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Paying for Chemotherapy
What Questions Should I Be Able to Answer About My Insurance?
Getting Maximum Coverage of Clinical Trials Costs
The cost of chemotherapy varies with the kinds and doses of drugs
used, how long and how often they are given, and whether you get them
at home, in a clinic or office, or in the hospital. Most health insurance
policies cover at least part of the cost of many kinds of chemotherapy.
There are also organizations who will help with the cost of chemotherapy
and with transportation costs. Ask your nurse or social worker about
these organizations. Finding the answers to the questions below will
help avoid problems in receiving payment later on.
What Questions Should I Be Able to Answer About My Insurance?
- What are the benefits of my insurance plan?
- What cancer treatments/care does it cover?
- Do I have a primary care provider? Can I use only certain
"preferred providers" under my plan?
- Am I entitled to a yearly checkup or does my plan only cover
office visits when I am sick?
- What are the benefits if I go outside of my health plan to
obtain care?
- What are the rules of my insurance plan?
- Do I need a referral from a primary care provider?
- Do I need a written referral form?
- Do I need to get approval from my health plan (pre-certification)
before seeing a specialist, obtaining treatment, tests, and
medical equipment or physical therapy services or going to the
emergency room or a hospital?
- Does my lab work, including blood work, or pap smear need
to go to a special lab?
- Do I have to pay a certain amount (co-pay) at the time of my
visit?
- Do I have an amount that I must pay for medical expenses (annual
deductible) before the insurance pays for services?
- Do I have a lifetime or annual limit on how much is covered for
medical expenses?
- Is there a special pharmacy where I need to get my medications?
- Are all tests and procedures covered both as an in-patient and
out-patient?
Getting Maximum Coverage of Clinical Trials Costs
Many clinical trials (treatment studies) offer some part of care
free of charge. But some insurers will not cover certain costs when
a new treatment is under study. Your doctor can work with you to try
to help you. If you are taking part in or considering a clinical trial:
- Ask your doctor about other patients in the trial. Have their
insurers paid for their care? Have there been any consistent problems?
- Talk to your doctor about the paperwork he or she submits to
your insurer. Often the way the doctor describes a treatment can
help or hurt your chances of insurance coverage.
- Find out what is in your policy. Check to see if there is a specific
exclusion for "experimental treatment."
Many insurance companies handle new treatments on a case-by-case
basis, rather than having a blanket policy. You can always ask about
their coverage of specific therapies. However, some patients say that
their questions may have hurt their chances for coverage by raising
a red flag. A call from your nurse or social worker to your insurance
company about specific coverage may be helpful.
Support groups
for cancer patients.
How doctors choose
a chemotherapy regimen
This website is sponsored by Brad Cooper* of The
Cooper, Hart, Leggiero, & Whitehead, PLLC. Cooper, Hart, Leggiero, & Whitehead is located in The Woodlands, Texas
(Greater Houston Area) and can be reached toll free at 1-800-998-9729
for more information on mesothelioma. Brad Cooper is not a medical
doctor. The information on these pages is for the education of mesothelioma
patients and their families regarding potential medical and legal
options. Patients are advised to consult with a medical doctor.
* Licensed
by the Supreme Court of Texas.
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