To reduce their costs, private insurance companies more often are deciding not to pay for the use of some chemotherapy drugs, even if those drugs are effective cancer therapies. Before you begin treatment, find out whether your insurance company or Medicare will pay for your care.

For more information on how to maintain control of your finances so you can better focus your energies on treatment and recovery, see the American Cancer Society booklet, Financial Guidance for Cancer Survivors and Their Families: In Treatment.

What you need to know about insurance coverage

Insurance companies deny payment for chemotherapy for these reasons:

• They may not be aware of new treatments.

• They may limit the selection of drugs that doctors can use for chemotherapy.

• They may restrict payment to the uses first approved by the Food and Drug Administration.

If you are going to take part in a clinical trial, find out if your insurance will cover the cost of patient care. In some cases, insurers may deny payment. Coverage may vary by state.

If your insurer denies payment for your treatment, don’t give up. Most people do get payment eventually.

What to do if your claim is not paid

• Tell your health care team if you have been denied payment so that they can contact your insurer and help answer any questions.

• Ask your doctor's office staff to provide insurance companies with the results of scientific studies showing that a certain drug is effective for your type of cancer.

• Ask hospitals and cancer centers to provide similar information. These actions are often enough to get your claim paid.

• Contact reimbursement specialist hotlines at pharmaceutical companies.

In some states, Medicaid (which makes health care services available for people with financial need) may help pay for certain treatments. Contact the office that handles social services in your city or county to find out if you are eligible for Medicaid and whether your chemotherapy is a covered expense. Medicaid approval can take a long time, so begin the process as early as possible.

You can also contact your hospital’s social service office which may be able to direct you to other sources of help.

A last alternative may be to sue the insurance company to get payment for your chemotherapy. In many cases, courts have sided with patients and ordered insurance companies to pay for a patient’s treatment.

Always ask your doctor and nurse any questions you have about your chemotherapy treatment. Open and honest communication between you, your family, and your cancer care team is the best way to understand what is happening to you, your body, and your cancer.

Revised: 03/08/2008