Insurance Disputes written and compiled by doctordee | Search LMS site |

Your Medical Insurance Coverage Medical Insurance Disputes MORE Medical Insurance Disputes HMO Disputes Military Hospital Disputes Medicare Disputes Medicare, Medicaid, Social Security Disability Employment Rights Financial Assistance
Your Medical Insurance Coverage
Some Information on Working With Your Health Plan/Insurance Company (from a dear friend in the industry) Make sure that you have a current copy of your health insurance policy or Certificate of Coverage or Health Care Contract. Don't rely on a policy or certificate that is more than one year old to have the most correct benefit information. Benefits change based on legislation, community standards, changing technology, etc. If your policy is more than 12 months old, ask for a new policy. Read your health insurance policy or Certificate of Coverage or Health Care Contract and make notes to ask questions about things that are unclear or confusing to you. If you have coverage through your employer, find out if the group/account has a special customer service contact at the health plan/insurance company. Use that special contact to walk you through any benefits that are confusing to you. If you have coverage through your employer, find out if the employer has a special contact or expert that you can contact to discuss coverage/benefits and use as a benefit expert, or an advocate. Pay attention to policy/contract exclusions. If a service or item is expressly excluded, discussion about the service or item with the health plan/insurance company may be academic. Find out if the health plan/insurance company has a Case Management department or has a contract with a case management company. Find out what criteria the health plan/insurance company uses to identify potential case management patients/members/subscribers/enrollees/policy holders. If your health plan has a case management department, there should be well-defined "triggers" whereby the health plan identifies patients/members who would benefit from case management. If you don't meet the criteria or triggers, ask if the health plan includes patients in case management that are unusual or require coordination of care that exceeds usual requirements. Request a case manager. It's o.k. to be your own advocate. Be reasonable, rationale, persistent. Be prepared to justify assignment of a case manager, if you have an unusual case. Presentation of the clinical details of your case should be compelling - unusual diagnosis, multiple diagnosis, etc. Request a copy of the health plan's/insurance company's Medical Policy. The Medical Policy is not your certificate of coverage, health insurance policy, or health care contract. This is the set of policies used by the health plan/insurance company to make medical necessity decisions, and it deals with a wide variety of issues. The Medical Policy (or criteria) determines whether a service or item is eligible for payment, or whether the service or item is experimental, investigative, ineligible. Health plans/insurance companies typically exclude experimental or investigative procedures. FDA approval of a service/item does not guarantee coverage/payment by a health plan; in some instances, the service/item may not be clinically accepted, or the specific use of the service/item may be excluded for certain instances/applications. If you have a special contact or a case manager, have them walk you through the rationale behind specific policies applicable to your treatment. Experimental and Investigative treatments/services/items. Technology is moving at an amazing pace. Many accepted technologies and treatments are being used in new, innovative ways that may not have medical community acceptance, and new technologies are introduced every day. Health plans/insurance companies may or may not pay for clinical trials related to experimental and investigative treatments/services/items. Ask about clinical trials that the health plan may participate with. Work with your case manager to discuss options. Benefit Deviations. If you have coverage through your employer, benefit deviations may occur with approval from your employer. Be aware that benefit deviations may pay for services that are not eligible for coverage, but there are direct IRS tax implications related to any such authorization of payment for ineligible services as a benefit deviation. Payment of services through benefit deviation are reportable income, and will appear on a 1099 as such. Most employers are reluctant to depart from benefits with a deviation because of the tax implications for the employee, and because any deviation sets precedent for future cases. Benefit Substitutions In the interest of extending health benefits, a health plan/insurance company may pay for a service/item/supply in place of another service/item/supply. For instance, in lieu of an extended inpatient admission, home health services may be