DEALING WITH PAPERWORK AND INSURANCE COMPANIES WHEN YOU'RE ILL 

By: Steven Pradell, Esq.

Seven years ago, I was diagnosed and treated for cancer. Today I practice law in good health. Here are some tips which should help seniors to deal with the paperwork which occurs while one is experiencing a life threatening disease.

A. CREATE A FILE

When you are ill, the creditors do not go away. Life goes on for the rest of the world as if you were well. Welcome to the paper nightmare of a patient with a life threatening disease. It may have already begun for you: the bills, the forms, the information about your disease, the test results, the cards and letters. Hopefully you have kept all these documents. A filing system will be very important later when tax time rolls around. It will also make it much easier on you and those who assist you as things pile up and get complex, or if you become unable to handle your own paperwork. Have a filing system that includes sections for at least the following information:

Research and facts about your disease

Insurance and disability policies, claims procedures, forms and other documents

Medical bills

All other bills and obligations of normal life, including house and car payment, credit cards, etc.

Important personal paperwork, which may include a will or living will, and other documents

Addresses and phone numbers of friends and relatives, doctors, employers, insurers, etc.

Keep in mind that someone else may have to rummage through your belongings when you're ill, so be clear and specific when labeling topics. Finding someone to help with your paperwork may make your life a lot easier. Many people will ask if there is anything that they can do to help. Take them up on their offer. Having someone there to assist in making sure all mail is read through and all bills are paid can help to reduce your stress level.

B. INSURANCE COMPANIES

Insurance companies can be very difficult to deal with. They are the "good hands" people when it comes to taking your premiums. They spend hours telling you up front what kind of coverage you can expect, and how safe and secure you should feel if you purchase their product.

However, their attitude can change dramatically once they discover that you have cancer or another life threatening disease. Your insurance company sold you a policy because you were a good statistical risk. The odds of you getting ill were low compared to your premiums, so the company thought it would make money. By becoming ill you beat the odds. Now the company's previous goal of selling insurance to a good risk who will make them money changes to minimizing their loss from a good risk that did not pan out. In short, the company will now use a fine tooth comb on your claim in an attempt to find a reason why you should not have been covered for the illness in the first place, or, if they cannot, to pay you as little as possible.

To effectively deal with your carrier, you must carefully study any booklets and forms the company has provided to you which explain your coverage. Be sure to follow meticulously the required procedures outlined by the book--give notice as soon as possible regarding the illness, get prior approval for surgery, etc.

If you are asked give a written or recorded statement to the insurance company, or if there are any questions you may have about coverage questions, it may be in your best interest to consult with an attorney, your insurance broker, or your offices personnel department.

Be affirmative in dealing with an insurance company. Demand coverage if you feel that you are entitled to it. If the insurance company questions procedures, get a doctor to back you with a letter stating why such procedures are necessary.

My personal doctor wrote a letter the first day I found out about my disease. The letter stated that the doctor's opinion, going to Boston for treatment was in my best interest. The letter helped me to receive reimbursement from the insurance company for flights to and from Boston, and for subsequent flights annually for after-care.

Don't just roll over if the insurance company refuses to pay, and you believe it should. Speak to a superior, appeal the decision, or consult a lawyer. You paid for that insurance. You are entitled to reimbursement for any bills covered by the promises made in the policy, and if its terms are ambiguous, depending on the law of your state, the ambiguity may be construed in your favor.

If you think you need special care, follow up treatment, or therapy, argue to the insurance company for these specific things as a necessary part of your treatment.

C. FUTURE INSURABILITY

One important factor that may impact the rest of your life is the problem of insurability. Now that your illness has been diagnosed, you may be virtually uninsurable. Even if you are pronounced cured, insurance companies may not want to assume the risk that you will have a relapse or contract another related illness in the future.

Many small businesses or individuals find themselves in an impossible position: after the onset of cancer or another life threatening illness, the insurance company either drops the insured or raises the rates by so much that it is virtually impossible to keep the policy in effect.

A person who has work-related insurance throughout treatment should be aware that staying insured at each moment is extremely important. If insurance lapses for a minute, any new insurance company with whom you request coverage may view your illness as a pre-existing disease which may not be covered. If your employer switches companies, make sure that the new coverage will carry your prior problems, and that there will be no lapse.

Those who are uninsured after treatment run the risk of relapse, which may result in huge debt and the filing of bankruptcy. It may be in your best interest to seek employment with a large company or a state or federal agency with enough employees so that the insurance company does not look at preexisting injuries to provide coverage. This reality may change your plans for early retirement or starting your own business. Think about these problems before embarking on a new career path or changing your lifestyle. For those who feel the stress of prior work brought on the illness, it may be an extremely difficult choice to make--stay and receive insurance and expose yourself to the stress that may again cause you to become ill, or go out alone and risk not being insured.

COBRA is a federal law that, at the time of this writing, requires insurance companies to continue to insure former employees for 18 months for the same premium rates given while employed. This gives an ill person who leaves employment a period of time to remain insured. However, upon the expiration of the 18 month period, there is no guarantee that the patient will be able to find affordable insurance. However some states, such as Alaska, do offer some protection for high risk residents. In 1992, Alaska's legislature passed created a Comprehensive Health Insurance Association. By law, the association must make heath insurance available to residents who are high risks. The association may not refuse to offer coverage to high risk residents of Alaska who are eligible for the insurance and pay the required premiums. In order to be eligible for this insurance, you must not be covered by another policy, and must obtain rejections for medical reasons by at least two other health insurance providers within the six months prior to applying for the insurance. Check the laws in your state to see if there is anything comparable.

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This article was authored by Steven Pradell, Esq. with offices in Anchorage, Alaska. He is also the owner of Pradell and Associates and Abracadabra Entertainment. This article is not intended to provide legal advice and should not be relied on for that purpose. Phone: (907) 279-4529. Email address: pradell@alaska.net. Reprinted with permission of Steven Pradell. Copyrighted by Steven Pradell.