Navigating Insurance

Managing Insurance Issues for Cancer Treatment

Health insurance coverage for your cancer treatment and all of the needed follow-up care is critical for most people. However, the amount of paperwork, and number of insurance questions, can add up quickly. It’s a good idea to learn what you can about the basics of health insurance.

For an in-depth discussion of issues around cancer treatment and insurance (including topics like health insurance and financial assistance for the cancer patient, how health insurance works, prescription drug assistance programs, and more), visit cancer.org, the website of the American Cancer Society.

What Are Deductibles, Copayments, and Coinsurance? And How Do They Work?

A deductible is a specific dollar amount a patient must pay before insurance applies. A copayment is typically a fixed dollar amount the patient must pay out-of-pocket for a covered service. Coinsurance limits an insurer's coverage to a certain percentage, commonly 80 percent of an allowable charge. If a patient’s insurance includes coinsurance, he or she is responsible for charges beyond those covered by the insurance plan.

For examples of how deductibles, copayments, and coinsurance work, visit cancer.net, the website of the American Society of Clinical Oncology (ASCO). Scroll about halfway down the page for the examples. Also, please note that the examples are very general. For questions about your own insurance coverage, you should always speak with a representative of your insurance carrier.

Tracking Medical Bills and Insurance Claims

People with cancer often receive a large number of medical bills and health insurance statements. It can seem overwhelming. But there are ways to track and manage bills, statements, and payments. Careful management of these important documents can help you reduce stress, feel more in control, and better manage your finances.

For tips on creating a tracking system and a filing system, visit cancer.net, the website of the American Society of Clinical Oncology (ASCO).

Appealing an Unpaid Health Insurance Claim

Occasionally, your health insurance carrier may deny payment for a claim or only reimburse you for part of the claim. If this happens, you can appeal. Sometimes, the carrier may simply need more information from your healthcare team before the claim can be fully processed.

For steps to take when a claim for payment is denied, visit pancan.org, the website of the Pancreatic Cancer Action Network. Scroll down to #11. Also, check out cancer.org, the website of the American Cancer Society.

Read more at pancan.orgThis link is to a third-party website.

Clinical Trials, Costs, and Payments

One thing to consider when deciding whether to take part in a clinical trial is cost. Some services may be paid for by the trial’s sponsor and others by the patient’s health insurance. It’s a good idea to figure out who is paying for what beforehand.

For a discussion of these issues, see cancer.gov, the website of the National Cancer Institute.

Chemotherapy Copayment Assistance

Even pancreatic cancer patients with insurance can have high out-of-pocket costs. What initially seems like a manageable copayment amount can quickly add up. But assistance with copayments may be available.

For information about copayment assistance, eligibility requirements, and how to apply, check out cancercare.org, the website of CancerCare.

Read more at cancercare.orgThis link is to a third-party website.

There are many programs to help people in their search for copayment assistance. For one example, visit CancerSupportCommunity.org.

Read more at CancerSupportCommunity.orgThis link is to a third-party website.

Glossary of Billing and Insurance Terms

People living with pancreatic cancer may encounter a variety of unfamiliar terms related to billing and insurance.

To learn more about billing and insurance terms, visit cancer.org, the website of the American Cancer Society.

Read more at cancer.org This link is to a third-party website.