The following excerpt is taken from Chapter
of Colon & Rectal Cancer: A Comprehensive Guide for
Patients & Families by Lorraine Johnston, copyright 2000 by
O'Reilly & Associates, Inc. For book orders/information, call
(800) 998-9938. Permission is granted to print and distribute this
excerpt for noncommercial use as long as the above source is
included. The information in this article is meant to educate and
should not be used as an alternative for professional medical care.
For colorectal cancer survivors, problems may arise with health insurance,
unemployment insurance, or life insurance. Of these, health insurance is the
most likely to cause heartache, frustration, and anger, but first, we'll discuss
the main impediment to purchasing all kinds of health, life, disability, and
care insurance: medical underwriting.
State and federal authorities have begun to address the problem of health
insurance being denied to those with serious illnesses (for which see COBRA and
HIPAA, discussed later in this section), but purchases of life, long-term care,
and other insurance policies are still impossible or expensive purchases for
those with a cancer diagnosis.
The impediment is the medical examination or medical history questionnaire. If
the policy is indeed offered to you after the actuaries have examined the
statistics for your illness, it may be offered only with very high premiums.
Moreover, employers who have no annual open enrollment period may refuse to ever
insure you if you did not elect certain insurance options at time of hire, which
is their only open enrollment period.
When my husband changed jobs, we decided to just add his name to my employer's
medical policy in order to save money and have one provider. What we didn't
realize is that his employer did not have annual open enrollment--the only time
he wouldn't be asked about his health was when he was hired.
If your insurance needs are unmet, you should consider any offer that states
that medical underwriting--insurance jargon for a close scrutiny of your
health--is not necessary. Some advertisements state very clearly that a medical
exam isn't necessary, or that pre-existing conditions will not result in
After he was diagnosed with cancer, I wanted to change jobs. By then, I'd heard
horror stories about changing jobs and losing coverage because pre-existing
conditions were excluded. I asked him to follow up with his employer to see if
he could enroll for their medical insurance. They referred him to the policy's
underwriters. (That should have given us a hint of what was to come.) "We will
never insure you," they said. This meant I could never leave my job.
Since then, his employer's policy has been renegotiated for more leniency, and
federal laws have been passed to look after the medical insurance needs of
people like us. But it was a bitter experience.
Note that some medical questionnaires for insurance enrollment ask health
questions but do not mention cancer, not even in the section titled "Other."
It's always worthwhile to ask for an application form to see just how rigorous
the medical scrutiny may be.
Of course, while most of these offers may be aboveboard, a proportion of these
policies may be very expensive. The usual considerations for shopping wisely
still apply, but if your insurance needs are great, or your estate planning
justifies purchasing a whole-life policy that might bypass estate and
inheritance taxes, for example, the additional cost may be worth it.
Insurance companies are evaluated by A.M. Best, Moody's, and Standard and Poor.
Choose only those with top ratings.
Cancer survivors in the US complain about health insurance problems more than
any other issue except cancer itself. The delays and denials of managed care are
the most common complaint, but other insurance issues also arise.
I have battled with insurance companies and won. I start at the top when things
don't go my way. I call the state insurance commissioner. That office can make a
difference. My next call is to the state attorney general's office.
If your medical insurance plan is in some way lacking, find out if your
I had one doctor who failed to respond when I asked for a copy of my records.
After three phone calls, I wrote him a letter. The records were in the return
mail. You can even pose more of a threat to them by sending it by certified
mail, signature required. This way you will know who picked up the piece of
Back in 1997 I wanted to sell a small business, but since I had a group policy,
I had to keep the business until the Kennedy-Kautzenbaum bill that protects the
portability of an employee's health insurance passed and became law. Maine had
no problem giving me insurance; however, Florida thought they found a loophole
and would not provide insurance to my ex-wife due to pre-existing conditions. I
ended up writing to the insurance commissioner and then emailed my state
senator. It took us a while, but we did prevail, and got the insurance.
