While health insurance helps pay for some of the medical costs associated with breast cancer diagnosis and treatment, it's likely that you'll have some out-of-pocket costs. It's important to know exactly what your health insurance plan covers. The tips below can help you work with your insurance company to make sure you receive all the benefits to which you're entitled.
- Make sure you have an up-to-date copy of your plan's basic information (sometimes called a summary plan description). This will tell you how your plan works, its benefits, and how to file a claim. Also make sure you have accurate contact information for the insurance company.
- If you buy your own insurance rather than receiving it as a benefit of your or your spouse's employment, make sure you pay your premiums on time.
- Ask your insurance company if you can be assigned a case manager so you talk to the same person each time you call.
- Your doctor may want to refer you to one or more specialists, such as a radiation oncologist or a reconstructive surgeon. Make sure these specialists are in your plan.
- Know which procedures require you to pay a copayment and how much it will be.
- Keep detailed records of all the claims you submit and note when they were submitted, whether they're still pending, and when they were paid.
- Keep copies of any and all paperwork related to your treatment, diagnosis, and insurance claims, including:
- requests for sick leave
- letters from your doctor, employer, and insurance company
- letters you write to your doctor, employer, and insurance company
- summaries of phone calls to your insurance company, including the date, time, and the person's name to whom you spoke
- Know how you should pay for treatment. Does your insurance company make the first payment? Or do you pay the bill and then get reimbursed?
- If you're required to submit bills to your insurance company, try to send them in as soon as you get them. If you're recovering from treatment, ask a loved one or friend to help you.
- If your insurance company denies a claim, talk to your case manager to find out why. Ask if and how you can file an appeal. Talk to the person who handles insurance claims at your doctor's office. This person may be able to help you with the appeal process and provide any documentation your insurance company requires.
- If you have short-term disability insurance, find out exactly what your benefits are. In some states, laws require that most employers provide short-term disability benefits for up to 26 weeks. Short-term disability usually pays you a percentage of your salary for a specified period of time. Some policies may require that you use up all your sick time and vacation days before you receive any disability benefits. Talk to your company's human resources representative so you know exactly what you will receive, when you'll receive it, and for how long.
- Your employer isn't required by law to offer long-term disability insurance. Still, the insurance industry estimates that about half of medium- and large-sized businesses offer long-term benefits for at least 5 years. A typical long-term disability policy pays about 60% of your salary and starts when short-term benefits have been used up. The length of time you receive long-term benefits can range from 5 years to life. Long-term disability policies vary widely. Talk to your human resources representative at work and find out if you're covered, what is covered, and how long you can receive payments. It's also important to know if your employer's plan considers other benefits you may be receiving (Social Security disability benefits, for example) when figuring out how much long-term disability pay you'll receive.
In the United States, if you change jobs during breast cancer treatment or lose your insurance coverage because you're working fewer hours, the COBRA (Consolidated Omnibus Budget and Reconciliation Act of 1986) allows you to temporarily stay in the insurance plan sponsored by your former employer. Still, the rates for COBRA insurance are usually much higher than the rates you were charged as an employee. COBRA coverage is available when people lose insurance coverage because of work stoppage, reduced hours, divorce, death, or other "qualifying events" that cause insurance coverage to be lost.
The amount of time you can continue in your former plan through COBRA depends on the reason why you lost your coverage:
- You get up to 18 months of COBRA coverage if you stop working or reduce the number of hours you work.
- You get up to 3 years of coverage if you lose coverage because of divorce or death.
It's important to know that COBRA coverage isn't automatic. You have to ask for it within 60 days of getting a written COBRA notice. This may not be within 60 days of when you stopped working or when your hours were reduced. It's a good idea to talk to the human resources director as soon as you have a COBRA "qualifying event," such as working fewer hours. You also might want to talk to your insurance company to find out who needs to do what to make sure you have uninterrupted coverage. For more detailed information on COBRA benefits, visit the U.S. Department of Labor COBRA web site.
If you've had health insurance for at least a year with no loss of coverage for more than a couple of months, the U.S. Health Insurance Portability and Accountability Act of 1996 (HIPAA) allows you to switch jobs and be guaranteed health insurance through your new employer, as long as your new employer offers group insurance. HIPAA also guarantees that you can't be denied coverage because of a pre-existing health problem. For more information on HIPAA, visit the U.S. Department of Health and Human Services web site.
The resources listed in this section are based in the United States and the regulations mentioned are U.S. regulations. Other countries may have different laws regulating insurance coverage and hospital operations. If you live outside the United States, ask your doctor about resources in your country.