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The health care system can be extremely complicated and a source of great stress for families. Working with the insurance provider can help families understand their medical plan, what it covers, and where care is available.
Review insurance plan documents carefully to understand benefits coverage, network providers and potential out-of-pocket costs. These documents include:
Insurance companies and employers (if an employer-based health plan) are required to provide a summary of insurance coverage. Request a copy if you do not have it.
To prepare for conversations with the insurance company, the care team can provide information about the patient’s treatment plan. Getting clear answers to questions will minimize unexpected costs, manage stress, and help families make more informed decisions.
Key questions to ask the care team to better understand recommended tests and procedures include:
The insurance company will have questions such as:
The insurance company may ask questions about the cancer medicines prescribed. Ask the care team:
During treatment, the child may need at-home care from a parent or a specialized caregiver. Insurance plans may cover some of these costs. A clear understanding of specific care and anticipated timeframe will help insurers provide answers.
Ask the care team about home requirements to provide accurate information to the insurance company.
Once a treatment care plan is in place, contact the insurance company to understand the services covered and their costs. Ask the insurance company to assign an individual case manager or patient advocate to help answer questions. The case manager can guide families through the insurance plan rules, coverage limitations, and potential out-of-pocket costs. Questions to ask the insurer include:
If the insurer denies coverage for any portion of the care plan, consider these next steps:
Reviewed: June 2018