paid, if medically appropriate. Usually done to conserve dollars, if a patient is reaching a life- time maximum, this is typically negotiated by a case manager. Find out about your Appeal Rights Appeal rights should be clearly provided to you in materials provided by the health plan/insurance company. If you don't know what rights you have to appeal decisions, contact customer service and ask for a copy of your appeal rights. Most health plans/insurance companies provide appeal rights in any written denial issued. Most health plans/insurance companies will take your appeal either verbally, or in writing. Due to confidentiality constraints, your health plan/insurance company will decline to handle such sensitive information via internet, but telephone, US Mail and facsimile transmission are acceptable methods of communicating. Use regulatory oversight authorities to help you work through complaints or grievances. Insurance is heavily regulated on a state and national level. If you don't think you've been treated fairly, contact the Commissioner of Insurance, , the Department of Health, or the Attorney General in your state. Each state regulates health insurance differently, but one of these three oversight authorities will take an interest in helping you resolve problems Grace and Peace, Strength and Courage, Lisa 2002
Medical Insurance Disputes
Your loved one needs a treatment or a consultation, your insurance company or HMO refuses. What do you do? A. Case Managers and Social Workers and Doctors' Assistants 1. Social Workers are often excellent patient advocates. They not only know how the system works, they know how to work it. They can ease many situations by getting things done. One couple advises that whenever they were referred to a new facility, one of the first things they would ask was to contact the social worker. They would introduce themselves, explain their situation, and tell the social worker they would call on them when needed. And the social worker always seemed to come through when we needed them. It was not an additional cost to use the social workers in the various facilities, and they WANT to help. They would recommend contacting the social workers and asking them what they can do for you. 2. Case Managers are often R.N.s or nurse practitioners. Insurance companies or HMOs sometimes have them working for them. Ask to have a case manager assigned to your case. This means that one person will understand what needs to be done, and can get your needs seen to within the rules of the insuring organization. She will be the person you contact for all problems and requests. 3. Doctors' Assistants are R.N.s or nurse practitioners. They are useful in getting the tests, letters, or recommendations that you need. All of the above work as patient advocates, and can help when things seem to fall through the cracks. B. The Patient Advocate Foundation. You need to have your ammunition in place, but the Patient Advocate Foundation which can also be contacted at 800-532-5274 has "scripts" on how to deal with your insurance company to get their approval. It is a useful resource. The Patient Advocate Foundation has Guides for Patients in .pdf files - including Managed Care Answer Guide and Your Guide to the Appeals Process Patient Advocate Foundation Board Members - Physicians, Attorneys, Advocates Nancy Davenport-Ennis C. General Approach in Dealing with Insurance Carriers [by Richard, caretaker husband] My wife is a rare cancer survivor. I work closely with patients and physicians that treat this disease and unfortunately I have had to battle each of the majors for my wife's treatment -- Prudential, Aetna (you bet ya), and Cigna. I am a scientist and have managed in business for many years. I am not a physician. The opinions I express below are based on my personal experience in fighting insurance carriers to keep my wife alive. You need to confront them with the material BUT get really prepared and BE SURE this is the only treatment that holds reasonable promise before you start on this path. Once that is determined then RAISE THE STAKES TO THE HIGHEST LEVEL. Your life depends on it. Some points based on my past experiences. 1. Have at least two (2) doctors' letters advising that this is the only treatment that might save your life. 2. Get the stats on your cancer and mets and lay that out on paper 3. Put the specifics of your case on one page. 4. You will have an insurance company case manager - get their name and the name of the Medical Director for the area that serves you. 5. Get your employer benefits director involved if you are employed. If you have a large employer that is really good because the insurance carriers listen better. Remember insurance companies don't give a damn about anyone. It is all about money to them and that's what they understand. This is a war for your life. You have to make the price of their denial intolerable for them!! I cannot stress this enough. 