Paying for chemo treatment

How do I pay for my chemo?

The cost of chemo 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, cover at least part of the cost of most kinds of chemo.

To reduce their costs, private insurance companies are more often deciding not to pay for the use of some chemo drugs. They may do this even if those drugs are proven cancer therapies. Before you start treatment, find out whether your health insurance will pay for your care.

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

You can also learn more about health insurance in our documents called Health Insurance and Financial Assistance for the Cancer Patient or Children Diagnosed With Cancer: Financial and Insurance Issues.

What do I 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 approved by the Food and Drug Administration (FDA).

If you’re going to take part in a clinical trial, find out if your insurance will cover any of the costs. 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 if they keep working on it.

What do I do if my 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 the staff at your doctor’s office to provide your insurance company 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 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 are the best way to understand what’s happening to you, your body, and the cancer.

The American Cancer Society can help you, too. Contact us anytime, day or night, for cancer-related information and support. Call us at 1-800-227-2345, or visit www.cancer.org. We want to help you get well and stay well.