Can You Be Denied Health Insurance If You Have Cancer

Why Is Access To Top Cancer Centers Important

Smart NC: Health Insurance Claim Denied? We Can Help.

Testicular cancer is a perfect example of why access is so important. There are more urologists and medical oncologists in the U.S. than there are cases of testis cancer each year. This means, statistically, that not every urologist or oncologist would even get to treat a new testis cancer patient every year. Think of skills or things that you only use once a year. Do you consider yourself an expert at these tasks? Well, perhaps neither are the doctors that only see one new testicular cancer patient.

There are doctors that are experts in testis cancer. They have dedicated a large portion of their career to advancing the treatment of this disease and see numerous patients a year. However, these doctors are not next door at the “I Try Hard Hospital” but rather at larger centers of excellence. Their volume of patients seen helps increase the quality of their outcomes. Higher volumes and better outcomes is not something new and has been shown to correlate in other disease states such as cardiac surgery.

These larger centers are also where the cutting edge clinical trials are being conducted and by denying coverage at these centers the insurance companies could be denying access to needed clinical trial participants. There is an Obama Care clause that mandates that insurance companies have to cover the routine costs of clinical trials but discussion of this is beyond the scope of this piece.

But Why Are So Many People Still Left Uninsured

According to Key Facts About the Uninsured Population, even under the ACA, many uninsured people cite the high cost of insurance as the main reason they dont have coverage. In fact, they estimated that 45 percent of uninsured adults cite the cost of coverage being too high as the reason they remained uninsured. It seems that the affordable part of the ACA may not have applied to everyone and that is why some people remain uninsured.

This tends to mean that low-income families are the most affected by a lack of insurance, leading to even more stress for this demographic. According to the American Psychological Association, more than 63 percent of adults, cite uncertainty about the future, both with their own health and that of others, as a source of stress. They address that insurance costs and the looming uncertainty about the future as two common stresses surrounding health. Perhaps finding an affordable short term plan is the best option for many.

Medicare Part A And Part B

Basic Medicare has 2 parts:

Medicare Part A covers hospital costs and most out-patient appointments.
Medicare Part B covers medical costs, including some equipment, supplies and ambulance transportation.

Medicare doesnt provide comprehensive health care. However, as part of the Affordable Care Act, it covers a yearly wellness visit, screening mammograms and some other preventive services.

Medicare doesnt directly pay for prescription drugs, although there are insurance companies that work with Medicare to help cover the costs of medications.

Medicare also doesnt cover experimental treatments or services outside the U.S.

Medicare plans have co-payments and deductibles.

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Yearly Income May Be Above Allowed Levels

Those applying for certain government-administered health insurance plans like Medicare or Medicaid can be rejected if their income is above a certain level. How much income Americans can have and still qualify for these plans depends on some different factors. There is a sliding scale that increases or decreases depending on how many children are in the family. For example, a family that has three children can earn more money and still qualify for medical care, over a family with one child. The base numbers on the scale change year to year, so families are advised to check this information on a regular basis.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.

Obtain And Fill A Claim Form

You can contact your health insurance company to get the claim form or download it from their website. The claim form will include a list of other things that they may need from your medical service provider. The claim form will enable your health insurance company to learn more about the illness or accident in question. They need this information to determine whether the expenses you are claiming are covered under your plan. Therefore, the more information you provide the better. A typical insurance claim form will include the following sections:

Personal details such as your name, date of birth, and address
Insurance details like your group and policy number
Reasons why you visited the hospital and detailed background information on your condition
Provide your doctors name and address
Any out-of-pocket expenses that you have incurred

Can A Genetic Test Affect My Health Insurance

Q: My doctor recommends that I get a genetic test for breast cancer. I know it will help me decide on therapy, but if I get the test and Im positive, will it affect my health insurance?

If you’re thinking of getting a genetic test, talk to your doctor, check the laws in your state, and ask your insurance company if they will cover the test and whether the results could affect your future eligibility.

Dr. Reichmans Bottom Line: I would hate to have the fear of discrimination stand in the way of your getting a test that could impact your future health. Check the laws in your state and talk to your doctor and, oh yes, your insurance company. Dr. Judith Reichman, the TODAY show’s medical contributor on women’s health, has practiced obstetrics and gynecology for more than 20 years. You will find many answers to your questions in her latest book, “Slow Your Clock Down: The Complete Guide to a Healthy, Younger You,” which is now available in paperback. It is published by William Morrow, a division of .