6. Try to find out if the denial was done by a nurse (which I bet it was). If so you may have them for practicing medicine without a license as a physician. Keep that in mind. 7. Pull the latest data on the treatment you want. Whether it says that it is less invasive, and that it can be essentially a very short stay in the hospital for the procedure. Get the facts and make sure you know what the procedure will cost versus any other possibilities if there are any. Why it is the best for the situation. Or why it is more cost effective. Quote the medical literature. 8. Pull all that together and make these points: a. Only way to save your life b. Rare cancers/NCI suggests clinical trials etc. c. You have documented your physician's recommendations that this is the procedure that should be done. d. It is cost effective. [Ineffective treatments are not cost effective because of treatment of recurrence, so if this treatment has advantages in effectiveness, but costs more, the effectiveness should be emphasized.] 9. Right before you send it get with your local State representative in your State and your Congressman. CC them on the letter. 10. I do not know what State you are in but suggest you call the Attorney General's Office AS WELL AS the State Insurance Board for assistance. (Let them help you fight if they will - in Texas they are banging the hell out of the insurance folks and they listen because they have been repeatedly fined!) They should be copied in on the letter also. 11. Consider "site appeals". For instance, if the FDA has only approved TheraSpheres on the basis of a "Humanitarian Devise Use" in the US for Hepatocellular Carcinoma (HCC), then consider a site appeal, that is liver site. The TheraSphere Docket and exception is FDA # H980006. It was provided to MDS Nordion, Inc. maker of the TheraSphere, Ontario Canada. 12. *** Make it a national issue after that and petition Nordion and the Canadian government to allow the procedure to be done in Canada and get your Congressman and Senator involved. CC them on every correspondence. 13. Bottom line, wake their butts up that you are in danger of losing your life if you cannot get this treatment and they will be responsible for that outcome. 14. Document everything and I mean EVERYTHING related to your case. 15. If you send them a letter keep it somehow on ONE page and send by certified mail with appropriate copies to above: benefits; state rep, state senator, US Congressman, US Senators, State Attorney General, State Insurance Board, Doctors who you have a letter from. (Attach their letters). I have yet had this general methodology fail. Go to the top right away, don't screw around with the worms answering the phone. Richard D. Insurance company websites: Here are some consumer oriented websites: Health Insurance Consumer Guides US Dept of Labor - Health and Benefits A Consumer Guide to Handling Disputes with Your Private or Employer Health Plan Patient Advocate Foundation - Under "Resources" has a "Managed Care Resource Guide" to help answer questions in selecting an insurance plan. compiled by doctordee February 2003
MORE Medical Insurance Disputes
Petitioning for Insurance Coverage for Disputed Treatments Health Care Rights Appeal Letters are available online. These are form letters which help you write appeal and other letters to insurance companies when medically necessities are denied. Useful. Denial of Clinical Trial Coverage: The Patient Advocate Foundation may be able to help / provide resources for patients with insurance problems, including problems with clinical trial coverage. A Listmember wrote: The insurance company rejected claims for treatment for the ET743 Clinical Trial. We had our hearing last night. Even the local oncologists went to the hearing with us! I guess the next step is to appeal at the state level. Does anyone have any other ideas that we could use to get this covered? 1. Take a look at this NIH site titled, Clinical Trials and Insurance Coverage: A Resource Guide 2. If your insurance carrier is already covering clinical trials in other states, they may find it harder to reject your claim. Here's part of a press release from 16 Dec 1999 - more than a year ago - that mentions a number of states requiring insurance coverage. Note, also, the number of major carriers participating. The reason they're doing it is that it's good business - finding better medicines will reduce their overall costs and clinical trials is the only way that new medicines can be evaluated. PRESS RELEASE The American Society of Clinical Oncology, representing 14,000 cancer specialists, today called on insurance companies nationwide to immediately follow the lead of companies operating in New Jersey and cover the costs of patient participation in cancer clinical trials. The news that Oxford Health Plans, Aetna/US Healthcare, Cigna HealthCare and Prudential HealthCare would cover the costs of patients participating in clinical trials for