Financial, Insurance and Legal Resources for Patients with Breast Cancer

From Breast Cancer Options:

INSURANCE RESOURCES

HMO’s and INSURANCE: If your insurance company or HMO turns down your claim for treatment, you don’t have to take no for an answer. You can appeal the carrier’s decision. If the answer is still no, in many states you can file what’s known as an external appeal. The following organizations can be of help if your claim for cancer treatment has been turned down.

NEW YORK STATE ATTORNEY GENERAL’S HEALTH CARE BUREAU
Protects and advocates for the rights of all health care consumers in NYS. The staff at the toll-free Hotline will assist with individual problems. There is an online complaint form.

NEW YORK STATE INSURANCE DEPARTMENT
The New York State Insurance Department supervises and regulates all insurance business in NY State and investigates complaints about insurance company problems including violations of the NYS Prompt Pay Law (which requires health insurers & HMOs to pay undisputed health insurance claims within 45 days of receipt and levies fines for delayed payment). The insurance company has 35 days to respond to the NYSID’s letter, a copy of which will be sent to the complainant.

Mid-Hudson Valley Financial Assistance Program
CancerCare® : $300 grants to help patients living in Putnam, Dutchess, Columbia, Greene, Orange, Ulster, Sullivan and Delaware Counties, NY.
Patients can apply grant toward the costs of:
* Transportation to treatment
* Homecare and childcare
* Housekeeping and Pet care
* Treatment expenses and co-pays
* Prescription medication
* Medical equipment and supplies
The funder has set the eligibility at 600% of the Federal Poverty Guideline (FPL)

Provides direct co-payment assistance for pharmaceutical products to insured Americans including Medicare Part D beneficiaries who financially and medically qualify. Counselors offer personal service to guide patients through the enrollment process.

Patient Services provides peace of mind to patients living with specific chronic illnesses by:
-Locating health insurance in all 50 states
-Subsidizing the cost of health insurance premiums
-Providing pharmacy and treatment co-payment assistance
-Assisting with Medicare Part D Co-insurance
-Helping with advocacy for Social Security Disability

Covered Illnesses and Conditions

-Breast Cancer- Together with Right Action for Women (www.rightactionforwomen.org) and
Cancer Support Community, PSI offers an Incidental Medical Expense (IME) program for women who are 45 years of age or younger, with a family history of Breast Cancer, or have tested
positive for the BRCA gene mutation. The financial support program can assist with the costs of the MRI screening associated with diagnosing Breast Cancer. Patients are eligible to apply
regardless of insurance or financial status.
-Bone Metastases- PSI offers a co-payment program to address the needs of persons needing
medical treatment of bone metastases from solid tumors or bone lesions from multiple myeloma to prevent skeletal related events.
-Breast Cancer Screening- Together with Right Action for Women www.rightactionforwomen.org, the Entertainment Industry Foundation (EIF), and Cancer Support Community (CSC), PSI offers an Incidental Medical Expense (IME) program for women with a family history of Breast Cancer, or have tested positive for the BRCA gene mutation. The national financial assistance program assists women at high risk for breast cancer, in gaining access to Magnetic Resonance Imaging (MRI) screening. This program is accepting new applications. Short-term financial aid, for basic living expenses, on behalf of breast cancer patients who have lost all or a part of their income during active treatment. Payments are made directly to creditors.

  1. Short term is defined as a period of up to three consecutive months of non-medical financial assistance with a cap of $3,000, based on available funding. Please note our ability to provide support varies based on the number of qualified applicants and available funding. We suggest you seek out additional resources. Please visit our resource page by clicking here.
  2. Basic living expenses considered are health insurance premiums, mortgage or rent payments, car payments, car insurance, or utilities. The Pink Fund does not make payments for any medical treatments, prescription drugs (including hormone therapy), medical co-pays, insurance deductibles, prostheses, wigs, food, gasoline, or car repairs.
  3. Active treatment is defined as the period after a positive diagnosis of breast cancer has been made (with a diagnostic biopsy), and during which therapies are being administered, including surgical procedures (e.g., single or bi-lateral mastectomy, lumpectomy, axillary dissection or sentinel node biopsy), chemotherapy or radiation. For the purposes of The Pink Fund, active treatment does not include long-term hormonal therapies (including Tamoxifen, Fareston, Arimidex, Aromasin, Femara, Zoladex/Lupron, Megace, and Halotestin).
  4. Recovery defined as a time period determined by your physician. Includes a return-to-work date

UNITED BREAST CANCER FOUNDATION (UBCF)
▪ College Fund: The Audrey B. Mastroianni Scholarship Fund is designed to help college bound students of single parent homes who have lost a parent to breast cancer and are in need of financial assistance in order to make their higher education dreams a reality.
▪ Holistic Care Scholarships: UBCF has partnered with the Omega Institute, Rhinebeck, NY to provide grants to those affected by breast cancer who wish to learn about alternative therapies and holistic treatments.
▪ Individual Grants: UBCF awards a limited number of partial and full individual grants to qualified applicants with limited finances.

LEGAL ASSISTANCE OF WESTERN NEW YORK, INC. (Orange & Sullivan)

NEW YORK SENIORS LEGAL ASSISTANCE PROJECT (NYSLA)
Free legal assistance to New Yorkers aged 60 and older in areas most commonly affecting low-income seniors but there are no income or resource requirements. Health care issues (including Medicaid, Medicare and Medicare Part D); income security issues (Social Security and other benefits); advance directives (living wills, other wills, health care proxies, and powers of attorney); consumer issues (debt collection and bankruptcy); nursing home transition issues and guardianship issues. NYSLA offers advice, brief services, limited representation, and referrals to other legal services providers or volunteer attorneys.
Mondays, Wednesdays and Thursdays:10 am and 1 pm, Tuesdays: 5 pm and 8 pm.

For the Community section has downloadable forms as well as other resources for the public Living Wills available in English and Spanish. Health Care Proxy Forms in English, Spanish, Russian, and Chinese.