At any stage following a cancer diagnosis, you may experience strong emotions, including disbelief, fear, sadness, anxiety, and even anger. They are a form of grief and are very normal—most patients with a cancer diagnosis will feel one or more of these emotions at various times in their cancer journey. Cancer is a serious, potentially deadly disease. Treatments can be lengthy and difficult, causing uncertainty and an emotional roller-coaster. While everyone deals with a cancer diagnosis in their own way, unfortunately, most people will also have to answer the question of whether insurance will cover their cancer treatment.
In most cases, a person with insurance will have at least some of their cancer treatments covered. Unfortunately, insurance premiums, deductibles, co-pays, and out-of-pocket maximums can be a serious worry. If your insurer is refusing to pay for a specific cancer treatment your doctor believes will benefit you, you need experienced legal assistance. Attorney Scott Glovsky has been helping people in similar situations for more than two decades. Don’t face an insurance denial for your cancer treatment on your own—call The Law Offices of Scott Glovsky.
Does Insurance Cover Cancer Treatment?
Generally speaking, most insurers will cover at least some of the costs of cancer care, although many will not cover all the costs, and may even deny certain treatments prescribed by your doctor. While there are additional types of insurance that can help you pay for the costs associated with cancer treatment, these are typically costly, even unaffordable for many. Supplemental insurance can help cover expenses not covered by your primary insurance, including your deductibles, co-insurance, co-payments, and other out-of-pocket expenses. Some supplemental policies may even cover a portion of lost income if you are unable to work because of your cancer.
Hospital indemnity insurance provides coverage for hospital stays, usually a fixed amount per day, with a cap for a specific maximum length of stay. While every situation is different, it can be helpful to read through your health insurance plan/benefits to determine what your insurer will pay—and what it won’t. Even if your insurance policy appears to cover your cancer treatments, insurance companies may deny a specific treatment by calling it “not medically necessary,” “experimental,” or “investigational.” Immunotherapy drugs often fall onto this health insurance “chopping block,” even when an oncologist feels they are the patient’s best chance at regained health and a future.
How Do You Determine Which Cancer Treatments Are Covered and Which Are Not?
Unfortunately, the cost of cancer treatments—and the ability to pay—are inextricably linked to cancer survival rates. According to asbestos.com, cancer death rates are 20 percent higher among residents of poorer counties in the U.S. as compared to more affluent counties. Mortality rates of lung and liver cancers are almost 40 percent higher in poorer U.S. counties, while women in poorer counties are twice as likely to die from cervical cancer. In other words, your ability to pay the cancer treatment costs not covered by your insurer has a direct bearing on whether you will survive your cancer.
The only way you can know for sure which cancer treatments are covered under your insurance plan and which are not is to read through the plan carefully. Even then, you could be dismayed to find that a treatment your physician believes will help you survive your cancer diagnosis is not covered for a reason not spelled out in your plan. Some cancer treatments may be deemed not medically necessary by your insurer even though insurance companies claim they do not practice medicine. What they sometimes do practice is keeping a healthy financial bottom line.
If a prescribed treatment is expensive, it stands a much better chance of being denied under the “not medically necessary” umbrella. For example, the CRISPR treatment Casgevy is $2.2 million per person. The medication Kymriah, a CAR T-Cell therapy sometimes used to treat acute lymphoblastic leukemia and B-cell lymphoma costs $475,000 for a single course. And the medication Yescarta that treats certain types of lymphoma costs over $420,000. In addition, sometimes doctors order diagnostic tests like genomic tests, Guardant 360® and PET Scans to diagnose cancers that are also quite expensive. And at times physicians order cancer therapies like proton beam radiation therapy and high intensity focused ultrasounds that are more expensive than other types of radiation and ultrasounds.
However, you do not have to accept your insurance company’s denial. You have many options available to you—options an experienced insurance denial attorney can assist you with.
What Will My Out-of-Pocket Expenses Be Even If Insurance Covers My Cancer Treatments?
Even if your cancer treatments are covered under your plan, you may find yourself overwhelmed with co-pays and out-of-pocket maximums. Most insurance plans require you to pay 20 percent of the treatment amount up to a specific maximum. Once you have met the maximum out-of-pocket, the insurance company will pay 100 percent. According to Forbes, the “average” medical out-of-pocket maximum for a plan in the ACA marketplace is approximately $8,403.
The ACA has a requirement that almost all healthcare plans have an out-of-pocket maximum of no more than $9,450. If you have insurance through your employer or you have purchased health insurance on your own, your out-of-pocket maximum could be higher. For most middle-class Americans, coming up with $10,000 during any given year to pay medical expenses can be difficult, if not impossible, while also paying monthly health insurance premiums.
Where Do I Get Help for Cancer Treatments Denied by Insurance?
There are many variables associated with how much your cancer treatment will cost, and whether your health insurance will cover most of those expenses. If you’ve been diagnosed with breast cancer, prostate cancer, liver cancer, kidney cancer, colon cancer, skin cancer, lung cancer, or any other type of cancer, the answer to the question “Does insurance cover cancer treatment,” is multi-faceted. Attorney Scott Glovsky helps individuals determine whether their insurer will pay for cancer treatments—and helps with appeals when treatment is denied.
The Law Offices of Scott Glovsky have a long history of success, helping people just like you. We make a promise to our clients that we will listen to them, support them, be available and responsive to their needs, and always treat them with dignity and respect. Just as important, we vow to fearlessly fight for you, your family, and your future, ensuring you receive the treatment you need to fight your cancer. If results matter, contact The Law Offices of Scott Glovsky today.