If so, use the open enrollment period to upgrade to a better policy. Examine all
plans closely for what they cover, especially for coverage of care given under
the auspices of a clinical trial. Weigh an indemnity or preferred-provider plan,
which may trade higher convenience for lower coverage, against a high-coverage
HMO requiring referrals and gatekeepers. The indemnity plan may cost more per
doctor visit, but may provide you with the freedom to get care wherever
you think best, without the delay of preapproval, including out-of-state
care within a clinical trial, or at a distant but excellent cancer center.
- Offers more than one medical insurance plan.
- Holds an open enrollment each year. Open enrollment is the time period
during which you may change plans without a medical examination or
questionnaire, that is, without having your pre-existing health conditions held
If you have been approved for Social Security Disability Income (SSDI, discussed
under "Disability income," later in this article) you'll be automatically
enrolled in Medicare after getting disability benefits for two years. Moreover,
Medicare coverage is free for 39 months after returning to work if you're still
disabled. If your income is low, your state may pay your Medicare premiums as
part of Medicaid benefits. Contact your local Social Security Administration
office for more information.
Losing medical insurance coverage if you change or lose jobs is still a problem,
but less of a problem than before. In addition to various state laws, two
federal laws exist to help you retain coverage:
Some states have older, stricter laws that resemble HIPAA but provide better
coverage. Call your state insurance commissioner for details, but note that
self-insured employers, which generally include very large businesses, are
governed by the federal Employee Retirement Income Security Act of 1974 (ERISA)
laws that override state laws.
- HIPAA, the Health Insurance Portability and Accountability Act of 1996, is a
federal law intended to prohibit the permanent denial of medical coverage based
on pre-existing conditions. HIPAA covers only employers with 20 or more
employees. In general, it states that if you have had continuous medical
insurance coverage for more than 12 months, your new medical insurance company
cannot refuse to pay for medical care for your previous health problems. If your
previous health coverage was for less than 12 months, each month you were
covered reduces by one month the amount of time your new medical insurance
company can refuse to pay for your previous health problems. No medical
insurance company, however, can refuse to pay for your previous health problems
for more than 12 months. There are loopholes in this law, though, that medical
insurance companies might exploit. Some companies define a change of coverage
from husband-and-wife to family coverage, for example, as a switch to a new
plan, which could, in theory, restart the 12-month clock. In July 1998,
President Clinton issued a warning to insurance companies covering federal
employees, stating that such denials of payment will not be tolerated.
COBRA, the Consolidated Omnibus Budget Reconciliation Act of 1985, provides for
a continuation of your old employer's medical insurance coverage for a temporary
amount of time--from 18 to 39 months, depending on your circumstances. Always
elect COBRA continuation coverage if you lose or change jobs, until you're
certain that your new employer's policy will cover expenses associated with your
care. HIPAA, discussed above, does not always provide the continuous coverage
the law intended, owing to its design and various loopholes.
Self-insured employers may hire a medical insurance company, such as Blue Cross,
to administer their plan. The insurance information you receive, such as
explanations of benefits, may contain the insurance company's letterhead, but
your employer is bearing the exact and full cost of your care at the time it is
incurred, instead of paying large indemnity premiums in advance.
ERISA was a piece of legislation intended to safeguard employee pension rights,
but it has impacted employee health insurance as well, and in confusing ways.
For example, owing to the overlap of state and ERISA regulations, self-insured
employers cannot be sued in state courts for failing to pay claims. For this and
other reasons, disputes about health insurance claims can become very complex
and may require the assistance of an attorney.
Shelly describes his unhappiness with his HMO:
I'm on the Freedom Plan, which is a misnomer. Here Zofran is about $25 or so a
pill--wonder what they will think if my oncologist gives me a month's supply? I
can almost see the rejection and frustration now. I am going to ask for a
prescription tomorrow because Zofran so far is helping me.
Medicare is not just government-supplied medical insurance for those over age
65. If you have been entitled to Social Security Disability (SSDI) benefits for
the past two years, you are eligible for Medicare.