experimental cancer treatments that have been sanctioned by federal health agencies was reported in today's New York Times. "It is high time that cancer patients nationwide benefited from promising new therapies offered in clinical trials," said Dr. Joseph S. Bailes, President of ASCO. "These companies should be applauded for recognizing their role in encouraging cancer patients to participate in clinical trials." "Companies are seeing the writing on the wall. Coverage of cancer trials is seeping into Medicare reform legislation, budget agreements, the Patients' Bill of Rights, and state laws, including those in Maryland, Virginia and Illinois. In addition, the Department of Veterans Affairs, Department of Defense and United HealthCare have all reached agreements to cover cancer clinical trials. This is now a trend, and other insurers and Medicare should sit up and take notice," said Dr. John Durant, ASCO Executive Vice President. Here's another Press Release regarding insurance coverage for clinical trials along with an excerpt from that press release: PHS Health Plans Extends Coverage to Clinical Cancer Trials "September 27, 2000, Shelton, CT -- PHS Health Plans will begin covering federally approved clinical cancer trials for its commercial members in Connecticut and New York, effective today. Coverage will now include routine care for cancer patients enrolled in Stage I, II and III clinical cancer trials at health care facilities and physician offices in the PHS Health Plans network." "To qualify, PHS Health Plans members must be enrolled in a clinical trial that is approved by at least one of the following organizations: The National Institutes of Health (Stage I, II, and III); The United States Food and Drug Administration, in the form of an investigational new drug (IND) exemption (Stage I, II, and III); The United States Department of Defense; or The United States Department of Veterans Affairs." Denial of Consultations or Treatment at a Sarcoma Center Another listmember wrote: Dad is retired from The Company and has an appointment with Dr. Demetri, the insurance company said they would not pay for ANY treatment or office visits...they said they wouldn't even cover surgery 1) Ask your dad get the denial in writing including specifically (citing chapter and verse) why they say it isn't covered. 2) Review the Summary of Coverage booklet that's provided to every employee or retiree and see if the reason for denial matches the summary. 3) Most Summaries of Coverage make reference to the insurance contract between the employer and the insurance company. In most cases the employee or retiree is entitled to request a copy of the insurance contract. If not, then it can probably be reviewed on The Company's premises. Review the contract. 4) Contact The Company's Human Resources (Personnel) Department and see if they agree with the insurance company's interpretation of coverage. If not, they should help your dad get the decision reversed. 5) Was your dad a union man? If so, the union will help him. 6) See if your state's insurance department will help. What state does your dad live in? 7) See if you can get any help from the Patient Advocate Foundation. Patient Advocate Foundation 753 Thimble Shoals Blvd, Suite B, Newport News, VA 23606, Phone: 800-532-5274 Fax: 757-873-8999. 8) Your request for the consultation and/or treatment at a sarcoma center is justified by the medical journal articles that show better survival rates for patients treated at sarcoma centers, as well as the NCCN Guidelines recommending treatment at a sarcoma center. These should be printed out and attached to all queries, appeals, and requests. Ammunition Still another listmember wrote: Also check with your insurance and with your benefits dept. LMS is complex enough that often you can ask for, or insist upon, a case manager. Here is a little excerpt from a friend of mine at a national insurance company: Just wanted to send a few tips on working with your health plan and requesting a case manager. If your health carrier is the same carrier that you had when the patient was originally diagnosed and treated, you should have a very easy time persuading the health plan to assign a case manager. You may even get the same nurse. If not, you might want to put together a written request for the current health plan, to document the original treatment plan. Just remember to stay as calm and unemotional as possible. They'll know how urgent this is and work with you to find the best solution. Many health plans automatically assign a case manager to complex cases. I'd suggest calling the health plan and finding out how to contact case management directly to determine whether they have an automatic assignment protocol, or if you need to request the case manager. Check with Customer Service and or case management to find out how to select or help in the selection of an oncologist. Find out if you are absolutely restricted to a limited