Our 24/7 cancer helpline provides information and answers for people dealing with cancer. We can connect you with trained cancer information specialists who will answer questions about a cancer diagnosis and provide guidance and a compassionate ear.
Our highly trained specialists are available 24/7 via phone and on weekdays can assist through video calls and online chat. We connect patients, caregivers, and family members with essential services and resources at every step of their cancer journey. Ask us how you can get involved and support the fight against cancer. Some of the topics we can assist with include:
For medical questions, we encourage you to review our information with your doctor.
Sometimes insurers will deny claims or say they won’t pay for a test, procedure, or service that your health care provider orders. Know that it is your right to be able to appeal many health insurance denials.
If an insurer denies a claim, they must tell you that you have a right to appeal. They also must let you know how you can appeal. Make sure to find out how long you have to file an appeal.
If you ask for it, the insurer must explain the reasons for the denial. You can also ask for more information from a customer service representative or case manager at your insurance company. It can be helpful to develop a relationship with a case manager early on in case you need them in the future.
You might also be able to re-submit the claim with a copy of the denial letter and your doctor's explanation. Include any other written information that support using the test or treatment that has been denied. Sometimes the claim will only need to be “coded” differently.
If getting help from your health care team or insurance plan doesn’t work, you may need to submit an internal appeal.
If your internal appeal is denied, you can ask for an external review. External reviews are done most often for care that may be a medical necessity or denials of other decisions based on clinical judgment.
Check with your insurance company about the external review process. For an urgent health situation, you may be able to ask for an external review at the same time you ask for an internal one.
You can also find more information about external reviews and the laws that apply to them on Centers for Medicare & Medicaid Services website.
If your claim is still denied after internal and external appeals, ask the health care provider if the cost of the bill can be reduced. Many providers are willing to reduce bills to get paid faster.
If none of these steps work, you might have to take your appeal to a government body.
It helps to know who regulates a health plan. You can talk to the government group that regulates the health plan to find out if they can offer more information or extra help.
Offers contact information for your state insurance commission. You can contact your state insurance commission for insurance information specific to your state, or report problems with your insurance company.
This service can help you understand your rights and benefits, work through the Medicare system, and get quality care. They can also help you apply for programs that help reduce your costs for prescription drugs and medical care, and guide you through the appeals process if your Medicare prescription drug plan denies coverage for drugs you need.
Patient Advocate Foundation (PAF)
Toll-free number: 1- 800-532-5274
Works with the patient and insurer, employer and/or creditors to resolve insurance, job retention and/or debt problems related to their diagnosis, with help from case managers, doctors, and attorneys. Typically for cancer patients in treatment or less than 6 months out of treatment.
Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.
KFF. Consumer Appeal Rights in Private Health Coverage. Kff.org. Accessed at https://www.kff.org/private-insurance/issue-brief/consumer-appeal-rights-in-private-health-coverage/ on August 9, 2023.
National Association of Insurance Commissioners (NAIC) Map: states and jurisdiction for consumer reference links and insurance department contact information. Accessed at https://naic.org/state_web_map.htm on August 9, 2023.
Tricare. Medical necessity appeals. Accessed at https://tricare.mil/ContactUs/FileComplaint/MedicalNecessity on August 9, 2023.
US Centers for Medicare & Medicaid Services. Appealing a health plan decision. Accessed at https://www.healthcare.gov/appeal-insurance-company-decision/external-review/ on September 6, 2023.
US Center for Medicare and Medicaid Services (CMS). External appeals. Accessed at https://www.cms.gov/cciio/programs-and-initiatives/consumer-support-and-information/external-appeals on August 9, 2023.
US Center for Medicare and Medicaid Services (CMS). The center for consumer information and insurance oversight: consumer assistance program (CAP). Accessed at https://www.cms.gov/CCIIO/Resources/Consumer-Assistance-Grants/ on August 9, 2023.
US Department of Veterans Affairs (VA). Board of veterans' appeals. Accessed at https://www.bva.va.gov/index.asp on August 9, 2023.
Last Revised: September 30, 2023
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