Cancer and Managed Care

Here’s what you need to know to be prepared for your cancer treatment (or any other major health care service/procedure):

• Understand your benefits as much as you possibly can. As insurance experts, we realize that your plan is written in opaque legal mumbo-jumbo. But your employee benefits person or insurance agent should explain anything you need to know. If they cannot, find an ombudsman in your plan to do so for you. If all else fails, use our Webography to find a patient advocacy organization for your disease, or try one of the drug company hotlines (if you are on chemotherapy). Do not go into treatment without the facts.
  
• Know what needs to be authorized by your insurance company . If you need referrals or authorizations and you (or your clinic or doctor’s office) do not obtain them, these services can be denied. Depending on your plan, this bill can fall right in your lap.
  
• Ascertain the expected treatment plan for your cancer . Cancer patients must depend on their providers (nurses and doctors) for the fight against cancer, but that does not mean you forfeit your right to be informed. Knowing your treatment plan means you can ascertain your costs. You would not buy a pair of shoes without knowing the cost, right?
  
• Keep your PCP informed about what is going on with your treatment . You do not need to correspond with him or her yourself, but someone needs to make sure your cancer provider is doing so. You do not want them denying something after the fact. Send them your own patient health record from time to time, if you want to make sure this is being done.
  
• Understand all of your treatment alternatives . Cancer drugs can be expensive. Some policies pay for injectable drugs in all settings. On the other hand, you may have specialty pharmacy, home health, physician office, and hospital outpatient coverage for drugs like growth factors (Procrit, Neulasta, etc), interferons, or some oral drugs. It would be in your best interest to find out which setting would cost you the least.
  
• Never forget that insurance payment is a battle. While the fight against cancer takes all the courage you and your family circle can muster, don’t forget that the insurance and financial aspects of your treatment will also require time and energy. If possible, appoint someone to be captain of the reimbursement team — ideally the toughest, smartest member of your family or a friend — to take care of insurance issues when you do not feel well enough to do so yourself.