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Ayita | Will i have to worry about my healthcare insurance covering the cost of cancer treatments? |
It is a group insurance acquired through my employer. |
 |
 
mbrcatz
|
Honey, if you need cancer treatment, get it. You've got a lot more things to worry about than if your health insurance is paying it.
If you're moving from a prior group plan to this new one, with a lapse in coverage less than 63 days, then there shouldn't be a problem. If it was uninsured before, they can exclude paying for it as a preexisting condition, for up to 18 months.
Worry about paying for it later, concentrate on doing what you need to do to get better, now. |
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zippythejessi
 |
If it's an "experimental" treatment, or one not widely used, it's a possibility they'll fight on paying it. In general though, it should be covered.
That said, that's not a blanket statement on all policies. Employers have the option to pick what they'll allow the plan to pay for. For example - some employers don't pick the riders that cover preventative care, even for children. (IMO, that's dumb.) They do it to keep their costs low. You need to check your specific policy. |
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dimples_in_nj
|
Sounds like an Aflac sales rep recently visited your office. Their cancer policy pays their agents the highest royalty and often is not needed by the insured.
In my travels, I have only seen a handful of policies that would find conflict with one of their members developing cancer and not handling the expenses that go with it. These policies are usually limited benefit programs intended for part time employees.
Your insurance policy will most likely not address cancer itself however; will talk lifetime maximums and medically necessary treatment. Generally speaking, you are fine if you have 5 million or more maximum, hospitialization and office visits.
Don't gamble on buying ancillary insurance products that only cover one specific condition. It is a waste of money.
If your concern is pre-existing conditions, don't sweat it if you had prior coverage within 60 days. Your have protection under the Health Insurance Portability Act, 1996. |
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Irish
 |
No, but there is a maximum limit. Usually today it's 5 million. |
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Size 2
|
Cancer is really one example of why you actually buy health insurance! Overall, the answer should be "YES". Services should be covered subject to out of pocket expenses. You can get into hurdles with the insurance company on particular procedures (especially the new or experimental), but if you prove them as medical necessesity are often approved (doctor's note and records often needed).
Make sure you're not subject to pre-existing condition exclusion. Meaning, if you did NOT have any insurance when you were already seeking treatment, the insurance company can waive coverage for up to 12 months (!) for pre-existing limitation. Some plans are underwritten to waive this limitation even if you had no prior coverage. Others waive the limitation if you did have an insurance before the one you have now, even if the one you have now was purchased AFTER the condition.
If you go to providers that are not in your network you can end up with bills. As horrible as it sounds to pick a provider by financial convenience over expertise, if you have no out of network benefits, you should consider finding a good doctor in the network.
Copays and deductibles shouldn't be an issue before seeking treatment. They don't amount much against your health. But if maximum lifetime payments is applicable to your plan (example 50K), you might have a problem. |
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Diane M
|
A lot depends on your group plan. You will usually have a deductible and then it will only pay reasonable and customary charges. Not all treatments are covered, especially if they might be new or experimental. They may require step therapy where you try one thing first and if that doesn't work then you can try another. Some plans only pay 80% or 90% of the covered charges and some doctors may not be in your group. Just remember to check with your carrier before you embark on any expensive treatment (and get it in writing if possible) and also you can always appeal a decision. I found that different people had different answers at my insurance carrier to make sure you note the date and who you talked to. |
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