Paying for cancer

March 16, 2009 12:25 PM

I may have breast cancer. I do not have health insurance. What now?

I am in my late thirties and the sole support of two teenagers. We live in California, and our closest family is in Florida. I am a long-term contractor at my current job, but no longer think they are going to hire me on, and so I have started looking for permanent work elsewhere. I don't have health insurance, and open enrollment has passed on my agency's health plan.

A hereditary breast/ovarian cancer risk factor, a BRCA1 deletion mutation, runs in my family. According to the literature, women with this particular mutation have an 80% chance of developing breast or ovarian cancer. My sister, my mother, my mother's sister, my grandmother's sister, and my grandmother's sister's daughter have have had breast or ovarian cancer. My mother, my mother's sister, and my grandmother's sister died from it. My sister was diagnosed stage 1/2 borderline, and had chemo and a bilateral mastectomy less than a year ago.

Well, yesterday I felt a lump in my breast. It was about the size of my fingertip to the first knuckle.

It could be nothing, but it could be cancer. If it were cancer, the treatment would probably be very aggressive -- meaning I may not be able to work.

• If I got a diagnosis before securing insurance -- would that be a 'pre-existing condition' the company would not like to pay for?
• And how do I get health insurance? Is 'Emergency Medi-Cal' or medicare an option?
• If I had to go out on disability, I could not pay my rent. What if I moved to Florida to live with my dad -- how would that affect my state insurance and/or disability benefits? Would I apply here, then go there? Go there, then apply?

I don't mean to be hysterical. I know that it could very well be nothing at all. But it does seem like the timing of the diagnosis wrt insurance could be important, so I need to be smart about this. Hope for the best and plan for the worst, as they say.

Thanks for any advice you can give me.

posted by anonymous to health & fitness (13 comments total)

Call the American Cancer Society. My mom just went through Breast Cancer and they were beyond helpful with everything. They can probably point you towards a free screening and explain your options.
posted by csimpkins at 12:36 PM on March 16 [2 favorites has favorites]

I can't answer the insurance questions, but my wife and I got a lot of information about breast cancer from this thread. Feel free to send me MeFi Mail if you have questions.
posted by maurice at 12:41 PM on March 16

Yep, if you're diagnosed with cancer -- or even if you're still in the process of getting a diagnosis -- it will be considered a serious pre-existing condition, which will automatically disqualify you from most individual private health plans. However, there are state programs for people who fall into high risk pools. You'll specifically want to contact the California Managed Risk Medical Insurance Board.

Good luck, be well, and take care of yourself.
posted by scody at 12:47 PM on March 16

Medicaid (called Medi-Cal in California) is definitely an option if your income doesn't exceed certain limits. Specifically, there is a program called the Breast and Cervical Cancer Prevention and Treatment (BCCPT) funded through Medicaid that gives free or low-cost screenings *and treatment* for breast and cervical cancer to women under age 65 who are uninsured and not eligible for regular Medicaid.

You should check out the webpages here and here for more information about the program in California. If your income is below 200 percent of the federal poverty line (which is based on household size and can be found here), you can get screening & treatment paid for by the state.

Definitely contact the people at that office before you go and get tested. One of the really, really screwy things with the BCCPT is that some states will only cover treatment if you receive your initial diagnosis through a provider that participates in the screening program. If that's the case in California, it's really important that you start in the right place so that you're eligible for free treatment in the worst case scenario.
posted by iminurmefi at 12:52 PM on March 16 [3 favorites has favorites]

Call the American Cancer Society now. They can help you find a screening program and give you other info about what you can do as someone who may be diagnosed that is uninsured.

This may be a great option for you if you meet the guidelines: CA Breast and Cervical Cancer Treatment Program I'm almost positive the American Cancer Society will refer you to this as well, but I would still call them.
posted by fructose at 12:54 PM on March 16

I should have previewed, what iminurmefi said. I forgot to mention the part about how you probably have to get screened through the program to get covered. I would still highly recommend calling the American Cancer Society because they have people who work there whose job it is to answer these exact questions.
posted by fructose at 12:55 PM on March 16

I faced something similar. I went to Planned Parenthood, who hooked me up with a Komen grant for the mammogram. I was able to "Jane Doe" it. I didn't use my name or my SS#.

My mammo turned out to be normal, thank gods, but I understand both the fear and the financial freakout because of insurance.

I've never understood how enrollment periods work for insurance, but even when you miss the window, there are often ways to get in the plan. Call the person at your agency who deals with insurance and talk to them. (Don't mention your concerns. Never admit that anything is wrong, just say that you thought you'd signed up for it, but haven't seen it taken out of your check, was there a box you missed? sort of thing.)

