The insurance page of the issues section will try to highlight some of the issues that may be relevant in your own myeloma struggles.  Read, learn and discuss. 

This is information from the Leukemia and Lymphoma Society web site about your insurance policy-

Using Your Health Coverage
When you need to make a claim on your health insurance, it is important to remember a few important things.

Read your policy, if possible, before you go for care in the first place. You may need to get permission (a referral) to see a specialist or to get a lab test. You might be restricted to a network of doctors or hospitals.
Keep good records, including copies of all bills and correspondence. Ask for names and phone numbers of people you speak to.
Submit your claims on time and in the right order. Your insurer will pay some bills directly to the appropriate parties if you request that on the claim form. Other bills you must pay yourself and then send copies of the bills to your insurer who then reimburses you.
If a claim is denied, appeal it. Send the claim back and back again if necessary. Ask your doctor to help make your case. Keep records of all your correspondence. And again, be aware of anytime deadlines that might apply.
Understand your coverage for experimental therapies and clinical trials. Sometimes an insurer will deny coverage for care they say is experimental. Insurers generally regard drugs, devices, and courses of treatment still under study as experimental. In other cases, some patients may want to enroll in a clinical trial. A cancer clinical trial is a study designed to determine the effects of a particular therapy or drug against cancer.
Know how you can protect the privacy of your medical information. Some states have laws protecting the privacy of your medical information. These laws vary a great deal. For more information about rules protecting the privacy of your medical information, see www.healthprivacy.org.

Below are two posts from a member of the A.C.O.R mm listserv relating some everyday experiences with her oncologist and her insurance.  I am including this comment in this site to highlight the need for survivors to pay attention to the many charges that accumulate during months of your various therapies.

"My health insurance has a website I can go to to view my claims and other info.  While doing so the other day, I noticed that my hem/onc was charging my insurance for office visits and myself a $20 co-pay each time I went to his office for Velcade injections, even tho I never saw him.  He did so also for 2 BMBs I had, even tho I never saw him then either.   When I first started on Velcade last month, I had asked his receptionist if there was a co-pay and she said by law there is no co-pay unless you actually see the doctor, but to check with my insurance.  I called United Healthcare and they confirmed what she had said and stated that it is all defined by the CPT code they file on the claim.

I wrote a letter to the hem/onc and the matter will be handled.  I don't think that my hem/onc is into insurance fraud, but someone in his office is coding the claims wrong.  I am not sure if this is a general law or just an Alabama law, but obviously it could affect us all at some time or another.  Those $20 co-pays do add up.  This also brings home the fact that we need to be scrutinizing all our insurance charges and asking for corrections when necessary."

I am 59 and single and was just approved for disability due to MM.  After 2 yrs. on it, I will qualify for Medicare.  When my COBRA ran out a 2 years ago, I was forced to find an individual medical insurance plan offering group rates that I found thru my home state.  Part of the problem with finding individual plans are the "pre-existing condition" clauses.  The state plan I'm on allowed me to transfer my COBRA eligibilty showing that I had been on a group plan before and therefore I had no problem with pre-existing condition clauses.  It is expensive, but is my only alternative until Medicare kicks in.  Even then, I may need some wrap-around coverage to cover all the bases.  MM costs are expensive and ongoing for the rest of our lives.

You may want to have your doctor refer you to a social worker that can discuss different insurance alternatives with you.

Good luck,
Karen

"I thought it might be helpful, too, to throw in a little info on
 denials/appeals in general with commercial insurance plans."

>"I thought it might be helpful, too, to throw in a little info on
> denials/appeals in general with commercial insurance plans.  Most denials
> for tests, scans, etc. stem from a lack of necessary documentation from
> the
> provider. This can usually be cleared up by a call from the ordering
> physician to the company.  It may stem from an out of date medical policy
> (as Mark shared with us earlier).  If that's the case, pushing for
> additional reviews can get the policy updated more timely.  If they are
> telling you the policy is based on Medicare guidelines, ask for a Medical
> Director to review.  No one over age 65 gets Ewing's so, those aren't
> appropriate guidelines to be following for children or young adults.
>
> However, if those don't work you have options and should exercise them.
>
> First and foremost, read your certificate, summary plan description (SPD)
> or
> benefit booklet that you receive either from the employer providing
> coverage
> or the insurance company.
>
> Make sure you know if your plan is actually an insured plan or if the
> employer self insures the claims (also referred to as Administrative
> Services Only (ASO), self administered, self funded, etc.).  The back of
> your id card should also tell you if it is an ASO/self funded plan.
>
> The Dept. of Labor (DOL) issued regs that guarantee certain appeal rights.
> Who is responsible for handling the appeal is based on whether your
> coverage
> is insured or self funded so that's why it's important to know what kind
> of
> plan you have.  The time frame for filing appeals can vary based on who
> handles the appeal.  If a claim has been denied, your EOB should have a
> rather large "blurb" on it advising you of your appeals rights and where
> to
> appeal.  The same info should be contained in your certificate or SPD.
> It's
> important to file them within the time frames specified because you lose
> your appeal rights if you wait and file outside of those time frames.
>
> Keep in mind that a network provider can appeal for you (assuming you have
> PPO/HMO/POS coverage with a network).  They are better equipped to talk
> with
> a Medical director and provide the right information for review.  However,
> don't hesitate to file an appeal yourself and know that you can do it
> verbally, just by calling customer service and telling them you want to
> appeal the finding/denial.
>
> As a last resort, you may be able file a complaint with the Department of
> Insurance in your state.  Keep in mind, though, that most state's DOIs
> won't
> touch a complaint on an ASO/self funded group.  They will generally only
> investigate complaints on fully insured benefit plans.  They will also not
> investigate until the whole appeals process has been exhausted.
>
> Again, getting complete information in the right hands usually takes care
> of
> any questions, but if not, don't take an initial "no" for an answer and
> make
> sure you've exhausted every review available to you under your plan."

Viatical Settlements-

In 1997, with few long-term financial responsibilities yet (no mortgage or other debt) with lots of medical bills piling up, I sold my life insurance policy.  My viatical settlement worked for me.  Click on the link below and read what quackwatch has to say about viatical settlements.   

This is a link to the discussion of viatical settlements on the quackwatch site.

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