Navigating the Healthcare System When Diagnosed with Cancer

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Topics include: Living Well

Sherea Cary, a communications specialist, caregiver and CanCare volunteer, shares valuable information to help you and your family navigate the complex healthcare system.  She provides advice for dealing with your insurance company including the best ways to communicate, how you can find out what medications and procedures are covered, and how to familiarize yourself with your insurance policy.

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Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:

Hello and welcome to Patient Power.  I'm Andrew Schorr.  Joining us once again to help with valuable information for you and your family is Sherea Cary from Houston.  Sherea is one of the trained volunteers at CanCare, which helps cancer patients. 

Sherea, back in 2000, your dad, Chester, was diagnosed with prostate cancer, and happily he's doing well.  Welcome back to Patient Power. 

Sherea Cary:

Oh, thank you for having me. 

Andrew Schorr:

Some people have Medicare.  Some people have private insurance, as Sherea's dad, Chester, did.  Sherea is a trained paralegal, and so she helped her dad navigate which can be the insurance maze.  Sherea, what tips do you have for our viewers? 

Sherea Cary:

The first tip I would give anyone is to understand that insurance is a contract, which means there are responsibilities on either side of the contract.  Everything that's covered should be written in the contract. And if there's a reason why something isn't covered, such as a treatment, someone with the insurance company should be able to explain to you where you would find that information.  So that's the first thing that I would say.  You've got to understand that it's a contract. 

The second thing that I would say is a good tip is to make sure and document whenever you contact the insurance company who you have spoken with, what they told you, and ask where—where to find it in the insurance contract.  It's very important to have a copy of the Group Health Insurance book, the contract, and all of the information when you're talking to the insurance representatives.  That's very important so that you can kind of track and be on the same page. 

Andrew Schorr:

Now, of course. part of this is knowing which facilities and which providers you can go to that would be covered, right? 

Sherea Cary:

Yes.  One of the things—one of the first things that you want to do once a loved one has been—or a family member or a friend has been diagnosed with an illness and you're going to help them with the insurance portion of their illness, it's very important for you to become familiar with their policy.  It provides some interesting late-night reading.  It can help you if you are having a sleepless night.  But if you read some of the information and become informed, then you're better able to assist the person that you are helping, the loved one, the family member or the friend.  So it's real important to know what's in their policy.  Not every detail, but understand who are their doctors, what plan they are participating in, what benefits are covered, what things aren't necessarily covered. 

And usually there's an information sheet or some early part of the policy that tells you the basic information of what the deductibles are if there are any, what things are covered a hundred percent.  So I would look at that information first to become familiar. 

Andrew Schorr:

Cancer treatment can be quite expensive. And now happily there are some new medicines coming up, targeted therapies, that can make a real difference.  But they can be super expensive, and it's not always clear whether they are covered.  So, Sherea, what advice do you give on finding out whether the cancer treatment that's prescribed is covered? And if there's a debate about it, how you can advance that towards a favorable resolution? 

Sherea Cary:

I think that it's important that you ask particular questions. And at that point when you're trying to get medications approved and things like that, I think it's real important to try and deal with the insurance company in writing so that you can have documentation of what's going on. 

I also think it's important to ask the doctor to assist you with trying to get certain medications or getting things approved.  I think that a team approach would be very helpful when dealing with the insurance company. 

Andrew Schorr:

Sherea, you work at a law firm.  At what point should a patient or a family member say, hmm, I think I should get our lawyer involved here?  Or should they mention it at all? 

Sherea Cary:

It's difficult to determine when you need to hire counsel.  Insurance law is very complicated.  You can always seek counsel and ask a lawyer a question whether you think you need representation.  If you believe that your policy entitles you to a certain benefit and you're not receiving it and you're not getting a sufficient answer, then it may be a good idea to contact legal counsel and take your paperwork with you and explain to them what's going on and see if they can be of assistance. 

Andrew Schorr:

Sounds like the bottom line is document, document, document. 

Sherea Cary:

Documenting is very important.  It's hard to keep track of phone conversations with insurance people or doctors or anyone.  The one thing I learned about my process with my farther is the more paperwork I had the better off I was.  I didn't have to rely on memory or what I thought someone else said.  I could go to my notes and say, well, this is what we discussed, and that was much better for me. 

Because when a loved one is sick or ill, you're emotional too as—you're the caregiver and you're taking care of someone, but you're also emotional, so you've got to be able to kind of keep all that information in a sys—in a method that you can rely on some documentation as opposed to how I was feeling that day. 

Andrew Schorr:

Those are great tips for helping you and your family navigate the system during a difficult time.  Sherea Cary from Houston, thanks for being with us. 

Sherea Cary:

Thank you for having me. 

Andrew Schorr:

And all the best to your dad, Chester, for continued good health. 

Sherea Cary:

Oh, thank you.  He's doing wonderful, and we're happy about that. 

Andrew Schorr:

I'm glad to hear that. 

Great information for you and your family.  Thanks for watching.  I'm Andrew Schorr.  Remember, knowledge can be the best medicine of all.  

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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Page last updated on June 24, 2015