insurancetips

Dealing with insurance issues can be overwhelming. But it is very important you know all the specifics of your policy and get the maximum coverage for your care.

Insurance Tips

greybarIt’s important to know the benefits and limitations of your health insurance.

As the patient, you will be focused on fighting for your life, and your energy may be somewhat diminished after surgery and during radiation and chemotherapy. As the family and/or caretaker, you will want to devote your energy to the patient instead of multiple forms.

When you are first diagnosed with a spinal cord or brain tumor, paying for treatment may be the last thing on your mind. Dealing with health issues is often all consuming. Insurance and medical bills often become secondary.

The Cost of Treatment

The costs associated with brain tumor treatments can be astronomical, and there is a good chance you or your family may need financial assistance at some point.

It is important to note that every insurance plan is different so check with your insurance carrier for the specifics of your plan. Also, be sure to check with your doctor or hospital to make sure your plan is accepted.

The Brain Tumor Foundation did a calculation of the cost for a patient and family to deal with a brain tumor. From the time of diagnosis, through surgery, treatment, rehabilitation – and through hospice care when needed – totals are close to $700,000 or $800,000.

While your health insurance will cover some of this expense, there are still some out-of-pocket expenses for patients and their families. Besides diagnosis and treatment, other related costs may include:

  • Travel to and from treatment
  • A driver, if you are no longer able to drive
  • Psychological support
  • Home health aides
  • Rehabilitation
  • Hospice care, if necessary (Hospice care is often covered by private health insurance. You will need to check your insurance coverage to see what specifics it covers.)

MEDICARE VS. MEDICAID
Medicare and Medicaid are both government programs that help pay for health care.  However, the benefits, costs and eligibility requirements are different. Medicare is a federally funded program available to most U.S. citizens and permanent legal residents who have lived continuously in the country for five years or more and are age 65 or older. Medicaid is jointly funded at the state and federal levels.  Medicaid supports low-income individuals and families by covering costs associated with both medical and long-term custodial care for those who qualify.

Some of the benefits covered under Medicaid overlap with Medicare, such as inpatient and outpatient hospital care and doctor services.  However, depending on the state, Medicaid may also offer coverage that is not included under Original Medicare, such as personal care, optometry services, and dental services.  In addition, the service providers (such as hospitals and doctors) available to people using Medicaid are often different than those available to people using Medicare.

Financial Resources

The truth is, financial resources are NOT nearly as limited or tough to come by as one might think. For those who need outside/further assistance, there are organizations and private or government funded sources where one can find much needed financial help:

Government Agencies
If you do not have health insurance, you may qualify for Supplemental Security Income (SSI) (LINK TO SOCIAL SECURITY PAGE) or Social Security Disability Insurance (SSDI). Your local Social Security office (800.772.1213) can help you determine if you qualify for these programs.

Federal Grants
Some hospitals and nursing homes receive federal money to provide care to people who cannot afford it. Contact Hill-Burton Funds (800.638.0742) for a list of participating facilities.

Pharmaceutical Companies
Most pharmaceutical companies will give you, for free, a three-month supply of medications if you cannot afford to buy them yourself. Your doctor can make the request for you. And if you qualify for the Medicare Prescription Drug Program (212.869.3850), you can get help paying for prescription drugs. Some major discount stores now offer generic drugs at a very low cost.

Co-Pay Relief Program
If you have brain cancer and your co-payments are adding up, the Co-Pay Relief Program might be able to provide some assistance.

Home Service Companies
Call your gas, electric, water, and phone companies to see if they will work out a payment plan so that these services won’t be shut off. In many states, these companies are prohibited from turning off these services if your doctor or social worker can attest that they are medically necessary.

Cancer Fund of America
If you need medical supplies such as nutritional supplements or incontinence supplies and cannot pay for them, the Cancer Fund of America distributes donated supplies to people in need.

Corporate Angel Network
Some organizations, like the Corporate Angel Network, provide free flights on corporate aircrafts when seats are available.

Food Service Organizations
Organizations such as Meals on Wheels (800.677.1116) deliver meals to eligible people who cannot leave their homes. A small donation is sometimes required.

Non-profit Organizations
The Brain Tumor Foundation offers additional financial advice and can direct you to other associations and facilities as needed. Finding those organizations that can help get you through this very difficult time might take a little time, but they are out there and we will help you find them. And that’s a comfort.

Online Brain Tumor Financial Assistance
Free brain tumor financial assistance can also be found by creating a free medical fundraiser online. Individuals can create and run a fundraiser completely for free using PeoplePledge or GoFundMe and raise thousands of dollars for surgery and treatment online instantly without having to worry about the cost on you.

What You Should Know

FAMILY AND MEDICAL LEAVE ACT (FMLA)
Under the FMLA:

*  Eligible employees are entitled to up to 12 workweeks of unpaid, job and benefit-protected leave in a 12-month period for specified family and medical reasons
*  Time to care for a spouse, parent or minor child with a serious health condition, or to take personal medical leave is covered. (However, this only applies to businesses that have 50 or more employees within 75 miles, and for employees who worked at least 1,250 hours during the past year.)

Additionally, the law states that when leave is needed for planned medical treatment, the employee must make an effort to schedule treatment in a way that won’t disrupt the employer’s business.

THE PATIENT PROTECTION AND AFFORDABLE CARE ACT
Under the Patient Protection and Affordable Care Act (ACA):

*  Expanded Medicaid eligibility and income-based sliding-scale subsidies to help patients purchase private health insurance will expand coverage to thousands more brain tumor patients
*  Patients covered by Medicare Part D will continue to have lower out-of-pocket prescription drug costs as the ACA phases out the prescription drug coverage gap
*  Limits will be placed on out-of-pocket costs patients have to pay to access health care services and treatments, including anti-cancer medications such as temozolomide (Temodar®).
*  Patients who enter approved clinical trials will have the routine medical costs associated with the clinical trial covered by health insurance
*  Brain tumor patients may stay on their parents’ health insurance plans until the
age of 26

Health Insurance Companies Cannot:

*  Refuse to cover children that have a brain tumor
*  Put a limit on the dollar amount they will cover throughout a patient’s lifetime
*  Deny coverage to an adult brain tumor patient or survivor because of a pre-
existing condition
*  Charge brain tumor patients more in premiums solely because of their health
status

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