I had a major problem with my HMO not wanting to pay for Prilosec that I must
take on a daily basis to prevent acid reflux. They wanted me to buy the
over-the-counter Zantac tablets. Finally I got my oncologist to write them a
letter and they agreed to continue paying for my prescription Prilosec.
If not for the HMOs in this country, a lot of us would have a better chance of
living longer. The doctor said I should avoid stress. How can I when my HMO
drives me nuts at least once a month by refusing to pay a bill?
Most frequently we hear of Medicare Parts A and B, but much fuller (and more
expensive) coverage may be provided by purchasing Medicare Supplemental
Insurance, often called MediGap insurance. Ten versions of MediGap insurance are
available, identified as A through J, with J providing the highest coverage.
Medicaid is a health payment program for the financially needy that is run
jointly by the federal government and each state government. As such, its rules
and benefits vary greatly depending on where you live. Examples of those who may
qualify are recipients of Aid to Families with Dependent Children (AFDC), those
receiving the Social Security's Administration's Supplemental Security Income
(SSI), or certain nursing home patients.
For more information on either Medicare or Medicaid, see the Mercer Guide, which
is published yearly and is readily accessible in libraries and bookstores.
Always apply for unemployment insurance if you lose your job, are laid off, or
if your hours are substantially reduced. Never assume that you're not eligible.
Apply even if you have a suit pending for wrongful discharge.
Unemployment law and the granting and calculation of benefits are very complex,
and vary from state to state. In order to find information that's appropriate
for your circumstances, you'll need to research the laws for your state, either
on your own or with an attorney who specializes in these cases.
Life insurance that you buy as an individual is likely to be terribly expensive,
if at all available, once you have had cancer. As mentioned in the section
called "Restrictive medical underwriting," if you have an opportunity to buy a
good life insurance policy at a reasonable rate without a qualifying medical
examination or other penalty for having a cancer diagnosis, consider the
Some employers offer life insurance policies requiring no medical exam with face
values in multiples of one's annual salary. Although this usually is term
coverage instead of whole life coverage, it may meet your family's needs very
well. Some such policies can be kept even if you leave the company.
Whole-life policies often can be borrowed against, or sold in a viatical
arrangement to a company that will buy your policy from you at less than its
face value in order to provide you with money now. This is a useful option if
your heirs don't need your money, but you do, in order to pay current bills.
Generally, viatical settlements require proof of terminal illness.
Check your existing life insurance policies for a clause that states you needn't
pay premiums if you're receiving disability benefits.
Now more than ever, you should consider a long-term care policy as a safeguard
against financially crippling nursing-home or nursing-care costs. As with life
insurance policies previously discussed, however, you're not likely to be able
to find or afford a long-term care policy once having had a cancer diagnosis,
unless one is offered at group rates with no medical examination required.
One very good option is to ask your children and their spouses if their
employers offer such a policy for parents or in-laws as well as employees. This
recent trend in employment benefits offerings is an attempt to recognize the
increasing responsibilities that families face in caring for their older
relatives while trying to work outside the home.
Many long-term care policies are eventually dropped by the client because they
are so expensive, and the probability of needing long-term care seems so far
away. If expense is an issue for you, you might choose a policy that has a
clause that allows you to stop paying premiums after a number of years in return
for lower benefits or payments over a shorter time. This compromise, while not
ideal, will afford you at least some protection against potentially devastating
long-term care costs.
Employers often offer long-term disability insurance at reduced rates or for
free. If you can elect or purchase such a policy, do so. Although the Social
Security Administration can pay you long-term disability under some conditions,
often it's temporary, and frequently policies available in the private sector
pay a better monthly benefit.
Note that most long-term disability policies encourage you to apply for SSDI,
and then pay you only the difference between SSA' s monthly benefit and the
higher benefit your policy authorizes.
Some long-term disability policies can be taken with you if you leave your
employer. Choose only a policy marked guaranteed renewable, so that your
policy cannot be canceled if your health gets worse.