I’ve wanted to write about how health insurance works when you have cancer for a while now, but haven’t really gotten around to it. But, here we go. How to deal with health insurance when you have cancer.
Cancer Claims with Health Insurance
First off, you really, really need health insurance if you have cancer. If you don’t there are grants, and copay assistance and stuff like that. You will need to pursue that at every turn.
If you do have health insurance, what you want to look up is what your “out of pocket maximum” is. As a cancer patient this is really the only number that matters. Sure, there is the deductible, but unless you are far enough into your treatment that you aren’t getting chemo or infusions, you’ll blow through that number so fast you won’t even notice you hit it.
One treatment can cost tens of thousands of dollars which will put you over the out of pocket maximum. In fact, if you’re lucky, a big treatment will get billed first to your health insurance so that you only have to pay one bill for one place.
None of these numbers are real, of course. This is all a game where the hospital bills enormous amounts so that when the insurance company takes its “discount” they still get paid the right amount. Then, the hospital turns around and negotiates its own discounts with the drug companies so that they don’t pay as much as is billed. It’s basically a big circle where companies exchange huge amounts of money while ending up with more “normal” amounts of money.
The good news is that once you meet your out of pocket maximum you get free healthcare for the rest of the year. So, basically, in exchange for your premium payments plus whatever the out of pocket maximum is, you get the healthcare everyone dreams of. Great doctors, cutting edge treatments, and top of the line facilities, all for free.
Paying the Right Bills
You don’t want to get stuck trying to get money back from medical providers and facilities, so watch your bills and your insurance carefully. Once you hit your out of pocket maximum, go back through your health insurance bills or website and figure out who they did NOT pay. Those are the bills you need to pay.
The bills they already paid you put aside. Don’t forget about them though. Some offices and labs don’t do a very good job of reconciling and they will continue to bill you even though the insurance paid. When that happens, call them and let them know that according to your Explanation of Benefits (EOB) your health insurance already paid.
They will likely say they need to research it. Let them. They usually figure it out. If not, keep it up. You don’t want to pay someone twice (once through insurance and once from your own checkbook.)
How To Figure Out Who To Pay
Figuring out which bills you actually need to pay and which bills were paid by your insurance company isn’t as easy as it sounds. Basically, you need to go through your EOBs and find the ones that have a “patient responsibility” that isn’t zero.
Then, download those EOBs, compare them to the bills you have, and also compare them to the amounts you expect to pay.
For example, my insurance pays nothing for the first $3,000 (deductible). From $3,000 to $7,000, the insurance company pays 80% (80/20 copay). Above $7,000 the insurance company pays everything or 100% (out of pocket maximum)
Once you have everything reconciled, you can start mailing out checks. Keep track you MAY be able to deduct some of your medical expenses on your taxes. You also may have a Health Savings Account or Flexible Spending Account that need proper documentation.