It's important to resolve financial issues before they become a source of increased stress or limit your access to needed treatments, prescription medications or support services. Therefore, discuss payment options with members of your healthcare team or the treatment centres' patient financial services department. Patients and providers can work together to devise ways to reduce costs without compromising treatment. Ask your providers about:
- Switching from a brand name drug to the generic
- Reviewing a medication list to see whether you're taking nonessential drugs
- Referring you to a public agency or a social worker
Social workers and caseworkers can:
- Help you better understand your insurance coverage
- Submit claims
- Refer you to assistance programs to help meet the cost of remaining bill
- Offer guidance on submitting the necessary paperwork
To better manage your health finances and get the most from your insurance coverage:
- Check that the personal information on your policy is correct.
- Review the policy's summary of benefits, noting any coverage exclusions or limits. Don't overlook riders or endorsement forms.
- Keep a copy of all claims and related paperwork, such as letters of medical necessity, bills, receipts and requests for sick leave.
- Keep a written record of phone conversations with insurers.
- Check your health policy often to determine what services and medications are covered.
- Obtain proof of previous health insurance coverage, called a certificate of creditable coverage, from former employers and insurers.
- Pay premiums on time and in full to avoid a lapse in coverage.
- Learn what to do if a claim is denied.
If a Claim Is Denied
If your insurance company denies payment for a recommended treatment, you may be able to get a decision overturned by filing an appeal. Ask your insurer the following questions when appealing a denial:
- Can you send me a copy of the denial letter?
- What is the specific reason the claim was denied? (This information should be included in the denial letter.)
- How can I get a current copy of the plan document and plan summary? (You may need to request these documents in writing.)
- Whom can I contact at the insurance company to discuss the denial?
- How can I request a physician peer review? (A peer review provides the chance for your doctor to discuss your treatment in detail with other doctors, usually within the same geographic area and medical specialty.)
- Can I speak with anyone else if I have questions about the appeals process?
- If a particular drug isn't on the prescription plan's covered drug list (formulary), what is the process for requesting an exception? Can my doctor submit a letter explaining why the drug is needed?
Record the date and time of each call to the insurance company, and the name, phone number and extension of the representative you speak with. Remain courteous, honour deadlines for obtaining key documents and submit all necessary paperwork.
Getting Help from Family and Friends
Delegate time-sensitive tasks to reliable family members or friends who can be counted on to be thorough and meet deadlines. Ask them to help with:
- Setting up a record-keeping system to track bills and submitted, pending and paid insurance claims
- Calling public and private agencies to determine eligibility for financial assistance, entitlement programs and other benefits and services
- Gathering documents to support insurance claims and appeals
- Following up with the insurance company
- Organizing fundraising efforts
Getting Help from Professionals
The professional counsellors who staff national organizations that support people with cancer can give you expert advice on how to:
- Preserve your assets
- Reduce your debt
- Access community resources
- Handle employment issues
- Reduce insurance problems
- Use legal remedies, if and when necessary
This type of guidance can be invaluable in helping patients advocate for themselves more effectively. The following organizations can help you navigate the healthcare system include:
- Canadian Cancer Survivors Network. Canadian Cancer Survivors Network empowers collaborative action by cancer patients, families and communities to identify and work to remove barriers to optimal patient care. They also ensure that cancer survivors have access to education and action opportunities to have their voices heard in planning and implementing an optimal health care system. Visit the CancerCare website.
- Cancer Advocacy Coalition Canada. Cancer Advocacy Coalition Canada aims to provide an effective, comprehensive, evidence-based cancer system that offers Canadians the best chances for preventing and treating this disease, and addresses the emotional, physical and financial needs of patients and survivors. Visit Cancer Advocacy Coalition Canada or call 1-855-572-3436
- Canadian Cancer Action Network. Canadian Cancer Action Network is a national umbrella organization comprised of diverse patient-centred organizations from across Canada, is dedicated to ensuring a coordinated patient and caregiver perspective is firmly embedded in work underway in cancer control. Visit Canadian Cancer Action Network or call 1-866-378-1986
- Canadian Cancer Society. Canadian Cancer Society is a national, community-based organization of volunteers whose mission is the eradication of cancer and the enhancement of the quality of life of people living with cancer. Visit Canadian Cancer Society.
- Canadian Partnership Against Cancer. The Canadian Partnership Against Cancer is an independent organization funded by the federal government to accelerate action on cancer control for all Canadians. The Partnership works with cancer experts, charitable organizations, governments, cancer agencies, national health organizations, patients, survivors and others to implement Canada’s cancer control strategy. Visit Canadian Partnership Against Canada.
We're Here to Help
Call The Leukemia & Lymphoma Society of Canada to speak with a Patient Education & Support Manager. You may reach your local LLSC office.