Managing finances and insurance coverage

Healthcare costs are a key concern for most people with blood cancer. Many patients don't have health insurance, and for others, coverage is limited. If you have health insurance, it's essential that you know what your plan covers and how to maintain your benefits.

Where to start 

You and your family will need to decide how to pay for treatment while managing household finances. You also need to consider additional indirect costs, such as lost time from work, childcare, and travel expenses. 

Many excellent guides and tools are available to help you work through these challenges and explore available resources. Start by taking the following steps to manage your finances before, during, and after treatment: 

• Speak with your doctor and ask for a treatment timeline
• Become familiar with your insurance plan's oncology benefits, mail-order pharmacy benefits, pre-authorization, referral, and claims appeal rules
• Assess your anticipated medical expenses
• Reduce unnecessary expenses
• Speak with creditors early if you anticipate difficulty making payments
• Keep and organize copies of medical records, bills, receipts, and other important documents
• Review time off benefits from your employer and whether your income might be reduced
• Check to see whether you have home mortgage or car payment insurance to help cover expenses during your illness
• Review and take advantage of disability plans if needed during your treatment and recovery
• Seek access to programs that help insured patients meet their pharmaceutical co-payment expenses 

Working with your healthcare team to reduce costs 

It's important to resolve financial issues before they become a source of increased stress or limit your access to needed treatments, prescription medications, or support services. Therefore, discuss payment options with members of your healthcare team or your treatment center's patient financial services department. You and your provider can work together to devise ways to reduce costs without compromising treatment. Ask your providers about: 

• Switching from a brand-name drug to the generic
• Reviewing a medication list to see whether you're taking nonessential drugs
• Enrolling in a Prescription Assistance Program (PAP)
• Referring you to a public agency or a social worker 

Social workers and caseworkers can: 

• Help you better understand your insurance coverage
• Submit claims
• Refer you to assistance programs to help meet the cost of remaining bills
• Offer guidance on submitting the necessary paperwork for Medicare or Medicaid, or other government programs

Getting organized

To better manage your health finances and get the most from your insurance coverage: 

• Check that the personal information on your policy is correct
• Review the policy's summary of benefits, noting any coverage exclusions or limits. Don't overlook riders or endorsement forms.
• Keep a copy of all claims and related paperwork, such as letters of medical necessity, bills, receipts, and requests for sick leave
• Keep a written record of phone conversations with insurers
• Check your health policy often to determine what services and medications are covered
• Obtain proof of previous health insurance coverage, called a certificate of creditable coverage, from former employers and insurers
• Pay premiums on time and in full to avoid a lapse in coverage
• Plan ahead for procedures or treatments that need a pre-authorization or pre-certification
• Learn what to do if a claim is denied
• Keep track of all unreimbursed medical expenses; you may be able to claim these for tax purposes
• Know the laws designed to protect patients and provide continuation of medical coverage (for example, COBRA, HIPAA, Family and Medical Leave Act, Americans with Disabilities Act)  

The worksheets below may help when you are thinking about the many financial concerns that come up after you have received a blood cancer diagnosis. 

Use these worksheets to keep track of questions to ask your healthcare and financial team members. Staying organized helps decrease many financial stressors and allows you to focus on feeling better. 

Financial Checklists
Insurance Costs Checklist and Budget Form 
Insurance Appeal Tracking Form 
Financial Assistance Record 
 

If a claim is denied 

If your insurance company denies payment for a recommended treatment, you may be able to get a decision overturned by filing an appeal. First, contact your state Department of Insurance to see what information or resources they have available. Then ask your insurer the following questions when appealing a denial: 

• Can you send me a copy of the denial letter?
• What is the specific reason the claim was denied? (This information should be included in the denial letter.)
• How can I get a current copy of the plan document and plan's Summary of Benefits Coverage (SBC)? (You may need to request these documents in writing.)
• Who can I contact at the insurance company to discuss the denial?
• How can I request a doctor peer review? (A peer review provides the chance for your doctor to discuss your treatment in detail with other doctors, usually within the same geographic area and medical specialty.)
• Can I speak with anyone else if I have questions about the appeals process?
• If a particular drug isn't on the prescription plan's covered drug list (formulary), what is the process for requesting an exception? Can my doctor submit a letter explaining why the drug is needed? 

Record the date and time of each call to the insurance company, and the name, phone number, and extension of the representative you speak with. Remain courteous, honor deadlines for obtaining key documents, and submit all necessary paperwork.

Getting help from family and friends 

Delegate time-sensitive tasks to reliable family members or friends who can be counted on to be thorough and meet deadlines. Ask them to help with: 

• Setting up a record-keeping system to track bills and submitted, pending, and paid insurance claims
• Calling public and private agencies to determine eligibility for financial assistance, entitlement programs, and other benefits and services
• Gathering documents to support insurance claims and appeals
• Following up with the insurance company
• Organizing fundraising efforts

Getting help from professionals 

Professional counselors who work for national organizations that support people with cancer can give you expert advice on how to: 

• Preserve your assets
• Reduce your debt
• Access community resources
• Handle employment issues
• Reduce insurance problems
• Use legal remedies, if and when necessary 

This type of guidance can be invaluable in helping patients advocate for themselves more effectively. Organizations and government agencies that can help you navigate the healthcare system include: 

• Triage Cancer is a national nonprofit organization that provides education and resources on the entire continuum of cancer survivorship issues for survivors, caregivers, and healthcare professionals. Triage Cancer created an online toolkit for navigating finances after a cancer diagnosis. Visit Triage Cancer.  
• CancerCare is a national nonprofit agency that provides free services, support, information, and practical help to anyone affected by cancer. The organization offers guidance on financial issues and gives financial assistance to help with some costs. Visit CancerCare or call (800) 813-HOPE (4673).
• Patient Advocate Foundation (PAF) draws upon the expertise of case managers, attorneys, and doctors who work with patients and their insurers, employers, and creditors to resolve insurance problems, job discrimination issues, and debt crisis matters.  Visit PAF or call (866) 512-3861 for a comprehensive state-by-state directory of financial resources for housing, utilities, food, transportation, medical treatment, and children’s needs.
• Localhelp.healthcare.gov. Get local help from an agent, broker, or assister near you. Visit Localhelp.healthcare.gov.
• Healthcare.gov. This government-maintained website includes information about the healthcare changes happening as a result of the Patient Protection and Affordable Care Act of 2010 (ACA), also called Obamacare. The site has information about insurance options in your state; compared quality of care in hospitals, home healthcare agencies, and nursing homes; an overview of the healthcare law; and healthcare options for different groups of people (i.e., families with children, individuals, people with disabilities, seniors, young adults, and employers). Visit www.HealthCare.gov.
• The United States Department of Labor (DOL). The DOL's Employee Benefits Security Administration (EBSA) regulates health plans offered by most employers and ensures that employees eligible for COBRA get the benefits to which they are entitled. Call (866) 4-USA-DOL for live assistance in English or Spanish. Visit EBSA for more information.
• The Centers for Medicare & Medicaid Services (CMS). CMS manages the Medicare program and works with states on Medicaid programs. Even if you are working, you may be eligible for Medicaid. Visit CMS for more information.  

We’re here to help!  

Call an Blood Cancer United Information Specialist at (800) 955-4572 for guidance about health insurance, government programs, disability benefits, financial assistance programs, and health advocacy. 

We also offer financial assistance programs to help individuals with blood cancer. Learn more about our Patient Financial Assistance Programs.