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The cost of chemotherapy varies with the kinds of drugs used,
how long and how often they are given, and whether you get them at
home, in a clinic, office, or hospital. Most health insurance policies,
including Medicare Part B, cover at least part of the cost of most
kinds of chemo.
To reduce their costs, private insurance companies are more
often deciding to not pay for the use of some chemo drugs. They may do
this even if those drugs are proven 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 our booklet, Financial Guidance for Cancer
Survivors and Their Families: In Treatment.
What you need to know about insurance
coverage
Insurance companies may deny payment for chemo for these
reasons:
- They may not be aware of new treatments.
- They may limit the selection of drugs that doctors can use
for chemo.
- They may restrict payment to the uses first approved by the
Food and Drug Administration (FDA).
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.
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 works for your type of cancer.
- Ask hospitals and cancer centers to provide information
like this too. 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 chemo 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 cancer treatment. 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 chemo. Open and honest talks 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.
Last
Medical Review: 08/28/2008
Last Revised: 09/11/2008
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