Health Insurance for Cancer Treatment: What to Know

Mesothelioma Cancer

Mesothelioma is a cancer caused by asbestos. It most commonly occurs in the linings of the lungs or the abdomen. The average life expectancy is 18 – 31 months after diagnosis, but prognosis may improve with treatment. Symptoms can include chest pain, shortness of breath and general fatigue.

What Are the Symptoms of Mesothelioma?

Mesothelioma symptoms can take 10 – 50 years to emerge after initial exposure to asbestos. Symptoms are often mistaken for less serious illnesses, which can complicate early diagnosis. When symptoms present, patients should seek medical attention, as early detection may improve mesothelioma prognosis.

Health Insurance for Cancer Treatment: What to Know

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In some ways, a battle with cancer today goes well beyond fighting the disease itself. Patients also face the hardship of affording increasingly expensive treatments on top of all the usual bills. And if that isn’t bad enough, it looks like the costs of cancer treatment aren’t coming down anytime soon. A study from 2014 found the annual cost of a cancer drug was over $120,000, and estimated that it would continue rising each year by 7.5 – 10.5% until at least 2020.

Health insurance can help cover some of these costs. Unfortunately for some patients, their insurance plans are proving to be limiting when it comes to treatment options, or just simply not enough to cover such high expenses. Though the Affordable Care Act (ACA) – also known as Obamacare – has been able to help cancer patients in certain situations, its future remains unclear under the new Trump administration as they develop and push for their health care reforms.

Patients can’t simply hold off on treatment until it’s more affordable when faced with a life-threatening diagnosis. Understanding your own insurance policies and other avenues of financial assistance can help lessen the stress of high medical bills.

Better Coverage for Cancer Patients

The ACA passed in March 2010 and has helped cancer patients in a number of ways. First, it allowed many families the opportunity to get coverage that previously didn’t have the ability to easily do so. Though insurance coverage may not completely cover treatment costs, it can certainly make a huge difference compared to paying completely out-of-pocket.

Before the ACA, depending on their insurance plan, patients with preexisting conditions, including a cancer diagnosis, could be denied insurance or denied coverage for their treatment. The law now forbids insurance companies from denying coverage based on preexisting conditions, with a few very rare exceptions. The ACA also prevents rescission, or dropping coverage of a policy holder upon learning they are sick.

The ACA has also helped cancer survivors and younger cancer patients. Prior to its passing, private insurance companies could limit the amount of coverage a patient received over their lifetime. This could be devastating for a cancer survivor, as their healthcare costs extend well beyond initial treatment. If an insurance company placed limits on how much it would pay for a patient in their lifetime, any followup scans or later treatment in the case of recurrence would likely not be covered.

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Unfortunately, ACA doesn’t solve every limitation of coverage. Many policies are considered “grandfathered plans” because they were in effect before the ACA passed. In these instances, the plans don’t have to abide by these new rules or others laid out by the ACA unless they later make adjustments to their plan. But even with the ACA in place, there are no guarantees for how well an insurance plan can cover such high costs.

Understanding the Costs Covered By Insurance

There’s a lot of variation in what insurance policies cover. People can be insured through private insurance agencies or government programs like Medicare and Medicaid. Private insurance has two basic care models: health maintenance organizations (HMO) and preferred provider organizations (PPO).

Regardless of type, most plans cover basic benefits such as annual checkups, hospitalizations, preventive care, and prescriptions. Out-of-pocket payments will vary based on the deductible, co-pay, or coinsurance amounts of individual plans. Under private insurance, there are often limits placed on what doctors and hospitals are considered “in network.” Though a patient can see a specialist or doctor outside of that network, it will cost more.

Sometimes the plan will also require preapproval for out-of-network visits. For patients diagnosed with mesothelioma, a rare cancer, they likely need to travel to seek the help of a specialist. Mesothelioma specialists are scattered around the country, and in many cases it could be difficult to find one that’s in-network. Not only would patients have the secondary costs like travel and lodging to seek help, but they would also likely pay more for an already expensive cancer treatment.

Expenses can pile up even before treatment begins. For example, seeking a second opinion can mean a high out-of-pocket expense for some patients. Many insurance policies will deny coverage for additional tests or scans if those tests were already part of the initial diagnosis or if they are deemed medically unnecessary. A single diagnostic imaging scan can cost anywhere from $800 – $1600, which can start adding to the medical bills quickly.

The American Cancer Society recommends keeping records of medical bills, reimbursements, and anything insurance wouldn’t cover. It’s also a good idea to keep track of other expenses related to treatment, such as travel, clinic visits, and any kinds of testing or procedures. This can help appeal decisions by the insurance company to not cover certain expenses.

