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After Your Diagnosis: Taking a Second Look at Your Health Insurance Plan

A guest contribution from

That one word – cancer. It is jarring. The syllables and sentences that flow after hearing cancer attached to a diagnosis can be incoherent. All an individual knows is that life has changed forever.

Anyone who has a cancer diagnosis has to get their medical care and treatment steps in line, first and foremost. However, one area that can be remiss in the flurry of planning for care is planning what providers are covered under the health insurance policy, and how much a healthcare plan will cover for surgery and treatment.

The first step is not to panic. You are in control of your healthcare. Here are some additional steps you can take to advocate for your personal healthcare, and avoid costly mistakes along the way.

HealthCare Blog ImageBecome best friends with your health insurance company. Your health insurance company is meant to be there when you need them most. Contact your health carrier to find out what medical providers are in-network for your specific healthcare plan. If your doctor refers you to a specialist or facility and states they are in-network, double check with your health insurance company before you s
chedule an appointment. Networks change every year, and your health insurance company is going to have the most update to date and accurate information on file. Many times, there are additional providers available that your physician might not be aware of.

 Shop your healthcare. Hospital and provider prices vary more than many realize. Sometimes driving an extra 10 miles might save you hundreds or even thousands of dollars for the exact same care. David Holt, attorney and cofounder of advises healthcare consumers to start with their insurance company to get the facts.

“Each insurance company varies, but there are typically representatives available that can advise on what facility and/or doctor is in-network, and to what degree treatment is covered under a patient’s plan. Some companies even have cancer advocates that specialize in cancer treatment coverage, so ask in advance if they have advocates on staff,” states Holt. “As an added safeguard, always request the insurance company communicate directly with your healthcare provider to give authorization on the treatment. To the extent you can, also get this authorization in writing.”

Get to know your health insurance plan in detail. If you haven’t looked at your policy in a year or two, reacquaint yourself. Understand what your out-of-pocket costs are going to be in advance of treatment. Do you know what a deductible is? How about coinsurance? When the explanation of benefits and invoices begin rolling in, you should be able to look at each itemized expense and determine if the charge is correct or if a coding error has been made. Studies estimate 40% to 80% of medical bills contain errors because of duplicate coding or incorrect coding, so it’s important to stay sharp and pay attention to what you are being billed for. If you suspect you’ve been billed incorrectly, contact your health insurance company.

Make an upgrade. Healthcare reform in the United States has given those with a critical illness several benefits. First and foremost, you are no longer at risk. Your health insurance company cannot cancel coverage or deny coverage for any reason. Second, you have the right to upgrade.

Think about your current policy. If you have a high deductible health insurance plan, your out of pocket expenses may sting if you need months of care. Specialty medications required for treatment might not be covered by your healthcare plan. Networks, out of pocket expenses and prescription drugs are all items to equally weigh when thinking about a health plan upgrade. Consider looking at richer health insurance plans with broader networks, lower deductibles and overall lower out of pocket expenses. Prescription drugs will many times have their own deductible, so be sure to add those expenses into your overall health insurance policy review, in addition to making sure your drugs are covered on the plan you are eyeing.

If you have health insurance policy through your spouse or your own employer, have your research done before the open enrollment period to change your coverage begins in the fall. For individuals that purchase a healthcare plan on their own, the open enrollment period to adjust your coverage for 2016 will be held November 1, 2015 – January 31, 2016.

By taking the time to learn more about your healthcare plan, network, and costs, you can come out ahead and focus on what really matters, your personal wellbeing.


The Colon Cancer Coalition does not endorse or the opinions shared in this guest post. The accuracy, completeness, and validity of any statements made within this guest post are not guaranteed. We accept no liability for any errors, omissions, or representations. The copyright of this content belongs to the author, and any liability with regards to infringement of intellectual property rights remains with them.’s president, Jeff Smedsrud, is the Chairman of the Board for the Colon Cancer Coalition.

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