What the doctor I saw said was that lumps as big as the one I noticed, and you noticed, are usually just clogged ducts or calcification, but rarely is anything that big malignant. Apparently, breast cancer hurts a lot, and there would be considerable pain *before* the lump got that size. Again, that was just one doctor, and he could be wrong...but it made me feel better.

So, call Planned Parenthood and make an appointment. When you talk to the NP, tell her what you've told us, and ask her how to go about doing it "Jane Doe" style, so that there is no record attached to your name/number. They deal with this sort of thing all the time, especially now with 40% of Americans uninsured or underinsured. And remember, Richard Nixon's SSN is the default "here ya go" number for anyone not using their own. (At least among a certain hippie set.)

I wish you all the best, and I hope it's just a swollen gland.
posted by dejah420 at 1:03 PM on March 16 [1 favorite has favorites]

Lets start by thinking positive thoughts and hoping that the lump you feel is more a hypersensitivity to your sister's recent issues, but with that said... you need some real advice, because this could also be very very real.

In Massachussetts, Tufts Medical Insurance does not have a pre-existing condition clause. Not all insurers have one. I would seriously *seriously* start talking to insurers and asking them if they do. Most insurances you apply for will ask you to go under a general exam to establish a baseline, and that's generally when they determine what they won't cover (if they have a pre-existing condition clause). Definitely line one up through your work for next year if you can't move on it immediately but there are other things you can do.

My employer allowed for me to apply for insurance after 30 days - not all companies require 90-180 days. Personally I'd be looking for work based on whether they carried an insurance provider which did not have a pre-existing conditions clause and with as short an ineligibility period as possible. If work is labeling you a contractor and treating you like an employee, unless there is very specific language as to a start and stop date, I'd be treating it like a professional temp placement - you owe them 2 weeks minimum notice, but you only owe them two weeks notice. If they aren't going to hire you on, you need to find someone who will. right now.

If you move to Florida, you will need to research both California and Florida law. From experience with my wife and VT/NH/MA, she was covered fine with VT/NH, because she resided in VT at the time, but we moved her to mine when we had the opportunity to, with about a 6 week period of time where she took extremely good care of her self. Generally speaking though, if you move there, you will need to re-apply for any programs in your destination state.

1. Try to find a policy provider who does not carry a pre-existing conditions clause.
2. Does your employeer or the company you are contracting with offer that company?
3. Find out what companies offer such a plan and apply to those companies.
4. Think positive thoughts.
posted by Nanukthedog at 1:04 PM on March 16

Oh, and specifically for your question about moving to Florida: Medicaid programs vary from state to state, and Florida is one of the states that will only cover breast cancer treatment for women who are diagnosed through the BCCPT program. Eligibility doesn't transfer across states, so qualifying for Medi-Cal in California means bupkis if you move to Florida, where none of the providers will accept Medi-Cal. If you think that you are going to need to use Medi-Cal to pay for treatment, that would be a pretty strong argument for staying put in California and seeing if you could get your dad to move up to you.
posted by iminurmefi at 1:05 PM on March 16

seeing if you could get your dad to move up to you

It may be worth mentioning here that if you have a homestead in Florida that you own and legitimately make your home, creditors can't take it unless it's ridiculously valuable. I hope for everyone's sake that it doesn't come to that, but...
posted by oaf at 2:32 PM on March 16

A friend of mine (in IL) got private medical insurance (think BCBS) and within a couple weeks learned he has testicular cancer. His claim was denied as a pre-existing condition. To put it mildly, it was bad timing for him, but the insurer saw it was misrepresentation/fraud and canceled his policy.

Basically, I'd approach this question as an uninsured person looking for treatment. Don't hold out any hope that a private insurer will cover you.
posted by sbutler at 4:33 PM on March 16

Definitely call the Breast and Cervical Cancer Treatment Program (BCCTP), as several people have already recommended. The eligibility for this program is not as stringent as for regular MediCal, & they cover detection, treatment & on-going follow-up.

According to the CA Dept. of Health Care Services web site, you can reach a BCCTP Eligibility Specialist at 1-800-824-0088, Monday – Friday, 8 a.m. – 5 p.m
posted by easilyamused at 4:47 PM on March 16

If all else fails, Massachusetts has guaranteed medical coverage. Basically no insurer can deny you coverage even if you have a pre-existing condition and they can't alter what they charge you based on risk factors either. The catch is that there is a waiting period for it to kick in if you didn't have insurance prior to moving there. You might be able to skirt the rules if you could get covered even briefly (perhaps by briefly paying a insanely high premium) in California then you would imediately be elegible for coverage in Mass. On the other hand the doctors up here are no where near as good as those that I had in Florida.
posted by thekiltedwonder at 8:37 PM on March 16