Understanding Insurance Coverage
Health Insurance, Simplified
Health insurance can feel like one of the most challenging and confusing parts of the breast cancer journey. When you’re already managing so much, figuring out your coverage and benefits can feel overwhelming. The information that follows is designed to help you feel more confident and in control, so you can make informed decisions about your care
Must-Watch: Insurance Guidance in English and Spanish
This video comes from Triage Cancer—a national nonprofit offering free education on the legal and practical issues that affect people with cancer and their caregivers—and covers the basics of health insurance to help you get started. Available in both English and Spanish, they’re a great first step toward understanding your options. Triage Cancer also offers a call and chat line where you can get answers to legal questions related to your care.
Insurance Words and Phrases to Know
Understanding the vocabulary of your insurance plan can help you make informed decisions and avoid unexpected costs.
Premium
The amount you pay each month to keep your insurance coverage active.
Deductible
The amount you must pay out of pocket for healthcare services before your insurance plan begins to pay.
Copayment (Copay)
A fixed amount you pay for a medical service — such as a doctor’s visit or test — after you’ve paid your deductible.
Coinsurance
A percentage of the cost of a healthcare service that you are responsible for paying after you’ve met your deductible.
In-Network (Preferred Providers)
Doctors, hospitals, and other providers who are contracted with your insurance plan. Services from in-network providers are covered by your plan, although you may still owe copays or coinsurance.
Out-of-Network
Providers who are not contracted with your insurance plan. Seeing an out-of-network provider often means higher costs, including higher copayments or coinsurance.
Out-of-Pocket (OOP) Expenses
Costs you are responsible for paying yourself. These may include deductibles, copayments, and coinsurance for covered services, as well as services that are not covered or only partially covered by insurance.
Getting Ready to Talk to Your Insurance Company
Calling your insurance company can feel intimidating, especially when you’re focused on treatment. Whether you’re verifying coverage, requesting approval, or asking about a claim, being prepared can help you feel more confident.
Before you call your insurance provider with questions, use this checklist to help you gather key details so you can get the most accurate answers. This preparation also prevents delays in your care.
Pre-Call Checklist
- Know your plan type: HMO, POS, or PPO.
- If you have more than one health plan: Write down each plan and be prepared to address Coordination of Benefits (COB). Some plans require documentation before they will cover services.
- Primary care provider (PCP) on file: For HMO or POS plans, confirm who is listed and decide if this needs to be updated.
- Treatment location details: Write down your provider and hospital or clinic names. If possible, have their NPI or tax ID numbers—your insurance company may need them to check network status.
Frequently Asked Questions For Your Insurance Company
Plan and PCP
Coordination of Benefits (if you have more than one plan)
Network and Referrals
Out-of-Network Coverage
Costs
Specific Services and Procedures
Medical Equipment and Supplies
Travel and Lodging (for specialized care)
If You Don’t Have Insurance
Here are questions to ask your care team or resource specialists where you receive care:
- If I lose or don’t have health insurance, what resources are available to me?
- Can you connect me with an oncology social worker or financial counselor to explore Medicaid, Medicare, or other public assistance programs?
- What payment plan options or hospital-based financial assistance programs are available?
Find Support
Learn how to connect with a social worker, therapist, or financial counselor. If you want help navigating insurance and care, connect with your hospital or clinic’s financial resource team or social workers.
