Ten Tips for Navigating Your Insurance Company and Coverage

Author: OncoLink Tean
Content Contributor: Christina Bach, MBE, MSW, LCSW, OSW-C
Last Reviewed:

If you have cancer, you need to understand how to navigate your insurance plan and your insurance company. These are some tips to make the most out of your coverage and your communications with your insurance company.

1)    Know your plan(s). 

  • Do this for ALL of your insurance plans-medical, dental and prescription.
  • Use the tool to get organized.

2)    Know how to contact your plan

  • This includes phone numbers and websites. If your plan has an online portal, set up your account and be sure to keep your user name and password in a safe place.

3)    Do you have a case manager at your plan?

  • Most insurance companies will assign people with complex health problems to a case manager. Insurance case managers can help you navigate your coverage as well as troubleshoot and advocate. But it is important to remember, they work for the insurance company.

4)    Make a written record of EVERY phone call with your insurance company.

  • Record the date and time of the call, who you spoke with, what department they are in and the basics of the discussion.  If the call is being recorded, there may be an ID for the recording. Calls often have reference numbers assigned. Be sure to ask for a call reference number and write it down with your notes from the call.

5)    Don’t be afraid to ask for a supervisor.

  • It’s okay to ask for more help if you don’t feel like you are getting the answers you need.

6)    Keep all letters, bills, and explanation of benefits forms you receive in one dedicated location.

  • Get a folder or binder and keep anything related to your insurance company in it. You can also scan paper documents and save them to a dedicated folder on your computer.  Be sure to make a backup copy of anything you save electronically on a flash drive or in the cloud.

7)    Understand your rights to appeal a service denial.

  • If your insurance company denies payment for a service, treatment, or test, you and/or your healthcare provider can appeal this decision. When you receive a notification of denial, you will be given instructions on how to appeal the decision. Be sure to let your healthcare provider know if a service is denied and that you want to appeal the decision.

8)    Make sure all of your providers have the correct insurance information. Be sure to update this annually or with any change in your plan coverage.

  • Many providers scan copies of your insurance card into your electronic medical record (EMR). Anytime you get a new card or change plans, update this information with the registration staff at ALL of your provider’s offices.

9)    Share your insurance information with a trusted family member or caregiver in case of an emergency.

  • This person can provide insurance information to providers in the event that you are unable to do this. This can help avoid delays in getting care.

10) Guard your insurance cards.

  • Health insurance fraud happens. Treat your insurance cards like your credit cards. Keep them in a safe place and report a loss or theft of your cards to your insurance company immediately.
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