PLEASE NOTE: The information in this column should not be construed as providing specific medical advice, but rather to offer readers information to better understand their lives and health. It is not intended to provide an alternative to professional treatment or to replace the services of a physician.

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How Do Health Insurance Companies Know If You Smoke

Health insurers consider you a smoker, subject to a hefty premium surcharge if you used any tobacco products four or more times a week in the past six months.

Some regular smokers facing a steep premium increase may be tempted to avoid telling the truth. Dont do it. If youre not honest about tobacco, you risk being charged with insurance fraud. Even such soft fraud is considered a misdemeanor and can result in sentences of probation, community service or even time in jail. Not to mention, youll very likely lose your insurance or at least be charged all the back money you owe as a smoker.

Although its nearly unheard of for an insurer or employer to actively investigate whether you smoke, your doctor will probably note tobacco use in your medical records as a result of routine blood and urine analysis. That paper trail could be uncovered and flagged as your insurer is reviewing your treatment before paying your bills.

Obviously, being honest when you answer enrollment questions is in your best interest.

Health Insurance Claim Denial

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Unfortunately, health insurance claim denial isnt an uncommon practice. In fact, a recent survey by AARP revealed that there are approximately 200 million rejected claims every year in the U.S. alone. It can be stressing when your health insurance claim is denied. But this doesnt mean that you have to tap into your retirement savings or apply for a loan. The good news is that your health insurance company will offer an explanation for denying your benefits through the EOB form. The EOB contains abbreviations and codes that help explain what your insurance pays for and why your claim has been denied. The EOB will also contain a customer service number that you can call to ask questions.

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When You Can Be Denied For Pre

Health insurance plans that started on or before March 23, 2010 â called grandfathered plans â are not subject to the rules of Obamacare. If you enrolled in a health plan prior to this date, your insurer can choose to cancel your policy or increase your premiums for pre-existing medical conditions. It is also possible for an employer to maintain and enroll new employees in a grandfathered plan under certain circumstances. An employer must notify you that it has a grandfathered plan. If your employer offers a grandfathered plan but you need coverage for a pre-existing condition, you can get a plan through the Obamacare marketplace.

Get Access To Primary And Preventive Care

Insurers are required by the law to cover yearly preventive care and checkups including vaccinations, mammograms, prostate cancer screening, and colonoscopies without copays. This means that you will be more likely to lead a healthy life and catch any health-related problems early when they are easy to treat and less expensive. Additionally, your health insurance should also provide essential health benefits that are often in ten categories: outpatient care services, preventive and wellness services, emergency care, maternity and newborn care, hospitalization, prescription drugs, mental health, and pediatric care. Contrary to common belief, young and healthy people need health insurance for regular checkups, preventive care, and chronic disease management, in case they have diabetes, asthma, or any other condition.

S To Take If Denied Coverage For Cancer Treatment

by | May 28, 2021 | Cancer Treatments, Health Benefits |

This article is the first installment in a series on appealing a denial of cancer treatment coverage. The second article may be accessed here.

A cancer diagnosis brings with it many challenges, including not just emotional and physical challenges but also financial and logistical hurdles as you attempt to find the best treatment options. Once you receive a cancer diagnosis, the next step is to identify a trusted oncologist with expertise in your type of cancer and the latest and most effective treatment options. Hopefully this provider will be close to home, but depending on how rare your disease is, you may have to travel to see the top specialists. This can cause problems if the provider is out-of-network. Even if the provider is in-network, your cancer treatment may nonetheless be denied if it is deemed to be experimental or not medically necessary. This article will address some of the common reasons cancer treatment is denied, and what you can do to protect yourself from unforeseen medical bills.

How Much Does Insurance Cover On Cancer Treatments

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As stated previously, there is no set limit on how much an insurance company can pay for cancer treatment bills for their clients. Your insurance is obligated to cover however, much is left after the dollar amount that you can afford to pay.

Another important thing to note is that if youre diagnosed with cancer, insurance companies cant charge you more for coverage. Instead of worrying about how much your insurance provider will cover, you can rest easy because your out of pocket expenses are automatically capped for cancer treatments.

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Eligibility For Coverage Through A Spouse

Those that are trying to obtain a subsidized health insurance plan through the government-sponsored health insurance marketplace may be ineligible if their spouse has a plan that can cover them. This does not mean that these applicants cannot get any of the plans listed on the health insurance exchange, it simply means that they are not eligible for government subsidy. Thus, they can be rejected if they apply through the health insurance marketplace for such plans. If those individuals go outside of the marketplace, they will not be rejected due to their spouses plan. Of course, plans purchased outside of the marketplace will be much more expensive.

