Tahlequah Daily Press

October 23, 2013

Cancer insurance can protect a budget

Staff Writer

TAHLEQUAH — Getting the right kind of cancer treatment can be a costly burden that puts you and your family on edge when it comes time to pay the bills.

Aside from the expected costs like doctor’s visits, lab tests, and medications, cancer patients often feel the weight of other expenses – like transportation, meals, lodging and more.

Out-of-pocket expenses can add up quickly, and cancer patients often decide to stop treatment early because of the cost burden.

The American Cancer Society recommends knowing the terms of health insurance policies and being aware of preferred or network doctors or clinics. Careful record-keeping is also important.

According to information from the American Society of Clinical Oncology, most people in the U.S. obtain insurance through their employer or government programs such as Medicare.

“If you have private health insurance, ... find out what is and isn’t covered, what your co-pays are, and what you can expect your out-of-pocket costs to be,” the American Cancer Society recommends.

Those who have Medicare, Medicaid or other public insurance should talk with their cancer-care team to see about getting cost and coverage information.

Freddie Ferrell, a Tahlequah representative for Insurance Professionals of Oklahoma, said cancer is typically treated like any other illness under a traditional health insurance plan.

“You’re going to be covered up to the plan limits. A traditional health insurance plan might have a standard deductible of $1,000, and then it goes to what they call a co-insurance arrangement after that,” said Ferrell. “Co-insurance is just the shared relationship between you and the insurance company. Those are done on percentages; typically you see like a 80-20 or 70-30 split, meaning that after that deductible is paid, the insurance companies will pay 80 percent or 70 percent of the bill, and you pay 30 percent or 20 percent of the bill, up until a magic number that they call your ‘maximum out-of-pocket expenses.’”

After that point, the insurance company typically pays 100 percent, Ferrell said.

A number of companies, like Aflac or American Fidelity, offer cancer-care supplemental plans to tackle costs not covered by traditional health insurance.

“What cancer plans are designed to do is try to fill some of those voids,” said Ferrell. “Quite a few companies offer them to help alleviate any of the financial burdens you might have as a result of being diagnosed with cancer. These are often offered at the work place as a voluntary benefit, but they’re permanent and portable, meaning they are yours and you can take them with you if you leave.”

Costs of supplemental plans vary, but Ferrell said group rates could range from $20 to $50 per month.

“One of the benefits of these cancer plans is you’ve got an initial diagnosis benefit,” said Ferrell. “For one particular plan, it might be $4,000; some might be $500. Those benefits are going to help you out, because you’ll have deductibles and co-insurance. These [supplemental benefits] go straight to you; they don’t go to the doctor, or your employer. They cut a check and it’s mailed to your house. That initial diagnosis benefit is very helpful.”

Some plans also cover other out-of-pocket expenses.

“Another that most [supplemental plans] have is a transportation benefit for a spouse or family member,” said Ferrell. “If you’ve got cancer, more than likely you’re not going to stay in Tahlequah to get treated. You might want to go to a center, and you’re not going to want to go by yourself, so they’ve got lodging, meals, travel expenses covered.”

For those who have already been diagnosed with cancer, adding a supplemental plan likely won’t be an option – and insurance professionals say they are still trying to grasp what changes will be made for pre-existing conditions with the introduction of the Affordable Care Act.

“Previous to it, Oklahoma had what was called a high-risk pool. You had to be denied by three different insurance companies, and after that, you qualified for coverage,” said Ferrell. “It wasn’t the cheapest thing, but at least you got coverage. But I’m still not sure how this is all working with ‘Obamacare’ – what’s going to stay in place, if it is, if it’s not.

Ferrell said the state insurance commissioner is working with local agents to hold a town hall meeting in Cherokee County before the end of the year, where topics of the ACA can be addressed by experts.

Types of health insurance, according to the American Society of Clinical Oncology:

• Private insurance provides “fee-for-service” coverage. Patients who have private health insurance often visit the doctor or hospital of their choice, submit a claim form, and the health insurance company pays the expenses. Patients are often required to make some type of a co-payment.

• With an HMO, patients typically select a primary care doctor from an approved network and pay a monthly premium, along with an additional co-payment for each office visit. Cover services vary, and there are often fewer choices of participating doctors or clinics. Seeing a specialist could require a referral from a primary care doctor; and pre-existing conditions aren’t always covered.

• In a PPO, a participant is offered a network of approved physicians. They may have more freedom in seeing a specialist than with an HMO, but may also face the need to pay a larger portion of the bill. As with a an HMO, some services and pre-existing conditions may prohibit participation.

• Government-sponsored insurance, such as Medicare for those age 65 and older and disabled Americans; and Medicaid, administered by each state for those who are elderly, blind, or disabled, or perhaps certain people in families with dependent children.

• Supplemental insurance plans help cover the costs not covered by primary insurance, such as a deductible or co-payment. Supplementals sometimes offer participants compensation for earnings that are lost as a result of missing work.