Mesothelioma Options and Insurance

Coping with the demands of mesothelioma can be difficult even without the worries of how you will pay for the exuberant costs of treatment, secondary expenses and loss of income.  Even for those with insurance plans, the costs of mesothelioma are often still very high.  For those without any health insurance, the thought of all those medical bills can be even scarier than the mesothelioma itself.  Luckily, there are some options available to cancer patients without insurance.

Turning Uninsured Into Insured

One of the easiest and most cost-effective ways of getting health insurance for mesothelioma is to get a job with a large company which offers good coverage.  Unfortunately, many mesothelioma patients will not be able to work due to the demands of the illness.  However, if patients are married, their spouses can try to get a job with good coverage.  As a spouse of the employed person, the mesothelioma patient will also get coverage.

It is also possible sometimes to get health insurance through certain organizations, such as retired teachers’ organizations.  Many organizations offer “guaranteed issue” plans which means that you will be approved regardless of your pre-existing mesothelioma.

Individuals should look into their states’ Pre-Existing Condition Insurance Plan.1  These plans are available to people who have been without insurance for at least six months and have a pre-existing condition, such as mesothelioma.  PCIP plans cover a wide range of services including mesothelioma primary care and prescriptions. As of July 2011, the premiums for PCIP plans have been reduced in many states.

Medicare is one option for mesothelioma patients who are uninsured and at least 65 years old or for some disabled peoples.  Medicaid may be available to uninsured mesothelioma patients if they have low incomes or are not employed.

If you have been insured through an employer in the last 60 days, then you can apply for COBRA – Consolidated Omnibus Budget and Reconciliation Act.2 Under this act, you can keep the health insurance you had from your employer.  The group rates of the insurance will remain the same though COBRA typically ends up being much more expensive than what it was as an employee or spouse/child of the employed.  In order to receive coverage through COBRA, you must apply within 60 days of having lost coverage.  The coverage is typically limited to a period of 18 months though it is possible to prolong this period.

Mesothelioma patients who are employed and have insurance through their employers should not quit their jobs until they are sure about their options.  Some employee health care plans can be turned into individual plans though they will likely cost much more.  This is similar to COBRA but without the restricted time period.

Aside from finding insurance plans, there are other options for uninsured mesothelioma patients. Some hospitals have what is called Hill-Burton funds which can be used to pay for all or some of the costs of treatments when patients cannot pay themselves. To receive these funds, you must qualify.3  Mesothelioma patients may also be eligible for cancer grants and stipends that can be used for paying for the costs of treatment.  There are also some grants for housing and transportation available.  You can ask your doctor for more information about these resources.

Even if mesothelioma patients have adequate insurance, they should be aware that they may be entitled to legal compensation from asbestos manufacturers or other organizations directly involved in the epidemic of mesothelioma. An experienced asbestos lawyer can help you file a legal claim and receive compensation.

Dealing with Health Insurance for Mesothelioma

When you have mesothelioma, insurance coverage becomes much more complicated than paying a few simple co-pays.  Handling the numerous claims can be incredibly frustrating and time consuming, particularly for those who are already dealing with the many other burdens of mesothelioma.  A systematic, well-planned approach can make dealing with insurance companies easier while battling mesothelioma.

Expect Some Claims to Be Denied 

Even if you think you have the best possible health insurance, some of your mesothelioma insurance claims will likely be denied.  Expecting claim denials can make it much less frustrating when they actually do happen – and you can be prepared to fight the denial.

Note that you do not have to be the one to make claims.  If dealing with insurance companies becomes too stressful or time consuming, you should delegate the job to someone else.  This is a good time to take advantage of the help that friends and family offer – particularly if you know anyone with legal or health-care knowledge.

Document Everything 

When diagnosed with mesothelioma, one of the first things that you may want to do is clear out a filing cabinet and get several binders for all records related to your illness.  You should always keep all documentation, including:

  • Medical bills; write down the date that you received the bill on each.
  • Filed insurance claims with the dates of the services, doctors’ names, and file date recorded
  • All costs related to mesothelioma which were not reimbursed or covered, including travel, housing, long-distance phone calls, and alternative treatment costs.  Also include costs which are waiting for reimbursement
  • All prescription receipts and the dates that they were filled
  • A log of all correspondence with the insurance company, including telephone calls, emails, and letters.  Record the name of the person/people spoken to, the date of the correspondence, and outcome of the correspondence.

Overtime, these records are likely to accumulate.  It is very important that you initiate some sort of organization system.  This system will help you find important documents in the event that a claim is denied or you have trouble being reimbursed.  It is a good idea to sort all documents by type, such as: prescriptions, medical bills, travel, housing, other secondary costs, and insurance correspondence. You may also want to pay all bills by check to make record keeping easier by having a document of payment.

What to do if Your Mesothelioma Claim is Rejected

There are many reasons why a claim may be denied.  Unfortunately, most mesothelioma patients and their families do not have the time to go through claim policies to understand the fine details, especially since insurance policies are so complex and legally encoded. However, it is important to have a basic understanding of what your insurance company will and will not cover in terms of mesothelioma treatment.  This will save you a lot of time and frustration in battling denied claims.  Keep in mind that there is no changing your policy: if your policy clearly states that it does not cover something, like certain alternative mesothelioma treatments, no amount of arguing with the company will change this.

If a claim is denied, then you should follow these steps: 

  • Request a full explanation of the reasons why your claim was rejected
  • Compare the reason for rejection with your insurance policy
  • Talk to your health insurance adjuster for more details

If you think that the claim should have been covered under your policy, then you should have your doctor provide a letter of explanation as to why the service in the denied claim is necessary.  Then, resubmit your claim with this letter and any other pertinent documentation including a copy of the denial letter.

In event that the denied service is vital to your life, then you should file an expedited grievance.  This is a letter stating your concerns. These must be resolved within 72 hours of when the grievance was received.  Always send expedited grievances by fax so they arrive quickly.  If the denial is not critical to your life, then it may take several weeks before a standard grievance is resolved.  You may be invited to attend a committee meeting about your grievance.

You may need to stop making payments until your issue is resolved with the insurance company.  Do not back down or be shy about dealing with the adjusters: if you feel that you are not getting the coverage you are entitled to, then demand to speak to a supervisor or request a review.  When these methods do not work, you may need to seek legal action to get compensation for mesothelioma from your insurance provider.

References 

1 Pre-Existing Condition Insurance Plan (PCIP) (2011) Retrieved from HealthCare.gov at: www.healthcare.gov/law/features/choices/pre-existing-condition-insurance-plan/index.html

2 COBRA Continuation Coverage Assistance Under ARRA (2011) Retrieved from the United States Department of Labor at: www.dol.gov/ebsa/cobra.html

3 Hill-Burton Free and Reduced-Cost Health Care (2011) Retrieved from Health Resources and Services Administration at: www.hrsa.gov/gethealthcare/affordable/hillburton/