Radiation Therapy vs. Your Insurance

We know how expensive a trip to the doctor’s office can be. It's even more costly when you’re seeing a specialist, like your favorite dermatologist. But you generally know what to expect when you go in for a check-up. You might pay for an office visit, or a treatment with liquid nitrogen, or for those suspicious-looking spots that needed a biopsy. Whatever it is, you have an idea of what your insurance will cover and what part of the bill you are stuck paying yourself.

It's the additional treatments that start being expensive. Do terms like prior authorization, copayments, coinsurances, deductibles, and out-of-pocket maximums sound familiar? It all starts to get confusing, even for us working in the office. Everyone has different coverage and different insurance plans. Plan details are vague, and even when they say it is covered, they may have hoops you have to jump through to receive that coverage. Honestly, I have started to believe that insurance companies purposely deny claims just in the hopes that nobody puts in the effort to question them.

The bottom line is the costs of skin cancer can add up and be unaffordable for so many.

What I can do about the costs of skin cancer

As an advocate for my patients and trying to assist in their treatment process, I have started to help handle insurance claims. Here is what I have learned about treatment with superficial radiation and insurance coverage:

If you have no insurance at all

Many offices, like my own, will offer a discounted rate for people not using any insurance for treatment. This includes people who do not have insurance, have no dermatology coverage, or are out of network with our doctors. We also offer payment plans to help patients pay for their treatments more conveniently. The costs of skin cancer can be high, especially if you don't have insurance!

Medicare, Medicare, Medicare

As skin cancer incidence increases with age, many of our patients are over 65. Luckily for them, Medicare covers the treatment of non-melanoma skin cancers with superficial radiation therapy. But Medicare doesn’t pay 100% of the costs. If you have secondary insurance, that company will typically pick up the tab of what Medicare doesn’t cover, but you may be left to pay the remaining portion if you do not have secondary insurance.

To make things even more complex, remember that there are sections of Medicare that allow you to sign over your plan coverage, and you no longer have standard Medicare. If you have modified your coverage, it is always best to check your insurance coverage before starting any treatment. The last thing you want to find in your mailbox is a bill for unanticipated costs of skin cancer treatment.

Worker’s compensation

I'll be honest: the world of workers' compensation is a headache, but it can sometimes be a blessing. Suppose you spent the last 20 years working in the sun as a lifeguard, and your exposure to ultraviolet light has, in turn, caused damage to your skin. In that case, a proper examination may qualify you for coverage through a worker’s compensation claim. These claims cover examinations and treatment of sun-related skin damage, including skin cancer treatment with superficial radiation. This coverage requires authorization but typically will not leave you with any expenses.

Private insurance plans

PPO, IPA, HMO, EPO; the list goes on and on. So far as these plans go, you get what you pay for, literally. If your plan is low coverage or for standard care only, you may find it hard to get a specialty procedure covered. The worst part is, even if you pay for a great plan that should, in theory, cover just about everything, you still may run into issues getting specialty procedures covered. A lot of us are thinking it: "oh, how great insurance works."

So how do you get anything covered then? Great question!

Did you know there's fine print all over the back of your card? Those are resources with phone numbers and websites you can use to contact your insurance company to find out:

• What's covered under your plan
• What you may be charged as part of your deductible, copay, or coinsurance
• If you need a referral or prior authorization for treatment such as superficial radiation

 

Sometimes you're on your own, and it's frustrating

Many offices will do this themselves, but some will simply give you the billing codes to let you do your own research. Trust me, nobody wants to spend their afternoon calling your insurance company and talking to robots and help-desk support who very clearly have no clue what they are saying… but calling your insurance to check your coverage is the only way to avoid unexpected bills and denials.

Let's face it...

There is no simple answer when it comes to insurance because, honestly, insurance isn’t simple. It is always best to get informed as much as you can and always get records and reference numbers of what the help desk told you, so just in case you ever need to argue with your insurance company, you have facts to back up your claim!

What's one best practice you've developed for dealing with insurance companies?