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28. Underinsured

Most Americans diagnosed with cancer are in some way underinsured. That's because medical costs not covered by their policy are very burdensome or because the costs of certain treatments are "capped" under their policy or totally excluded from coverage.

Common Definition. A family would be "underinsured" if more than 10% of the family's annual after tax income would have to be spent on out-of-pocket medical expenses (meaning not covered by their insurance policy) in the event of a catastrophic illness (and that's true for 28% of all cancer patients). Example: Both husband and wife work, and together take home (after taxes) $50,000 a year. They have two children. If one of them was diagnosed with cancer and the family spent $5,000 on the cost of treatment -- above and beyond costs covered by their health insurance - then this family would be viewed as underinsured. Tips When Reading Your Insurance Policy...

"Caps." These limit reimbursable costs related to a specific disease or cap costs over the lifetime of the policyholder.  If treatment costs go over these limits, then the patient is responsible for the excess.

"Experimental." This term often is applied to the costs of clinical trials and other cutting edge therapies; in that case the costs are totally excluded from coverage under the policy.

Caring for the Homebound. When a patient needs 24/7 care the services of home health aides and nurses often is essential. None of these costs are covered by health insurance – but they are by "long-term care insurance."

Precertification. This needs to be given by the primary care physician in most HMO plans and they may refuse to approve use of a specialist a patient prefers – in which case the patient must bear the cost of their doctor of choice.
Co-pays. Most policies require the patient to pay for part of every doctor visit and, in some cases, pay up to 20% of the bills for out-of-network treatment. These "co-pay obligations" can add up if a cancer patient's treatment is prolonged.
Helpline. The Patient Advocate Foundation is well known to those in the field of cancer care and provides free advice to cancer patients on many of the insurance coverage issues they face. Their toll free number is: 1-800-532-5274.