Breast Cancer, Medical Bills and Health Insurance

health insuranceLife after breast cancer may hold concerns and issues that impact on your quality of life. Two main issues are…medical bills and health insurance.

Life for some survivors includes finding ways to pay off medical expenses related to treatment, expenses not entirely covered by their insurance plans Unfortunately they will be doing so for some time to come. Most private insurance plans have co-pays that can be substantial when you have surgery, chemo and/or radiation.

Here are some suggestions for dealing with the medical bills impacting on your life following treatment from Laura Riley, ESQ, in her post of 7/29/2011 on the Pink Fund Blog (www.thepinkfund.wordpress.com):

  • Review, Review, Review Your Medical Bills: Many medical bills contain errors or items that are overpriced.  Also, sometimes insurance companies will incorrectly deny coverage and the provider will send you the bill. You can appeal that decision through your insurance company’s internal appeals process or your state’s external medical review process.
  • Request a Copy of the Medical Record and Pharmacy Ledger: The pharmacy ledger shows all the drugs you were given. The pharmacy ledger, along with their medical records, can give you a complete picture of your hospital stay so you can compare the medical records and the pharmacy ledger to the itemized hospital bill.  Additionally, check for procedures or medications that were ordered, but then cancelled.
  • Compare the Bill to the Hospital’s Standard Charges: Some states require that hospitals make their standard charges, regardless of payer type (e.g., private insurance, Medicare, Medicaid, etc.), available to the public for all products and services. This document is typically called the “charge master.”  Patients can compare their bills to the hospital’s standard charges to make sure they are not being over charged.
  • Look for Items Billed Due to the Hospital’s Negligence: Generally, when a hospital makes an error, the patient usually pays for it. For example, if an x-ray is lost or the results of a blood test are misplaced, those procedures will be redone and the patient will be billed a second time. You can challenge these charges.
  • Hire a Professional Bill Reviewer: If you try the techniques above, but still think the bill is too high, it might be time to call a professional bill reviewer, also known as a claims assistant professional.
  • Negotiate a Payment Plan: Setting up a payment plan with providers can be a good option when (1) the charges are legitimate, (2) you can make the payments, and (3) the debt will eventually be paid.
  • Dispute Items that You Believe Your Health Insurance Company Should Have Paid: Call the plan to determine the reason for nonpayment. The health insurance plan may have refused to pay the bill because of a mistake on the bill.  If you are able to resolve the error, follow up with the health care provider and health insurance company to make sure the bill is paid and that your account is cleared.  If you are unable to resolve the issue, and you disagree with a decision that their health insurance company has made regarding their coverage, you have the right to appeal that decision.  For more information about appealing decisions in your state, contact the Cancer Legal Resource Center at 1-800-THE-CLRC (866-843-2572) or CLRC@LLS.edu.

Remember…you have survived and you don’t need to agree to a payment schedule that is going to clearly compromise your quality of life. Negotiate a payment plan you can live with and the debt will get paid.

Having health insurance is a quality of life issue critical to us all, but of special concern for those of us who have had cancer.

  • Insurance Companies Can’t Deny Coverage to Women. Before the Affordable Care Act became law, insurance companies selling individual policies could deny coverage to women due to pre-existing conditions, such as cancer and having been pregnant. Under the law, insurance companies are already banned from denying coverage to children because of a pre-existing condition. In 2014, it will be illegal for insurance companies to discriminate against anyone with a pre-existing condition.
  • Women Have a Choice of Doctor-Thanks to the Affordable Care Act, all Americans joining new insurance plans have the freedom to choose from any primary care provider, OB-GYN, or pediatrician in their health plan’s network, or emergency care outside of the plan’s network, without a referral.
  • Women Can Receive Preventative Care Without Co-pays. Thanks to the Affordable Care Act, all Americans joining a new health care plan can receive recommended preventive services, like mammograms, new baby care and well-child visits, with no out-of-pocket costs.
  • Women Pay Lower Health Care Costs. Before the law, women could be charged more for individual insurance policies simply because of their gender. A 22-year-old woman could be charged 150% the premium that a 22-year-old man paid. In 2014, insurers will not be able to charge women higher premiums than they charge men. The law takes strong action to control health care costs, including helping states crack down on excessive premium increases and making sure most of your premium dollars go for your health care.

If you don’t have insurance, know that you can qualify for insurance and you will be covered for future medical visits. You don’t need to stay in a job just for the insurance. You can change jobs and not worry that the new carrier can exclude you for a pre-existing condition. You can get on with your life.

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