Learning you have cancer means you’ll want to work with a medical team that can help you create the best possible treatment plan. But it also means you need to understand your health insurance coverage. Like any complex health condition, treating cancer can involve many different types of care, and you’ll want to be sure your providers and treatments will be covered.
Start by calling your insurance company. The level of coverage for exams and other medical procedures will vary depending on your specific health plan. Dial the customer service number on the back of your health insurance card and ask for member services.
- Learn what’s covered. Ask about the type of insurance plan you have (such as an HMO, POS, or PPO). Ask whether you need a referral or out-of-network approval for services in order to be covered at your cancer center. In addition, ask about coverage for pathology or imaging (also called radiology) that may be reviewed before or as part of your first consult with a cancer care team.
- Ask whether your coverage differs depending on the site of service (inpatient hospital vs. outpatient hospital). For example, visits with specialists at outpatient clinics are often billed as an outpatient hospital service, while a procedure or any visit that requires an overnight stay at is typically billed as an inpatient service.
- Check your coverage for prescription medications. Does it also include coverage for oral chemotherapy medications?
- Ask about special requirements, such as extra costs for going out of network for doctors or hospitals. What percentage of the bill will you be responsible for if you go out of network? You should also ask whether you have an out-of-pocket maximum (the most that you might have to pay for covered medical services).
- Ask about coverage for related expenses and services. For example, does your plan offer traveling and lodging benefits for a stem cell transplant? What about support services, such as integrative therapies or survivorship?
After you’ve talked with your insurer, you should also check with your primary care physician. Many insurance companies require referrals or other approvals from your primary care physician or health plan before you receive treatment.