network of physicians, or if you can seek services from a wider network of physicians. You may want to do a search to find out if there are resources available to help you shop for a specialist; look for personal recommendations, and don't be afraid to schedule an interview process. If you're contemplating alternative treatments, ask whether any alternative/eastern medicine services are covered, or if there are any discount relationships with alternative/eastern medicine practitioners available. Blue Cross and Blue Shield of Minnesota has recently established an alternative medicine network of providers with whom the plan has negotiated discounts for services. Minnesota subscribers can access alternative services directly, without a referral, for the negotiated discount amount. California is so far ahead of the Midwest on this stuff, its possible that your health plan has a similar arrangement. If you hit a total roadblock, find out what the patient rights are in your state. Every health plan has a patient/member bill of rights, and many of them are based on state mandates. Find out if there are any advocacy groups in your vicinity, and check with the Commissioner of Insurance for the state, to find out if there are any mandated appeal provisions at the state level that you could pursue. I hope that this has given you a little help. [NOTE: in dealing with ANYONE, get deadlines for responses, do not allow "we'll call you" without a specific deadline. If that deadline is reached and surpassed, you call back and keep calling until the situation is resolved. doctordee]
HMO Disputes
An HMO Saga I cannot get my GP or Gynecologist to give me a referral to MDA cancer center. They both said my (HMO) Insurance would not allow it. Advice? I have to go to bed now as I have a bit of a hangover from my pity party (angry party?) yesterday and i can't possibly read or think another thing today! :) donna Dear Donna, I suggest that you tell your GYN and your GP both: "If you are stating that you are letting the HMO decide what is medically necessary for me on the basis of finances, then you are ripe for a malpractice suit. I suggest that you justify this referral medically, and let me worry about suing the HMO instead of suing YOU. " "The AMA has specific guidelines about second opinions, here they are" This website's discussion of Patient Rights The AMA listing of Patient Rights PRINT THESE OUT AND HAND COPIES TO YOUR DOCTOR/S. "If you do NOT know that sarcoma centers have much higher survival rates for their patients, and CONTINUE to make it difficult for me to be seen at one, you are seriously not practicing medicine correctly, and I will report you to the state medical board as well." Here are the References PRINT THESE OUT AND HAND COPIES TO YOUR DOCTOR/S. [You can do a Google Search to find your state's medical board contact details.] And change them for better doctors, if at all possible. Get in touch with the HMO management and DEMAND that they provide you a list of physician/oncologists who "customarily treat" LMS -- a rare cancer. Send them copies of the References as well. I am writing to Richard, who lives in your state, for further information on a plan of attack. doctordee Richard, Donna has LMS stage iv lung mets, needs referral to a sarcoma center and sarcoma oncologist, and her HMO doctors are refusing it. She lives in TX, needs information about Texas laws to make the HMO and its docs sit up and take notice. doctordee Richard's answer to Donna's HMO crisis Dear Donna: Get hold of the Texas Board of Insurance, Consumer Information - HMOs Texas Department of Insurance, Complaint Form/Insurance Texas Department of Insurance, Physician/Provider Complaint Form [He here gives a contact that he worked with at the Texas Dept. of Insurance for HMOs, her fax and email, and her direct number. Their help line is 1-800-252-3439 ] If you are going to see a Sarcoma Oncologist at M.D. Anderson that would most probably be M. Andrew Burgess. If a surgeon Dr. Pisters, radiation either Dr. Ballo or Dr. Zagars. M.D.Anderson Cancer Center Also for patient advocacy issues and information see these sites from the Patient Advocate Foundation Patient Advocate Foundation Patient Advocate Foundation Resources If you file a complaint be sure that you also contact your State Rep, State Senator and U.S. Congressman at the very least. **If you write a letter and the HMO is resisting sending you to a specialist DEMAND that they provide you a list of physician/oncologists who "customarily treat" LMS rare cancer. VERY IMPORTANT. Richard Medical Provider Groups (who contract under the HMO’s) have patient advocates or case managers. They can help with your insurance problems and advocate for treatment coverage by providers who are not with your assigned provider group [for Sarcoma Specialists or clinical trial lab and scan and hospital costs. You would call your HMO provider group to request a case manager be assigned to you.
