The West Clinic

Insurance & Billing

Billing update effective January 1, 2012

Insurance Issues

We understand that financial and insurance issues can be stressful and confusing for cancer patients. We want to do everything possible to ease your financial worries so that you can concentrate on getting well. As a West Clinic patient, you have the added advantage of dedicated staff members who work to ensure that you receive your full insurance benefits. We don’t want you to ever get over-whelmed by insurance paperwork. Simply call the West Clinic Insurance Department, and we will assist you.

With the monumental changes in the healthcare system over the last few years, both patients and healthcare providers now carry a greater burden in understanding and complying with guidelines outlined in individual insurance plans. Patients who do not follow the guidelines of their particular insurance coverage may be responsible for payment of fees and services; therefore, it is important that cancer patients determine what their coverage allows prior to beginning treatment.

The following is a list of basic plan features and questions patients may ask themselves regarding their healthcare benefits.

Plan Features Average Plans
Yearly Deductible. How much of your own money must you spend on doctor bills before the healthcare plan begins to pay? $100 – $300 per person
Annual Coinsurance Limit (Maximum Out-of-Pocket). The coinsurance limit is the cumulative amount of your 10% to 30% copayment for covered expenses beyond the deductible. How much in total you must pay before your insurance pays 100%? $1500 – $2500
Copayment. How much must you pay each time you visit an HMO or PPO healthcare provider? $10 – $25 per visit
Prior-Authorization. Is prior-authorization or referral required for visits, radiology, lab, chemotherapy, or surgical procedures? None or some
In Network Or Out Of Network. Can you pick your own doctor or must you use a provider within your plan group? Any or a wide choice within a network.
Second Opinions. Are second opinions covered? Yes
Hospital costs covered. What share of hospital costs will the policy cover? All (After deductible)
Prescription Drugs. How much do you have to pay for prescription drugs? $10 – $25 or 80% after deductible
Lifetime maximum. If sick or injured several times, or have a long-term illness, what is the cap on total benefits the policy will make? Unlimited or $1,000,000
Home Care Visits. If a nurse needs to see you at home, how many visits will the policy pay for? Unlimited

Resources for Patients without Insurance

For cancer patients without adequate insurance coverage, financial services and patient assistance programs are available on a local, regional and national basis. See Table A for a list of some of these resources and entitlements. These services include but are not limited to Medicaid/Tenncare Program, but also include programs such as patient drug assistance programs sponsored by virtually every major pharmaceutical company. Patients who know they are uninsured or underinsured should contact our patient services office for advice on how to participate or enroll in these services. Personal financial information is usually needed for enrollment.

TABLE A

Agency/Organization Resources/Support Available
American Cancer Society
800-ACS-2345
www.cancer.org
Chartered divisions in every state. Some financial assistance available.
Cancer Fund of America
800-578-5284
www.cfoa.org
National agency established to help victims of cancer, providing assistance with various medical supplies and essential items.
Directory of Pharmaceutical Manufacturer’s Indigent Programs
800-PMA-INFO (762-4636)
www.phrma.org
Directory listing pharmaceutical company programs to provide drugs to patients who meet eligibility requirements.
Leukemia & Lymphoma Society
Tennessee Chapter
800-332-2980
www.leukemia-lymphoma.org
Society can provide supplemental financial aid to patients with Leukemia, Lymphoma, or Myeloma who have significant financial need.
Social Security Disability Insurance
Apply at local SS office.
800-772-1213
www.ssa.gov/disablility
Pays benefits to disabled individuals who are “insured” meaning they have worked long enough and paid social security taxes.
Social Security Income
Apply at local SS office.
800-772-1213
www.ssa.gov/disability
Federal income designed to help disabled people based on financial need.
Tenncare Bureau
800-669-1851
www.state.tn.us
Medical coverage available for low-income families and uninsurable individuals.
Veteran’s Health Administration
877-222-VETS (8387)
www.va.gov
Provides a broad spectrum of medical, surgical, and rehabilitative care to enrolled veterans.
The West Clinic Financial Assistance Application
Main Office 901-683-0055
The West Clinic provides need based assistance with patient balances. Patient representatives at each location can assist with the application process.