Know your rights

Know your rights

By Victoria Tillostone

USA’s Healthcare system

A diagnosis of cancer can cause real concern about how your health insurance will cover treatment options and outcomes, and you may be worried about whether wigs, breast reconstruction and other aesthetic needs will be covered as well. Independent insurance agent and breast cancer survivor Kristy Fishman is no stranger to the United States' often labyrinthine healthcare system. She has these tips to make sure you get the best care you are entitled to.

General advice

Review your policy and understand your benefits offered. You need to know your rights! There are some major medical and surgical benefits that are mandated by the Federal law which provide coverage.

The 1998 Federal Breast Reconstruction Law (also Women’s Health and Cancer Rights Act of 1998 or WHCRA) provides the following services which are covered by health insurance:

  • Reconstruction of the breast where the mastectomy was performed
  • Surgery and reconstruction on the other breast to make both breasts symmetrical
  • Protheses/physical complication (lymphedema) coverage post surgeries
  • Micropigmentation (a.k.a. areola tattooing or re-pigmentation). If tattooing is part of your reconstruction process, it should be covered. Be sure to work with an artist who is an expert in 3-D areola tattooing and knows how to write an invoice with your diagnosis and whatever else your plan needs to cover the procedure. There are many resources available which provide information about your rights and coverage available to you.


Below are a few informative websites:


Wigs and Hair Coverings

One of the most devastating side-effects of cancer treatment is hair loss, and regrettably, wigs and other hair coverings can be expensive. Health insurance coverage for wigs (i.e., Medical prosthesis, also Durable Medical Equipment or DME) may have very limited benefits. Insurance plans pay for a percentage but the following may apply before you receive the benefits:

  • Deductible has been met, out of pocket maximum has been met, the wig provider is a participating provider or in-network provider
  • The plan may only pay for one wig up to a maximum dollar amount
  • If your plan allows, submit a claim form along with the receipt and a prescription from your doctor. The prescription should include the diagnosis code (very important) otherwise your claim may not be paid
  • Note: some wig providers offer discounts to patients receiving chemotherapy. If they do not offer this to you, ask! Support programs in hospitals and other medical centers often provide free wigs and hair coverings for women who cannot afford them.


More advice

When you're diagnosed, Kristy suggests you get an advocate, such as a health insurance broker or plan administrator/human resources. However, if you don't have one and call your health insurance company for help, keep the following in mind:

  • Insurance company employees do not make the rules. They just explain the plan’s benefits so ask them to help you. Most will be very helpful if you let them know that you need assistance.
  • Ask a lot of questions. Ask the insurance company to explain the benefits and answer any questions you have. Ask them to give you any information concerning your question. Ask them to also explain any plan limitations/exclusions that may apply. Ask if there is anything else you should know or be aware of.
  • Talk to your medical provider. Many providers who are affiliated with large hospitals will have great sources of information.
  • If you are currently uninsured, ask your provider about financial assistance, cash discounts, cash packages (major services) and also government programs. There are also private foundations such as The HealthWell Foundation, which has helped over 70,000 cancer patients since its inception in 2004, filling in the gaps for services that insurance does not cover for cancer treatment or chronic illness. 

Tagged with: well-being, beauty

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