those who need to raise funds for marrow transplants Maintains accounts to which
tax-deductible contributions can be made.
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National Transplant Assistance Fund (NTAF)
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P.O. Box 258
Bryn Mawr, PA 19010
email: ntaf@transplantfund.org
800-642-8399
Assists with fundraising for all types of organ
transplants.
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The Bone Marrow Foundation
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981 First Avenue, Suite 129
New York, New York 10022
212-838-3029
www.bonemarrow.org
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Nielson Organ Transplant Foundation
(Florida residents)
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580 W. 8th St.
Jacksonville, FL 32209
904-798-8999
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The Transplant Foundation
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8002 Discovery Dr., Suite 310
Richmond, VA 23229
804-285-5115
Provides financial assistance for anti-rejection medication for transplant patients.
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My Friends Care BMT Fund
(Michigan residents)
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148 South Main Street, Suite 101
Mt. Clemens, MI 48043
810-783-7390
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