Know Your Coverage
The cost of a child's cancer treatment often adds stress to an already tense situation. Parents want the best care for their child, but in some cases that may mean higher costs.
It is vital that you understand your child's health-insurance coverage. Your child may be covered by a private insurance plan, a public-assistance program (such as Medicaid) or both. It is very important that you maintain continuous health-insurance coverage. A lapse can result in refusal of a new policy to cover a preexisting condition.
To find out which treatments your child's insurance plan will cover, talk with the program's customer-service representative. It may also be helpful to talk with your child's social worker and a member of the hospital's financial department. A well-informed parent is a child's best advocate.
Here are some suggestions to help you be well informed:
- Always have an updated copy of your insurance plan.
- Ask questions.
- Take notes.
- Keep accurate records.
- Contact your insurance company to request a case manager to serve as your consistent point of contact and source of information.
- Be prepared to spend time on the telephone.
- Know if and when referrals are needed.
- Ask about co-payments and deductibles. Ask about organizations that can assist with these expenses and other treatment-related expenses not covered by insurance.
- Know what medications are covered by your child's health-insurance plan.
- Find out if your child's health-insurance plan covers any non-medical expenses, such as lodging, meals and transportation. If not, ask about organizations that can help with these expenses.
- Find out if your insurance covers home-health care and medical supplies.
- Know the 'cap' on your insurance coverage.
- Closely examine hospital bills and the insurance company's explanations of benefits. You may discover costly billing or reimbursement mistakes.
- Learn how to appeal the insurance company's decisions when necessary.
As already mentioned, it is extremely important that you maintain continuous health-insurance coverage for your child. Below is information to help you understand the different types of health insurance available to you for your child.
Employer-Provided Insurance
Most health insurance provided by employers is a form of so-called managed care. This approach provides coverage in the most cost-effective manner. Below are some descriptions of the more common managed-care models:- Preferred Provider Organization (PPO). This model has a network of providers. You can receive care with providers who are not listed, but there may be more out-of-pocket expenses associated with it.
- Point-of-Service Plan (POS). This plan will encourage you to choose a Primary Care Physician (PCP). A PCP makes referrals for care within the network. Again, you can choose to go out of the network, but there may be additional costs associated with it.
- Health Maintenance Organization (HMO). In this model, the HMO has a contract with specific health care providers and provides prepaid, comprehensive services to its members. There is often a set fee or co-payment associated with office visits and other services. You must pick a PCP under this plan and you must be referred for specialty care within the HMO network.
- Health Savings Accounts (HSA). In January 2004, Congress passed a new law designed to allow consumers to pay for qualified medical expenses with pre-tax dollars. HSA's are tax-free accounts individuals can use to pay for routine medical expenses. They must be combined with a high-deductible health insurance policy and are going to be used by many small business owners.
Group Insurance
If your employer does not offer healthcare coverage, or if you are self-employed, investigate group-insurance policies through other organizations, such as labor unions, fraternal organizations, professional or business organizations, student associations, religious groups or other special-interest groups. The Encyclopedia of Associations, found at most public libraries, includes information on groups that offer insurance coverage. Be sure to investigate any insurance carrier with your state's regulatory office; as in any industry, beware of fraudulent insurance providers.State and Federal Programs
In addition, you may qualify for state or federal health insurance. Currently, state and federal laws offer cancer survivors very limited help in obtaining health insurance, but advocates are working toward improving this situation. Listed below are government-sponsored programs you may qualify for:Medicaid
The Medicaid program pays for medical assistance for individuals with low income and limited resources. In addition to the financial criteria, you must fall into one of these categories: pregnant women, children and teenagers, and those who are aged, blind and/or disabled. As a childhood cancer survivor, you may qualify under the disabled category. Each state administers its own eligibility guidelines and services.
Of special interest to childhood cancer survivors are the services provided under Medicaid's Early and Periodic Screening, Diagnosis and Treatment program (EPSDT). The services covered are designed to reduce physical and mental disability and assist the survivor in living at the most functional level possible.
For more information on Medicaid call 1-877-267-2323 or visit the Web site at www.cms.hhs.gov/medicaid.
Medicare
Medicare is the national insurance program for people 65 or older, some under 65 with disabilities, and those with end-stage renal disease. Individuals who are under 65 who have received Social Security Disability Insurance (SSDI) payments for 24 months are eligible for Medicare. You must wait an additional five months (29 months total) before receiving Medicare benefits.
For more information on Medicare call 1-800-MEDICARE or visit the Web site at www.medicare.gov.
Children's Health Insurance Programs (CHIP)
This state-run program, also known as CHIP in most states, offers free or subsidized coverage for children from low-income families up to age 19. CHIP is a part of the Medicaid program in some states and a separate program in others. It often allows a higher income level than Medicaid and is intended for working families whose employers do not offer Medicaid.
For more information on CHIP in your state, check the government pages in your phone book, or contact the Centers for Medicare & Medicaid Services through its Web site, www.cms.hhs.gov.
Drug-Coverage Programs
Recently both the private and public sector have introduced programs to assist with the ever-increasing cost of prescription drugs. Listed below is information on drug programs. Because the programs are being constantly updated, it is important to check their Web sites for specific and current information.Medicare Prescription Drug Discount Card
Following the passage of the Medicare Prescription Drug Improvement and Modernization Act of 2003, the Medicare Approved Drug Discount Card Program was implemented. This program is designed to assist Medicare recipients with the cost of prescription drugs.
The Centers for Medicare & Medicaid Services Web site
(www.cms.hhs.gov/discountdrugs/) has detailed information, including drug-card sponsor lists.
Together Rx Access Card
Ten pharmaceutical companies united to provide access to a wide range of prescription products for people lacking insurance or prescription drug coverage. Qualification guidelines and enrollment are available at www.togetherrxaccess.com or by calling 1-800-444-4106.
Keeping Your Child Insured
As your child reaches young adulthood, monitor her health insurance coverage carefully. This is important whether your child is still in treatment or finished treatment years ago. Without health insurance, your child's health and financial future will be at risk.Young adults are one of the fastest growing groups without health insurance. Often children are dropped from their parents' insurance or public insurance at age 19 or when they graduate from high school. If your child attends college, he may be able to stay on your policy until he graduates or turns 23.
As your child becomes an adult, make sure she understands the importance of maintaining continuous coverage. Encourage her to seek employment with a company that offers health insurance or to explore individual health-insurance plans. Again, it is very important that you maintain continuous health-insurance coverage. A lapse can result in refusal of a new policy to cover a preexisting condition.
