How to Talk to Your Insurance Company and What to Ask


WhatNexters often feel that a lot of financial aspects of cancer go way over their heads. Even if a patient has health insurance, there can be anxiety when dealing with paying for treatment and insurance coverage. WhatNexters recommend taking a deep breath, staying calm, and doing your homework to find resources to help sort through the challenges.

Below are some common problems that WhatNexters have faced with their insurance situations. See what other WhatNexters had to say:

The bills keep piling up. What do I do for support after treatment?

Does insurance cover getting a second opinion?

Insurance Cancer

What do I do when my employer cancels our insurance?

What do I do for help if I have no health insurance?

Is financial aid available for someone who is unemployed with no insurance? Where should I begin looking?

Related Page: Health Insurance Issues Experience Pages

WhatNexter’s recommend reading the American Cancer Society’s Guide on Health Insurance and Financial Assistance for the Cancer Patient. This is an extensive guide to learn about private health insurance, government-funded insurance plans, options if you are uninsured, financial issues and potential resources, health insurance risk pools, other resources that may be available to you, along with how to think about money and handle all your finances.

Related Article: Dealing with the Financial Burden of Cancer

One WhatNexter, carolLHRN thumbnail CarolLHRN, was a case manager for an insurance company before she was diagnosed and she offered WhatNexters four tips to deal with insurance companies.

“1. Keep all of your receipts from the MD offices and all of the EOB's (Explanation of Benefits) that come from the insurance company. Be sure they are correct.

2. Obtain a booklet or look online for specific coverage information including out of pocket expenses, co-payments and annual max out of pocket. The booklet should also give you information on what is covered and what is not.

3. If at all possible, stay in network. Not only should this save you money but also claims are handled much better.

4. If you feel like you are lost with coverage or with your treatment plan, ask for a case manager. This is a free service. The case manager can help walk you through the process, find out specific coverage information, and be a source for health information. Oncology patients are very expensive to insurance companies so they encourage work with a case manager to help manage the costs, but there are benefits to the patient as well.”

Here is some practical advice given by WhatNexters on how they have handled insurance issues through their diagnosis:

  • Work out a payment plan with your doctor from the beginnings.
  • Keep records of all insurance transactions.
  • Obtain a substantial amount of insurance information including coverage, out-of-pocket costs, and co-payments in order to understand as much as you can.
  • If you have questions consider asking for a case manager (a free service).

The American Cancer Society’s Guide on Health Insurance and Financial Assistance for the Cancer Patient outlines ways to manage your health insurance, including:

  • Do not let your health insurance expire.
  • Beware of lapses if you are changing insurance plans.
  • Pay premiums in full and on time.
  • Know the details of your plan and get a copy of a description of the plan.
  • Submit claims for all medical expenses, even if you think they are covered.
  • Keep complete records of claims at all stages.
  • Keep copies of all paperwork.
  • Get someone to help you like a caseworker, hospital financial counselor, or a social worker.
  • Get help soon if you get overwhelmed with bills. Get in touch with a local support organization, such as your American Cancer Society or state’s government agencies.

Whatever it is, do not be afraid to ask. Many WhatNexters have felt relief from their financial burden or confusion with their health insurance just by asking for the help they need. What did you find were the best questions to ask when dealing with your insurance company? What suggestions would you give beginners who are dealing with insurance problems?

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  • 2 Comments
    • BuckeyeShelby's Avatar
      BuckeyeShelby

      I also work in the field of medical insurance. My advice to anyone who has been denied treatment their doctors feel is necessary -- call your insurance company and ask how to file an appeal. Generally, you'll need to write a letter and you'll need to get a letter of medical necessity from your doctor, possibly with copies of his/her medical notes to substantiate the need for treatment. And NEVER let a customer service rep from your insurance co get nasty with you -- if they do, IMMEDIATELY ask for a supervisor. And remain calm -- you may be upset, but it's easier to deal with the folks on the phone if you don't yell -- you'll get much farther if you take a deep breath instead.

      over 4 years ago
    • Geo's Avatar
      Geo

      Thank you, jut started to get the medical bills and now I am in the doughnut hole on meds. Thank you GW and congress!

      over 4 years ago