Identify The Reason For Claim Denial

There are numerous reasons why your health insurance company can deny your claim. Take the first step and identify why your claim was denied. Also contact your doctor, hospital, or insurance company after receiving the Statement of Benefits to ascertain the reason for claim denial. Some of the common reasons for denial include:

Using an out-of-network medical services provider: In case your health insurance company is an exclusive provider organization, it may be the reason why your claim was denied. Going out of an EPO or HMO simply means that you visited a medical provider who doesnt recognize your health insurance terms of payment. Visiting such a provider for nonemergency services may lead to denial of your claim which means that you will be responsible for all the medical expenses.

Noncovered charges: You may have undergone some medical procedures that arent covered by your health insurance plan. Therefore, ensure that you close check the terms of your policy because health insurance plans often dont cover certain medical care categories, such as dental surgery or infertility treatment.

Pre-authorization or referral was required: Some procedures such as MRIs and CT scans often require pre-authorization. This is often the responsibility of your doctor. Sometimes your insurance will deny your claim if there was no pre-authorization. However, if your doctor ordered for these tests, request your doctor to contact your health insurance company on your behalf.

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Is Pregnancy A Pre

If you are pregnant before the start of a new health insurance plan, it qualifies as a pre-existing condition regardless of how long you have been pregnant. Every health insurance policy must cover pregnancy and childbirth and the10 essential health benefits, which include maternity care and newborn care.

Apply To Patient Assistance Programs

Health Insurance for Pre-Existing Condition–NIK NIKAM, MD, MHA

Most pharmaceutical companies have patient assistance programs that will provide medications, free-of-charge, to qualified individuals. The eligibility criteria are not always based on income, so don’t assume that youre ineligible because you have a job. PAPs were created both for people without insurance and for those with insurance who are simply unable to pay for their medications.

PAP enrollment usually requires one or two applications with additional paperwork to be completed by your healthcare provider. Your oncologist’s office will most likely be aware of the relevant PAPs and can assist you with enrollment if needed.

Even if income excludes you, the same companies usually offer cost-sharing assistance programs to cover out-of-pocket drug expenses. In many cases, eligibility is most commonly based on having an annual income of less than 500% of the Federal Poverty Limit . Annual caps usually apply, but the savings can easily add up to thousands of dollars.

Appeal Insurance Claim Denials

As a health-insured member, you have the right to appeal any service or treatment your insurance company has denied. While the appeal process can be lengthy and emotionally draining, it can also be well worth it.

The process will involve writing letters and making calls to the insurance company while gathering information from your healthcare providers and other health professionals. Since appeals are approved on a case-by-case basis, its often best to work with a patient advocate who can help navigate the process. Many hospitals and cancer clinics have professionals on staff who can help or at the very least refer you to a qualified advocate in your area.

Another great resource is the Patient Advocate Foundation, a non-profit agency that provides professional case management services. They are great at offering advice and tips on how to fight an insurance denial even if your policy clearly states limitations to coverage.

Life Insurance With A Family History Of Cancer

Having a family history of cancer will increase your rates, but how much it does depends on your family’s medical history. Insurers typically want to know:

The type of cancer.
The number of relatives diagnosed and how you were related.
The age at which your relative was diagnosed. If they were a senior, this will likely have a lower impact on your rates than if they were young.

Cancer And The Affordable Care Act

Plans that comply with the Affordable Care Act in the United States cannot deny you health coverage or discriminate against you in any way if you have a pre-existing condition, including cancer. So even if you have cancer, your health insurance company cannot kick you off your plan. They also cannot charge you more for your plan.

The ACA also made two important changes that are particularly important for people who need expensive medical treatments. First, it got rid of annual and lifetime dollar limits on care that a particular individual can receive. Secondly, it introduced a maximum annual limit on what an individual can spend in out-of-pocket costs for their health care.

This is particularly good news for cancer patients who may be currently undergoing intense cancer care and ongoing treatment. And this also applies to cancer survivors who may be worried about whether they will be able to afford treatment again should they come out of remission.To learn more, grab our free step-by-step guide to enrolling in Marketplace health insurance here.

Travel Insurance For People With Cancer

Can You Get Health Insurance If You Have Cancer

Some high street travel insurance companies will give you medical cover if you have a doctors letter saying youre fit enough to travel. But many others will insure you only for treatment that isn’t to do with your cancer.

So although you’ll have travel insurance, it won’t cover any treatment you might need because of your cancer. You’ll have to pay for that yourself.