Cutaneous Lymphoma Foundation
6
Some may think that Yogi is speaking about the world of medical
insurance given its propensity for the complicated and complex!
Unfortunately most of us are not fully aware of the nuances in our
medical insurance policies until we or a family member begins to
have medical issues and are then forced to learn how to navigate
the details of our contract language.
“One of the biggest challenges we assist patients with involves
the discrepancy between what patients assumed their insurance
pays and what in actuality it does and does not cover” states
Erin Moaratty, Chief of Mission Delivery at Patient Advocate
Foundation.
For example, frustration and panic arises when patients become
aware of how large their co-payments can be for needed medical
procedures or prescription drugs, frequently rising into the
thousands for a major diagnosis. Patients can find themselves
feeling helpless when their insurance company denies the doctor’s
recommended treatment option, or when making endless calls to
the provider’s billing office to dispute a specific charge. Patients
may be quickly overwhelmed with the sheer number of bills that
come to them, some from providers the patient was not even
aware provided services in their care.
To prevent these scenarios, Moaratty suggests patients should
take some time to truly understand what is covered and what
is not covered by their current medical insurance. “Paying
close attention to annual deductibles, copayments for top-
tier prescriptions, charges that can arise from out of network
providers, etc. can help you identify your need for a budget or
savings plans to manage these potential expenditures.“
Remember that your policy is a binding contract between you
and the insurance company. It is enforceable only as the language
written in the policy states, so it is important to review your
policy in detail. Examples of areas that may lead to financial
vulnerability include:
• How does your insurance cover out-of-network providers?
• What if you are in a position to not be able to choose
providers or are away from home?
• Does your policy cover common high priced services,
including transplants, chemotherapy, hospice care, etc ?
• What is not covered by the policy? (Chiropractic services,
vaccinations, lab services, home therapy, mental health
services, etc)
• How does your policy cover participation in clinical trials or
experimental treatments?
• How does your coverage deal with pre-existing conditions?
• How am I covered for adjunct services involved in my care,
like medical devices, ground or air ambulance transport,
nursing or rehab facilities?
If patients find themselves dealing with specific coverage
questions, treatment denials or mistakes by their insurance
companies following their medical care they can contact the
customer service number listed on their bills, contact the
provider’s social worker or patient navigator, or contact an
experienced external advocate to bring clarity to the situation.
Insurance: Know Your Policy
You’ve got to be very
careful if you don’t
know where you are
going, because you
might not get there.
Yogi Berra
In a world where too many of us
are realizing that we are indeed
underinsured for a major medical crisis,
there are nonprofit organizations like
Patient Advocate Foundation that can
help you understand your benefits and
find solutions to your biggest insurance
challenges.
CLF’s Iron Men
Celebrating the Cutaneous Lymphoma Foundation in
Lake Placid at the annual Iron Man Competition are
patient Dr. Neil Dicker (center) and Board member
Brace Krag (right) supporting Neil’s son-in-law who
participated in the day-long event.