Military Hospital Disputes
Petitioning for Coverage of Disputed Treatments Army Hospitals Army hospitals, and most military health care systems, usually have one MD assigned as a "primary care provider" for each patient. This is the person that needs to refer their patient to a specialist. If they do not cooperate, then go to the hospital administration. If EVERYTHING fails contact the patient's congressman. At present the military medical care is in a state of flux, particularly with regard to the retirees, who had been promised full medical care "just like on active duty", which may not be in the process of being delivered. For references for backing up requests for treatment at a sarcoma center, use References
Medicare Disputes
Petitioning for Coverage of Disputed Treatments Dealing with Medicare From: Margaret Subject: Emergency Medicare Question I have an emergency and only have a few hours to figure it out - Georgia was on Gemzar for two months and then on Navelbine for the past three months. We received five letters yesterday from Medicare stating that they had reviewed her case and none of these chemo treatments were going to be paid for! They said she did not fit the criteria for these chemotherapies. The Navelbine has brought stability to tumors that were otherwise doubling in size in less than two months. I've called Medicare but they said that they had reviewed the case twice and the same decision was made. Georgia's due to have her next treatment today - in six hours. Any suggestions before we get to the doctor's office and face this dilemma?! Please write to me directly at so I can receive any advice you have to offer immediately. Thanks!!!!! From: Margaret Subject: Medicare dilemma Great news! I spent several hours on the phone with Medicare this morning, working my way up the ladder of authority. Finally I reached someone who was sympathetic to the situation and did more than say they were sorry, there was nothing more that could be done. I explained that lms was an extremely rare cancer and there was no "gold standard" for it. I explained that the chemos they were denying were actually working and saving Georgia's life. She asked the name of the cancer and looked it up - nothing. Then she asked where the tumors were located and I told her. She did some extensive research and found out that by coding the bills in a slightly different way, they would be paid! She even went so far as to call the gal at the billing office and explain to her how this needed to be done! When we arrived at the oncologist for Georgia's chemo treatment he told us that he would have gone all the way to court to fight this for her and would never have just cut off her treatment. But he was extremely thankful that we had pursued the matter and found the simpler course of action. So Georgia got her chemo, the doctor was happy and the day was good. Thanks to everyone who responded with wonderful advice and experience. You're all the greatest!!!! Margaret What arguments did you use? I explained repeatedly as I worked my way up the ladder of authority that lms was an extremely rare disease with no "Gold Standard". The few chemos (Adriamycin and ifosfamide) they had listed as approved for this disease were far more harmful and less of a chance of working than what Georgia was already taking. I also had the advantage that Georgia had just had a CT scan showing that the Navelbine was indeed providing stability to tumors that were otherwise growing rapidly. The manager I finally spoke to last asked where the tumors were now. I told her that they were in the retroperitoneal area and left lung. She did some extensive research and said that if we billed it as a "peritoneal neoplasm" instead of lms, it would get paid! She even called the doctor's office and explained to the billing office how to do this. I'm sure it helped a bit that my background is in health insurance, and I'm sure it helped even more that I simply would not take no for an answer. When we got to the doctor's office that day, both he and the billing gal thanked me profusely. He said that he was going to appeal the decision and would have gone to court to get this paid if need be. He would not have stopped the treatments, and for that I was thankful. But he was very appreciative that he would not need to spend hours of his time battling this obstacle. In the end: the bills get paid, Georgia gets her treatment, and ol' Margaret ends up feeling pretty good about herself - not bad all in all:) The Official U.S. Government Site for People with Medicare Medicare Website THE PATIENTS' BILL OF RIGHTS IN MEDICARE AND MEDICAID Patient's Bill of Rights Medicare Consumer Information A Collection of Government Publications about Medicare Last update December 2001 doctordee
Medicare, Medicaid, Social Security Disability
The links below are to government sites. Social Security Disability What you need to do is to look at the current form that SS uses to determine disability. Look at the questions they ask. Most of this is common sense. I don't have the current form but the concept is unchanged. Disability is about the impact of disease on functioning. Chronic fatigue; chronic and/or severe pain; Chronic nausea; Unable to concentrate; mobility impaired; Prognosis is that things will not get better; you are unable to function because of anxiety, worries; and supply documentation. Notes to your doctor on your inability to function normally become part of your medical record and document your difficulties. Notes to Social Security do not. Start writing progress reports to your doctor on what you cannot. Stage IV LMS or metastatic LMS is immediate grounds for disability. It is not about finances. Social Security Administration Office of Disability Disability Direct: Information on Disabilities for Americans HOW DISABILITY DECISIONS ARE MADE To allow