Know Your Rights

Women who experience breast cancer in this day and age have the advantage of social and media awareness on their side. Activism to unite and fight this disease is touted from prestigious and powerful organizations in all sectors of the business and political realm. Living with breast cancer has encouraged many women to become crusaders for the cause of breast cancer. Policy makers in the insurance industry as well as in government are listening and creating legislation to benefit women in general, and especially those with breast cancer.

Much has improved, but there is still much to do. The under-insured women population still could benefit from some sort of guaranteed coverage for cancer treatment as state-coverage programs vary greatly.

There are many things that can be done on the individual level to assure the breast cancer survivor is getting the treatment and services to which she is entitled. First, become familiar with any insurance policy language regarding the planned treatment. Insurance policy language varies from policy to policy. One of the most dangerous financial mistakes a woman with breast cancer can make is to assume that the insurance company will cover everything. Large, unanticipated bills can leave the unaware reeling financially.

Since January 1999, federal law requires all insurance plans that cover mastectomies must cover the cost of a prosthesis or reconstruction and must cover lymphedema treatments related to the diagnosis of breast cancer. Since that time, most insurance plans have included coverage for breast prostheses at least one every one to two years. Some plans cover one prosthesis per lifetime, despite the fact that prostheses should be evaluated for replacement every two years.

Many women have reported wearing high quality prostheses, such as Amoena, for four or five years before seeking replacement. For some women, the decision not to seek an new prosthesis is one of fear of reimbursement difficulties. Others are not aware that their coverage entitles them to a new prosthesis as needed. Women can make a difference with their own policy coverage. Write letters to the insurance companies and let them know if the coverage is inadequate. If the policy is through the workplace, let human resources know if the coverage doesn't meet needs.

Organizations such as the National Breast Cancer Coalition in Washington, DC work at the federal level to spearhead legislation and lobby causes beneficial for women with breast cancer (www.natlbcc.org). This site includes current issues before the legislators and outlines bills recently passed.

According to the American Bar Association (ABA), one of the best things a women with breast cancer can do for herself is to keep excellent records and documentation of her care. The ABA Commission on Women in the Profession created the "Breast Cancer Legal Advocacy Project" to teach patients and their families about their legal rights. Lawyers also receive advocacy training to represent the unique needs of the breast care patient. In this project, 10 Steps to Protecting the Legal Rights of Breast Cancer Patients were developed.

In summary, these were identified as:

• Scrutinize your health insurance policy. This way you know up front if there is a coverage issue.
• Take your policy manual with you. Look for coverage or exclusion of any treatment prescribed for you. Call the customer service number if the manual is not clear.
• Know how to appeal a coverage decision. Ask for the steps from the insurance company if it is not covered in the manual.
• Seek counsel from someone experienced in health insurance law.
• Make a personal appearance to your insurance carrier to explain your position.
• Put a face with the file. Send photographs if possible. Request copies of your medical records. Be persistent in your request.
• Very important: write down everything. Create a paper trail.
• Get your physician involved. Ask him or her to write or call on your behalf.
• Be persistent. Stand your ground and be firm, but assertive. You are not out to make friends.

“Ten Steps to Protecting the Legal Rights of Breast Cancer Patients: Legal Rights and Options for Breast Cancer Patients ” by the American Bar Association Commission on Women in the Profession, located at, 2007 Copyright © 2007 by the American Bar Association. Reprinted with permission.