A cancer diagnosis will have an impact on you and your immediate family in many ways. Having sufficient health insurance and the financial resources to pay for cancer treatments may be a concern. Whether you are newly diagnosed or no longer in active treatment, it is important to have an understanding of common health care coverage terms as well as access to treatment. Don’t be afraid to ask questions about covering your health care expenses, and where you might go for additional assistance.
Appeal: A process by which you can ask your insurance company to reconsider its decision to deny payment for a service.
Claim: When a request is made to a patient’s insurance company to pay for a medical service.
Co-payment (Co-pay): The amount you pay out of pocket for doctors’ visits, labs, tests. This amount is set by your insurance company, not the doctor.
Coverage: What benefits and services an insurance policy will pay for.
Deductible: The amount an insured individual must pay every year out of pocket before the insurance plan begins to pay health care costs.
Disability insurance: A type of insurance that provides income while a person cannot work due to illness or injury.
Essential health benefits: Everything that an insurance plan must pay for, according to the Affordable Care Act.
Family and Medical Leave Act (FMLA): A law that protects employees when they must take leave to deal with their own illness or the illness of a family member.
Health Maintenance Organization (HMO): A private health insurance structure by which a person can choose a primary care doctor from a list of “in network” physicians and any specialist care requires a referral from that primary care physician.
Insurance cap: The total amount of money an insurance plan will cover; this was eliminated under the Affordable Care Act.
Long-term care insurance: Insurance that helps pay for nonmedical needs, such as help with preparing meals and self-care.
Medicaid: Government health insurance for people with incomes below a set level.
Medicare: Government health insurance for people over 65 or with disabilities. (Part A covers inpatient care, Part B covers other medical expenses like doctor visits, Part C is also known as Medicare advantage plans managed by private companies, and Part D covers drugs.)
Open enrollment: Date range or time period when you can obtain new coverage or change to a new health care plan.
Power of attorney, financial: Legal document that appoints someone to act on your behalf with regards to financial decisions.
Preferred Provider Organization (PPO): Health insurance plan where you can select any doctor that is in the pre-approved network of doctors, even specialist physicians.
Pre-existing condition: A medical condition that someone has prior to enrolling in a new health plan.
Prior authorization or precertification: Asking an insurance company for approval for payment for services before they happen.
Premium: What you or your employer pays each month for your insurance.
Reasonable and customary fees: The average cost for specific services in a specific region that is used to determine what insurance will pay; anything above and beyond these may have to be paid by the patient.
Social Security disability insurance (SSDI) and supplementary income: Government programs run through the Social Security Administration that assist people with disabilities who meet specific medical requirements.
Specialist: A type of physician who focuses on and is trained in caring for a very specific set of health issues.
Qualifying for Social Security benefits for gynecologic cancer
From chemotherapy to surgery, gynecologic cancer treatments can take anyone out of the office. If you’ve been diagnosed with a gynecologic cancer and you’ll be unable to work for at least 12 months, you might be able to qualify for Social Security disability benefits. The Social Security Administration (SSA)[i] offers these much-needed financial resources to millions of people in need.
Medical qualifications for disability benefits
Not every woman with ovarian cancer will “automatically” medically qualify for disability benefits. The SSA uses its own medical guide known as the Blue Book[ii] to evaluate every applicant for Social Security. The Blue Book contains hundreds of potentially qualifying illnesses, and which test results or symptoms you’ll need medical records of to be approved.
“Cancers of the female genital tract” can be found in Section 13.23[iii] of the Blue Book. Under this listing, there are a handful of ways for you to medically qualify:
- Your cancer is not a germ cell tumor, and has at least one of the following:
- Extension beyond the pelvis, such as to the bowels
- Spread past regional lymph nodes
- Returned despite anticancer therapy (usually 3 months will qualify)
- Your ovarian cancer[iv] is germ cell, and it has returned since your initial anticancer therapy.
- Your cancer is small cell/oat cell, which is usually aggressive and more challenging to treat.
The Blue Book was written for medical professionals and is available online, so you can review the ovarian cancer listing with your oncologist to get a better understanding as to whether or not your unique diagnosis will meet a listing.
Medically qualifying without meeting a listing
Not every form of ovarian cancer will qualify under the Blue Book. This is especially true for women diagnosed at Stage I or Stage II. Fortunately, there is another way for you to qualify. People who do not meet a listing but can still prove they’re unable to work can receive disability benefits under what’s called a Medical Vocational Allowance.
You can qualify for a Medical Vocational Allowance[v] if your chemotherapy, radiation, surgery, or other anticancer therapies will have side effects so severe you’re unable to work. The SSA considers “work” to be earning more than $1,180 per month in 2018. Typically, older adults will have a much easier time qualifying under a Medical Vocational Allowance than younger applicants. This is because the SSA believes applicants aged 50+ will have a much harder time getting retrained for a sedentary job that’s easier to keep while going through cancer therapies.
If you currently work in an office and have a lot of skills that could be applicable to another career (computer skills, vocational work, etc.) you will likely have a tough time qualifying for a Medical Vocational Allowance. But older women who have physically active jobs have a good chance of qualifying. A Medical Vocational Allowance relies heavily on results from an SSA-standard form known as a Residual Functional Capacity (RFC) evaluation[vi]. This form determines how much physical labor you can do, from standing, walking, lifting weight, etc. You can download an RFC online for your oncologist to fill out on your behalf.
Starting your application
Most women with ovarian cancer can apply for disability benefits entirely online. If you’d prefer, you can also schedule an appointment with your closest Social Security office. You can make a date to apply by calling the SSA toll-free at 1-800-772-1213.
It usually takes around 5 months to hear back from the SSA, but if your ovarian cancer is advanced (has spread to other organs) or has returned despite treatment, your claim could be expedited and approved in as little as 10 days.
This article was written by the Outreach Team at Disability Benefits Help. They provide information about disability benefits and the application process. To learn more, please visit their website at disability-benefits-help.org or by contacting them at email@example.com.