When facing a cancer diagnosis, understanding and navigating the health care system can be a challenge in an already stressful time. The Florida Department of Financial Services offers a Health Insurance Consumer Guide that can help answer your insurance-related questions. Although the Florida Office of Insurance Regulation is responsible for licensing and regulating insurance companies, the Department of Financial Services handles consumer-related matters.
If you are a Florida Medicaid member and are experiencing challenges with your managed care plan, contact the Florida Agency for Health Care Administration online or by calling 1-877-254-1055 (TDD 1-866-467-4970).View the Health Insurance Consumer Guide
What do I need to know about my loved one’s health insurance?
It is important for adults and children with cancer to have a health insurance plan that covers necessary cancer treatment and does not lapse. As a caregiver, here is what you need to know about health insurance:
- Know the details of your loved one’s individual insurance plan and its coverage. Ask the plan administrator for a Summary of Benefits (SBC).
- When possible, call the insurer to make sure that planned medical services (such as surgery, procedures, or treatments) do not require prior authorization.
- If you are changing insurance plans, don’t let one policy lapse until the new one goes into effect. This includes when you are switching to Medicare.
- Pay health insurance premiums and other costs in full and on time, to avoid any gap in coverage.
Additional things to know about health insurance:
- If a bill looks odd or wrong, call or email the insurer to avoid being mistakenly charged more than you should.
- Submit claims for all medical expenses, even when you’re not sure if they’re covered.
- Keep complete, accurate records of all claims submitted, pending, and paid.
- Keep copies of all paperwork related to claims, such as letters of medical necessity, explanations of benefits (EOBs), bills, receipts, requests for sick leave or family medical leave (FMLA), and correspondence with insurance companies.
- Get a caseworker, a hospital financial counselor, or a social worker to help if finances are limited. Often, companies or hospitals can work with you to make special payment arrangements if you let them know about your situation.
The Florida Breast and Cervical Cancer Early Detection Program: Post Screening Medicaid Eligibility
The Florida Breast and Cervical Cancer Early Detection Program promotes the early detection and treatment of cancer by encouraging all women to receive regular screenings. If you do not have access to a health care provider, you may be able to receive free or low-cost screenings through the Early Detection Program. The care of most women diagnosed under this program is supported by the Florida Medicaid program.
In 2001, the State of Florida established a Medicaid eligibility determination process to enroll women with newly diagnosed breast or cervical cancer:
- Screened through the state breast and cervical cancer early detection program funded by CDC and state.
- Uninsured or coverage that doesn’t include necessary treatments.
- Not eligible under a federally mandated Medicaid group.
- Under the age of 65 years.
- Citizen or qualified non-citizen.
Given that individuals must first meet the qualification for the Screening program, nearly all women who apply qualify. In the rare situation when women don’t qualify for Florida Medicaid, they are referred to the American Cancer Society for charity care (if available). Eligible women receive full Medicaid benefits, rather than those being treated for cancer.
Florida Medicaid eligibility ends when:
- The course of treatment ends,
- The patient no longer meets eligibility criteria,
- The patient obtains health insurance or Medicare that covers treatment, or
- The patient moves out of Florida.