What is Cancer Insurance?
An estimated 10 million people have cancer insurance policies. Frequently sold through employee benefit plans, cancer insurance policies promise to provide cash benefits for cancer-related medical expenses such as hospitalization, surgery, anesthesia, chemotherapy, radiation and preventative care. This is not always the case. Many patients discover too late that there are problems with their policies, or have their cancer insurance claims denied.
The Problem with Cancer Insurance
Terms of cancer insurance varies based on cost and insurer. Many policies, however have limitations. People unaware of these limits when they purchase cancer insurance may find their claims for benefits denied.
Common problems include:
Pre-existing conditions. Most policies will deny coverage for pre-existing conditions. Some cancer insurance policies will deny claims even if the person did not know they were sick when they applied. Many cancer insurance policies also require a lengthy waiting period after enrollment before they will pay benefits. People who get sick during this waiting period may find their claims for coverage denied.
Limited Out Patient Coverage. Many cancer insurance policies over cover procedures and treatment that occur during hospitalization. Many of today's treatments, such as chemotherapy and radiation, are done on an outpatient basis.
Narrow Definitions of Terms. Some insurers have strict, narrow definitions of the conditions and treatment they will cover. For example, a cancer insurance policy may limit coverage for Stage A prostate cancer or exempt certain forms of skin cancer from coverage. Or the policy may deny coverage for chemotherapy treatments provided during hospitalization and not during outpatient treatment.
Secondary Illness. Cancer insurance policies often do not cover secondary or cancer-related illnesses and injury such as infection, diabetes or pneumonia.
Limited Dollar Amounts. Many cancer insurance policies pay out fixed dollar limits, often less than the actual cost of a procedure. Other policies terminate after a set amount of time, such as three years of payments.
Duplicate coverage. Often, the benefits provided by a cancer insurance policy duplicate those provided by your regular health insurance policy. However, double coverage does not necessarily mean double benefits. While your cancer insurance policy may state that it will pay no matter what your other insurance pays, this is not always the case with your other carriers. Frequently in the cases of duplicate coverage, your regular health insurance may deny your claim.
Insurance Claim Denied? Speak To An Attorney
If you have a cancer insurance policy and feel your claim has been unfairly denied, you many have a bad faith claim against the insurance company. A bad faith claim occurs when an insurer denies a claim wrongfully or without reason. At the Law Offices of James Sokolove, we've helped victims of bad faith claims recover the compensation they deserve.
When a person purchases insurance, they enter into a contract with the insurance company. The insurer agrees to pay certain benefits in exchange for regular premium payments. In other words, the person buying insurance can expect an insurer to honor the terms of the contract “in good faith." If an insurer denies a claim without cause, then the company has “breached the contract.” In other words, the insurer acted “in bad faith”.
Examples of bad faith include:
- Denying a claim for no apparent reason
- Delaying a claim investigation
- Inadequately investigating a claim
- Misrepresenting the meaning of the language in your policy