Mesothelioma Insurance Claim

Health-insurance coverage is vital for everyone, but for mesothelioma patients, the need is even greater. Asbestos cancer is difficult and expensive to treat, so having quality health insurance ensures that patients won’t have to worry about paying for disease treatment.

It is crucial that patients and their families fully understand their primary insurance coverage and any supplemental insurance coverage, including Medicaid, Medicare, Social Security and veteran’s benefits. Often, insurance coverage is difficult to understand and may require questioning insurance company representatives.

• How to Manage Your Health Insurance - For all healthcare patients, there are several guidelines to follow to manage a health insurance plan. If needed, asbestos-cancer patients may need to assign a proxy, such as a close family member, to ensure these guidelines are met:
• Do not allow insurance to expire - Expired insurance policies will not pay medical expenses, even if the patient assumed the policy was still active at the time of the medical procedure.
• If you change plans, do not allow any policy lapses - It is crucial that you always have an active health-insurance policy. When changing plans, get all of the start and end dates in writing.
• Pay premiums on time and in full - Insurance companies sometimes seem overeager to cancel policies, so it’s vital to pay all premiums quickly and accurately. Keeping good records of payment is important.
• Do not rely on new insurance - After an asbestos-cancer diagnosis, it may be difficult to get a new health-insurance policy. In addition, it’s important to get treatment started quickly.
• Understand the details of your plan and coverage - Even though it is difficult to know all of the specifics of your insurance coverage, it’s important to know the basics. If you have any questions, contact the insurance company’s customer service. They are often eager to answer complex questions.
• Keep accurate records of submitted, pending and paid claims - Start a file folder or electronic folder exclusively for your medical bills so they are always at your fingertips. Many cancer patients ask a trusted friend or family member to help keep track of these bills.
• Keep copies of paperwork related to your claims - Having easily accessible copies of your documents makes filing a claim or questioning benefits easier. Many patients find it easier to keep these documents in a computer or electronic file.
• Ask for a Summary of Benefits and Coverage (SBC) or Explanation of Benefits (EOB) - These are easy-to-read summaries of your insurance plan and the coverage. This will help you determine the procedures that are covered and the reasons for a denial.
• Call insurer to ensure any procedure has been approved for coverage - When you call, make sure you have all your important documentation at your fingertips. This way, you can ask the important questions.
• Contact your insurance company if your bill seems wrong - Be sure to keep all of your medical documentation in file. When you have questions, contact the billing department. Hospitals, doctor’s offices and medical centers are known to make mistakes.
• Submit claims for medical expenses even if unsure of coverage - Even if you've been told that the procedure is not covered, submit the claim for coverage anyway. The cost may go to your deductible or may be fully covered.

Asbestos-cancer patients must be vigilant to ensure all of their medical procedures are covered by insurance. In some cases, claims are denied. This can be a heart-wrenching, time-consuming and infuriating situation.

Reasons Insurance Claims Get Denied

Health insurance companies may cite many reasons why a treatment or procedure is denied:

• Treatment is considered experimental - Because asbestos cancers are such rare diseases with so few patients, there are a limited number of clinical trials being performed. Many of the most common treatments are considered experimental even though they have been proven to work for other patients.
• Not medically necessary - Insurance companies determine which procedures are medically necessary to ensure a patient will meet the maximum medical improvement.
• Out of network - Services provided by hospitals and doctors that are not contracted with the insurance company are considered out of network. This means the insurance company may only pay a portion of the claim or none at all.

Handling a Claim Denial

If your claim is denied, you should turn to your documentation to ensure no mistakes have been made. There are several steps to ensure you are receiving the coverage you deserve:

• Review the EOB - This document will tell you why your claim was not covered. Sometimes, it is due to a billing error.
• Contact the Insurance Company - The customer service representative can review your basic file and give you general information about your coverage.
• File an Appeal - Ask your insurance company about the process of filing an appeal of the denial. Many insurance companies have a two- to three-level appeals process.

How to File a Winning Appeal

In many cases, filing an insurance appeal is a time-consuming and difficult task. Our legal representation can help you through this process while you focus on your treatments. We understand the challenges that mesothelioma patients face and can guide you through this process by taking on the insurance company.

Options for the Uninsured

With the new changes to the nation’s healthcare laws, all patients have access to health insurance. You cannot be turned down if you have a pre-existing condition such as mesothelioma. Other options include the Hill-Burton free and reduced health-care program, which grants some patients access to free or deeply discounted healthcare.

If you are struggling with your insurance company to have your treatments covered or you have questions about your coverage, contact us today. Our representatives can help you find the answers to your questions and determine your next best step.