What to Do If You’re Uninsured or Underinsured
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Having no health insurance or subpar insurance is not only a financial burden. It could compromise your health outcome. “We know that in many parts of the country, people are recommended treatments they can’t afford,” says Sara Whelan, a licensed master social work and oncology social worker at CancerCare. “The reality is that some patients are unable to get the [recommended] treatment, and it is detrimental to their health.”
Being uninsured doesn’t mean you have to forgo the cancer treatment you need. Resources are available through your cancer hospital, nonprofit organizations, local agencies, and drug manufacturers to help you pay for care. Taking advantage of these programs can ensure you get access to lifesaving therapies without putting yourself into debt.
Can I Get Insurance After a Cancer Diagnosis?
What if My Insurance Company Denies Coverage for My Cancer Treatment?
Your insurance company does have the right to deny claims for a particular diagnostic test, treatment, or other service. If your provider denies a claim, they must tell you why, and you have the right to appeal the decision.
The process starts with an internal appeal. “An internal appeal is a request to the insurer to reconsider their decision. You will need to provide additional information and documentation from your doctor,” says Stefani Griffiths, director of patient access for City of Hope Orange County in Irvine, California. If that initial appeal doesn’t work, you can have an external review done by an independent third party.
Ask someone who specializes in health insurance law to guide you through the appeals process, Whelan suggests. If you don’t have an attorney, reach out to a nonprofit organization like Triage Cancer for advice.
Can I Get Treatment at Lower or No Cost?
One thing you shouldn’t do is skip a treatment or oncologist appointment because you’re worried about money. Instead, ask your hospital’s billing or financial department if they offer charity care — discounted care for uninsured or underinsured patients.
Another option is to ask your oncologist if you’re eligible to enroll in a clinical trial that’s investigating a new treatment for your cancer type. You’ll get either the standard treatment for your cancer type or a new drug, and the study’s sponsor should cover many of the costs involved. Talk to your cancer doctor and the clinical trial coordinator before you enroll so you understand what is — and isn’t — covered. “Your care team should explain the costs and other details involved so you have a clear understanding before deciding whether a trial is right for you,” Griffiths says.
Some pharmaceutical companies have patient assistance programs that provide their drugs for free or at low cost to people who need them. You can find one of these programs by searching PhRMA’s Medicine Assistance Tool.
Support Organizations and Programs
Many nonprofit organizations help people with cancer navigate the costs of their treatment and related expenses (like transportation and housing), including:
CancerCare
This nonprofit organization of oncology social workers offers support, including financial assistance, for cancer patients and their caregivers.
Cancer Financial Assistance Coalition (CFAC)
Enter your ZIP code and diagnosis into CFAC’s search tool, and you’ll find many different types of financial assistance, from copays to housing.
FamilyReach
This organization provides free financial assistance and help with navigating resources.
HealthWell Foundation
This nonprofit reduces the financial barriers that stand in the way of underinsured patients getting medical care.
Hope Lodge
This is an American Cancer Society program that gives people with cancer a free place to stay when they travel for treatment.
Mercy Medical Angels
This organization provides free transportation to medical care across the United States.
PAN Foundation
The Patient Access Network Foundation provides financial assistance to pay for prescription medications.
Patient Advocate Foundation
PAF offers case management services and financial aid to Americans with serious illnesses.
Other good sources for financial support are organization specific to your cancer type, such as Susan G. Komen for breast cancer, or the Colorectal Cancer Alliance for colon cancer.
Check with your local Department of Social Services to see if they offer help paying for food, housing, or other costs associated with cancer treatment. The American Cancer Society can also point you to programs in your area.
Where Can I Get Advice on Paying for Cancer Treatment?
Have a conversation with your cancer doctor early on in your treatment, so you’ll know what to expect and how much you’ll have to pay. Also lean on the resources available at your cancer hospital. “The best sources are your cancer center’s financial or social services counselors,” says Griffiths. “They are knowledgeable about local resources that help families with a variety of expenses, including managing day-to-day family needs.”
These professionals can explain your insurance benefits and anticipated out-of-pocket costs, help you navigate insurance authorization, and offer ways to manage financial burdens like time off from work, transportation, and childcare. They can also recommend financial assistance programs to help you pay for your care.
Your hospital’s social worker and financial counselor can take at least the economic burden of cancer off your plate. “The goal is to reduce financial-related stress and provide support to our patients and their loved ones so they can focus on their treatment,” Griffiths says.
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