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  • Questions for Your Insurance Provider

     

    A breast cancer diagnosis is a lot to handle. Thinking about the cost of treatment may be the last thing on your mind, but it is best to be informed.

    Understanding your plan

    The first step is to read your insurance plan. This will give you an overview of what is covered. The questions below may be a guide to understanding your coverage. These questions may also help you talk with your insurance provider.

    Talking to your insurance provider

    Before your first appointment with a specialist, talk to your insurance provider. You may need to have the first appointment approved for the insurance company to cover the cost. Some plans do not cover certain specialists.  

    No insurance plan covers all the costs related to breast cancer treatment. However, some cover more than others. It is important to find out how much of the cost of your treatment you will need to pay yourself so that you can plan ahead.

    • Is there a difference in coverage for physicians and/or treatments that are considered “in-network” versus “out-of-network?” (Your insurance plan may not have a network of physicians or treatment centers.)
    • Exactly what costs are covered (office visits, blood tests, radiology exams, surgery, chemotherapy, etc.)? How much of each is covered? Are there co-pays (co-payments) or deductibles
    • What is the process for payment or reimbursement?
    • What is my prescription drug coverage? Is there a cap for this coverage? Is it likely my drug costs will reach that cap (if you already know which drugs you will be taking)? What happens after I reach the cap? How much is my co-pay for prescription drugs?
    • When I need to stay overnight in the hospital for treatment, what costs are covered? Which costs are not covered?
    • Are second opinions covered? Third opinions? Are “out-of-network” second opinions covered? How do I go about getting a second opinion?
    • Are any integrative and complementary therapies, such as acupuncture, covered?
    • If I join a clinical trial, which costs are covered by my plan?

    Talking to a financial counselor at your hospital or medical center

    Most hospitals and treatment centers have financial counselors. They can help you with the details of your insurance paperwork and give you an estimate of the cost of your treatment.  

    Financial counselors can also help you work out a payment plan for the costs you will have to cover. If you are unable to pay, some places may be willing to reduce or wave the costs if you ask. And, no matter your income, you may qualify for financial aid from federal, state or local programs. A financial counselor can help you learn about these programs.  

    Updated 04/28/13 

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