How to Get Help When Insurance Denies Coverage for Cancer Medications
Cancer patients who have been denied coverage for their medication have few easy options for recourse. Switching to another insurance provider or threatening to do so isn't an effective strategy, because their pre-existing condition would result in needing to pay out massive premiums for any company that would agree to cover them. The chief method to get coverage is to file an appeal with the insurance company with the assistance of your doctors and potentially an insurance lawyer.
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Instructions
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Review your insurance agreement for information about medication coverage. If you have followed all the terms of your agreement and were still denied coverage for your cancer medications prescribed by a doctor, you may have a strong case for an appeal.
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Ask your doctor to write a letter in support of your appeal to the insurance company. The doctor's job will be to explain why the medication is necessary to improve your chances of survival and what the consequences of not taking the medication could be for you.
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Apply for Medicare Part D if you don't already have coverage. Medicare Part D can provide compensation for pharmaceuticals such as cancer medications. This can be used in addition to any private insurance you may be eligible for. Medicare does not cover all types of cancer drugs. Call 1-800-MEDICARE if you have any questions about whether your cancer medications will be covered by Part D.
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Contact your hospital's financial aid department about charity care options for your cancer treatment. You may not be eligible for charity care if you have not already exhausted your private insurance coverage and any other government benefits. Your family must earn less than 200% of the federal poverty level to be eligible for charity care. In most cases, you must file for financial aid from your hospital within six months of first receiving treatment.
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Contract with an insurance lawyer to assist in your appeal to your current insurance company. A lawyer will also be able to coach doctors and other health care providers to word their letters in such a manner that makes it more difficult for the insurance company to continue to deny coverage.
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File an insurance claim lawsuit if your lawyer believes you can win a settlement for wrongful denial of coverage.
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