or disallow -- that is the question. How do we decide who is disabled for Social Security purposes and who is not? It's a complex process, but the answers can be found in the "Blue Book." The "Blue Book" provides disability definitions and medical criteria for evaluating Social Security disability claims. A lot of factors go into making a medical decision, and we invite you to check out all the guidelines here. Blue Book MEDICARE Medicare is the same in every state. What is different is the type of medigap insurance that may be available. That gap can be pretty significant. The Federal Government has standardized Medigap plans, so that Plan B in one state is exactly the same as Plan B in any state. However two companies in the same state can offer the same plan for very different rates. And remember: Medicare does not cover prescriptions. The criteria for medicare are either: Age 65: U.S. citizens are automatically covered. (Actually the law was changed and it is up to a few months more than age 65 on a transitional scale they set up). Disability: You apply to Social Security for disability status. Once that is granted, medicare comes with it two years after the date of disability. The good news is that disability can be retroactive. The Official U.S. Government Site for People with Medicare Medicare Site THE PATIENTS' BILL OF RIGHTS IN MEDICARE AND MEDICAID Medicare Bill of Rights Medicare Consumer Information Consumer Information A Collection of Government Publications about Medicare Medicaid Medicaid is not a state program, but is a Federal program that is administered by state governments. It is usually operated as a part of the state welfare system but it is controlled by Federal Regulations. If the requirements are met honestly (therein lies a problem), eligibility generally requires that you have few assets and little income. You are generally allowed to own a house and car. Medicaid is different in every state. The criterion for Medicaid is poverty-low income. One goes to the State office in their area and applies. THE PATIENTS' BILL OF RIGHTS IN MEDICARE AND MEDICAID Medicaid Bill of Rights Medicaid Website December 2001 doctordee
Employment Rights
Employment Rights, Medical Insurance Employment Rights Short Edited Excerpt from Full Article on Employment Rights "Your Employment Rights as a Cancer Survivor Source: National Coalition for Cancer Survivorship Publish Date: 06/02/2000 Review Date: 07/13/2001 " "Work fulfills a critical financial and emotional need for most cancer survivors. ...Although most employers treat cancer survivors fairly and legally, some employers, either through outdated personnel policies or an uninformed or misguided supervisor, erect unnecessary and sometimes illegal barriers to survivors & job opportunities. Some survivors encounter problems such as dismissal, failure to be hired, demotion, denial of promotion, denial of benefits, undesirable transfer, and hostility by co-workers. Survivors can best protect themselves from employment discrimination by learning how to advocate for their rights in the workplace." "The Americans with Disabilities Act (also known as the ADA) prohibits some types of job discrimination against people who have or have had cancer by employers (who have at least 15 employees), employment agencies, and labor unions. Additionally, every state has a law that regulates, to some extent, disability-based employment discrimination. Some laws clearly prohibit cancer-based discrimination, while others have never been applied to cancer-based discrimination. State laws also vary as to which Employers, public or private, large or small, must obey the law." "Under federal and most state laws, an employer has the right to know only if you are able to do the job at the time you apply for it." Knowledge of these issues is relevant to all employed cancer survivors. Medical Insurance To use Medscape, you will have to register. It is free, and you do not have to be a doctor. Article on Insurance HCFA has launched HIPAA Online, an interactive tool that helps answer questions about employees' rights and protections under the Health Insurance Portability and Accountability Act of 1996. HIPAA added protections for employees who have lost their jobs or changed employers by restricting coverage exclusions for pre-existing conditions. The site is designed to guide visitors to an answer by asking questions about their health coverage and situation. It also contains links to specific pages relevant to consumers, employers, state regulators, and self-funded nongovernmental plans. HIPAA online A Shopper's Guide to Cancer Insurance Guide Information About COBRA About COBRA Conquering Cancer, but Way Behind on the Bills Medical Insurance: A "Hidden Crisis" for a Growing Number of Cancer Patients Article Kassabaum-Kennedy Consumer Guides The Medical Reporter US Social Security Information
Financial Assistance
The American Cancer Society provides many services and support for cancer patients. The support will vary from site to site, so contacting your local chapter is a good idea. They can supply wigs, counselling, financial support for travelling for treatment, and support in other ways. Air Flights to travel to oncologists are also available free or at heavy discount. See relevant section on this website. Drugs can be gotten from manufacturers for free or at heavy discounts. See relevant section on this website. CancerSource has sections on financial assistance. CancerCare has information on financial assistance. Catholic Charities Web Links United Way The Robert Wood Johnson Foundation last update 2001 doctordee

The information on this site is not a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with your doctor. Please consult your doctor with any questions or concerns you may have regarding your condition. Copyright © 2001-2006 LMSWEBSITE