Americans with Disabilities Act (ADA): ADA requires that organizations with 15 or more employees comply with ADA guidelines. The ADA recommends that any accommodation that you need does not cause “undue hardship” to your employer. For more information, call 800-514-0301 or visit the ADA website at www.ada.gov.
Appeal: You have the right to ask your insurance company to reconsider (or appeal) if your insurance denies coverage for any aspect of your cancer care. Find out from your insurance company what you need to do to appeal a denial of coverage. If your appeal is denied, you may be able to get help from your state’s insurance department. For more information on how to file an appeal, visit www.healthlawadvocates.org/get-legal-help/resources/document/FINAL-HLA-Guide-to-Appeals-1-27-16
Claim: A claim is a bill from your health care provider (doctor or hospital). Your health care provider sends a claim to your insurer to be reimbursed.
COBRA (The Consolidated Omnibus Budget Reconciliation Act): COBRA is a law that lets you keep your insurance for 18 months, sometimes more, after leaving employment. You pay the full cost.
Co-insurance: The percentage of a medical charge you are expected to pay after your deductible has been met. For example, if you have a 30% co-insurance, you would pay 30% of a given medical bill while your health insurance would cover 70%.
Co-Payment (Co-pay): The fixed out-of-pocket cost you are expected to pay upfront for your health care services. The amount can vary depending on the type of health care service. For example, your co-payment for an appointment with your primary care doctor may be $25 while a visit to the emergency room may be $250. Some health care services may require you to pay co-insurance in addition to a co-payment.
Deductible: This is the amount of money you are expected to pay out-of-pocket towards your health care each year, before your health care insurer pays. Out-of-pocket expenses typically do not include co-pays. For example – If your deductible is $3,000, you are expected to pay the first $3,000 towards your health care expenses. Your insurance will cover expenses after you have paid $3,000.
The Equal Employment Opportunity Commission (EEOC): EEOC is a federal agency that enforces the provisions of the ADA and FMLA and assists citizens who feel they have been discriminated against in the workplace. If you feel you are being treated unfairly, contact the EEOC at 800-669-4000 or visit www.eeoc.gov.
Family Medical Leave Act (FMLA): FMLA can cover some time off during treatment. Under FMLA, an employee can take up to 12 weeks of unpaid leave per 12-month time period. To be eligible for FMLA benefits, an employee must: work for an employer (one who offers FMLA) where at least 50 employees are employed within 75 miles; have worked for the employer for a total of 12 months; and have worked at least 1,250 hours over the previous 12 months.
Flexible Spending Account: A flexible spending account (FSA) allows you to put pre-tax money from your paycheck into a special account that later can pay for certain medical expenses like copays. Each individual decides how much money per paycheck goes into their FSA account. It’s important to estimate your yearly medical expense that would qualify for FSA because this money typically does not roll over. A FSA can only be set up through an employer. Learn more about your options by talking with your employer about a flexible spending account.
Health Insurance Portability and Accountability Act (HIPAA): HIPAA gives you the right to control who may receive your medical records and which information they may receive. When you visit a health care professional or are admitted to a hospital for the first time, you will receive HIPAA forms. Signing these forms states that you know your rights with regard to control over your medical information.
In-Network or Network Provider: A health care provider selects health care professionals or hospitals to be a part of their insurance plan or network. These preferred health care providers or institutions cost less than others not in-network.
Oncology social worker: Oncology social workers are professionals who counsel people affected by cancer and help them access practical assistance. They can provide individual counseling, support groups, locate services that help with home care or transportation, and guide people through the process of applying for Social Security disability or other forms of assistance. CancerCare’s oncology social workers are available to help face-to-face, online or on the telephone, free of charge.
Out-of-Network or Non-Network Provider: Health care professionals or hospitals not a part of a health care provider’s insurance coverage. Going out-of-network generally costs more.
Medicaid: Medicaid is a social health care program that provides health insurance for individuals with limited resources.
Medicare: Medicare is federal health insurance coverage for those 65 or older. It may also be available to individuals who have been deemed “disabled” by the Social Security Administration for two years. Visit www.medicare.gov for more information.
Network: A network is a large group of health care professionals, pharmacies and hospitals that are selected and preferred by an insurance company to provide care.
Patient Navigator: Navigators provide guidance through the health care system and help with any issues, challenges or barriers. They may offer practical assistance with financial support, transportation and child care. In addition, they may assist in coordinating care with other health care team members.
Pharmacist: A pharmacist is a professional who is qualified to fill prescription medications ordered by a doctor. They often provide information on how to take medications, potential drug interactions and tips on taking prescription medication on schedule.
Premium: A premium is the monthly fee paid to an insurer for health insurance coverage.
Provider: A provider is a health care professional (doctor, nurse, surgeon, etc.) or institution (hospital) that provides care.