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Insurance and Clinical Trials

Patients who don’t see the desired results from standard treatment often seek to participate in a clinical trial, which is a study of a promising new treatment.

With clinical trials, the two primary types of costs are patient care costs and research expenses. Patient care costs include doctor visits, hospital stays, standard cancer treatment, and treatment for any side effects, as well as any lab work or imaging tests. Insurance will typically cover these routine care expenses while in a clinical trial if:

  • The patient is eligible for the clinical trial;
  • It is an approved clinical trial, meaning it is federally funded and the researchers have submitted an application for the drug to be FDA approved; and
  • The trial does not involve out-of-network doctors and hospitals.
  • f the disease, accounting for about 15 – 20% of all diagnoses.

More About Peritoneal MesotheliomaPericardial Mesothelioma

  • Develops in the lining of the heart.
  • Pericardial mesothelioma is an extremely rare form of the disease, accounting for only 1 – 2% of all mesothelioma diagnoses.

More About Pericardial Mesothelioma

Mesothelioma Lawsuit

The two types of mesothelioma lawsuits are personal injury and wrongful death claims. A mesothelioma personal injury lawsuit allows the cancer patient to seek compensation from the company or companies that exposed them to asbestos. The average compensation from a mesothelioma lawsuit trial is $2.4 million.

Types of Mesothelioma Lawsuits

If your family is bearing the burden of mesothelioma, an asbestos exposure lawsuit may be right for you and your loved ones. 

You may be eligible to file a personal injury lawsuit if you were diagnosed with mesothelioma, or a wrongful death lawsuit if you lost a loved one to the disease.

The steps for filing a mesothelioma lawsuit vary depending on the type of claim filed.

Personal Injury Lawsuit

A person diagnosed with mesothelioma is eligible to file a personal injury lawsuit against the companies responsible for exposing them to asbestos. 

Asbestos liability is usually based on companies’ failure to warn employees and consumers about the dangers linked to inhaling the toxic mineral. When compensation is awarded in personal injury lawsuits, mesothelioma patients are the recipients.

Wrongful Death Lawsuit

The estate of a deceased mesothelioma patient is eligible to file a wrongful death claim, seeking compensation to cover medical bills, funeral expenses and lost income. 

Similarly, if a mesothelioma patient files a personal injury lawsuit but passes away before it is resolved, the estate may continue the claim. When compensation is awarded in wrongful death lawsuits, the estate is the recipient.

Statute of Limitations on Asbestos Lawsuits

In personal injury and wrongful death lawsuits, plaintiffs must file a claim soon after an injury occurs. Statutes of limitations set a time limit, usually around two years, for a plaintiff to file a lawsuit after they are injured.

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You should speak with a mesothelioma lawyer to ensure you are within the statute of limitations to file your claim.

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Filing a Mesothelioma Lawsuit

First, you must find an attorney who will prepare and file a written complaint with a court to start the legal process. 

Filing and the steps that follow may take several months, but if you are very sick, your attorney may ask the court to speed the process along before your condition worsens. Your attorney will guide you and represent you every step of the way.

. Choose an Attorney

The first step in a successful filing process is choosing an attorney experienced in asbestos litigation. Top mesothelioma law firms will provide you with a free consultation to talk about your case and go over your legal options.

2. Case Review and Preparation

Answer your attorney’s questions about your asbestos exposure history, work history and medical history. This is part of a mesothelioma case review. Work with your lawyer if they need additional testimony for your case. You might need to answer additional questions about your work history and asbestos exposure history.

Your attorney will research what claim and compensation options will fit your needs best and advise you on filing other types of claims that you are eligible for. Whether you file a personal injury lawsuit, a wrongful death lawsuit or a claim with an asbestos trust, a skilled attorney will help you prepare all the documentation needed to back up your claim.

3. File Mesothelioma Lawsuit

Once all the relevant information is gathered, your attorney will file your lawsuit on your behalf and manage the legal proceedings. They will advise you on whether to take a settlement offer or negotiate for additional compensation.

Notable Asbestos Lawsuit Verdicts

These payouts are known as trial verdicts, and they are often higher than what a patient may receive from a settlement offer or a trust fund claim.

  • $250 million awarded to a retired steel worker in 2003 over exposure to asbestos insulation
  • $75 million awarded to the wife of a race car driver in 2017 over exposure to asbestos-containing engine gaskets
  • $48 million awarded to the family of a construction worker in 2012 over exposure to asbestos in building materials
  • $29.4 million awarded in a talc lawsuit to a long-time talcum powder user in 2019 over exposure to asbestos-contamination
  • $18.6 million awarded to the family of a factory worker in 2014 over asbestos exposure at a tire plant
  • $18 million awarded to a barber’s son in 2016 over exposure to asbestos-contaminated talcum powder
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