Can Insurance Deny Cancer Treatment? Know Your Rights

Pinterest LinkedIn Tumblr

Cancer is a devastating disease that can leave patients and their families feeling overwhelmed. Unfortunately, if you have cancer, you may also find yourself dealing with insurance companies who deny coverage for certain treatments or procedures. In this article, we’ll examine your rights as a cancer patient and discuss what to do if your insurance company denies coverage.

Can Insurance Deny Cancer Treatment? Know Your Rights

Understanding Your Coverage

Insurance policies can be complex documents, but it’s important to read and understand all of the details related to your cancer treatment. Before undergoing any treatment or procedure, make sure to review your policy thoroughly so that you know exactly what is covered and what isn’t.

What If Your Insurance Company Denies Coverage?

If you receive a denial of coverage from your insurance company for cancer treatment or medication prescribed by a doctor, there are steps you can take:

  • Appeal: First and foremost, appeal the decision in writing within 180 days after receiving the denial letter.
  • Gather Documentation: Collect all relevant documentation including diagnosis reports, medical records summaries making it clear why this particular medication/treatment is necessary.
  • Get Professional Help: Consider hiring an attorney familiar with health care law or work with patient advocacy groups such as American Cancer Society (ACS) or Leukemia & Lymphoma Society(LLS)

Legal Protections for Cancer Patients

There are legal protections in place for people diagnosed with cancer which prohibits discrimination on the basis of pre-existing conditions like cancer under Affordable Car Act(ACA). A number of states also offer additional protection against cost sharing ($$$), network adequacy requirement(availability) among others. Also , COBRA continuation benefits lets eligible employees continue health care benefits after job loss/employment change.

The Affordable Care Act: How It Helps People With Cancer and Their Families

The health care law known as the Affordable Care Act (ACA, sometimes called Obamacare) includes protections for patients and their families. People have choices for getting affordable and understandable health care. The ACA helps reduce health care costs for many people by:

  • Providing preventive care, such as screening mammograms and colonoscopies, at no cost to patients
  • Not allowing yearly and lifetime dollar limits on the amount of coverage a health plan will pay for
  • Limiting out-of-pocket costs that an individual or family will pay every year
  • Encouraging more competition among health plans and empowering consumers to choose the best one for them
  • Helping low- and middle-income people afford health coverage in the health insurance marketplaces
  • Helping to make sure health plans don’t charge you more just because you have a pre-existing condition (except for grandfathered plans)
  • Not allowing plan to charge women more than men

Health Insurance and Financial Assistance for People with Cancer

Understanding the financial aspects of cancer care is important. It’s crucial to know the costs related to cancer care, how to ask about costs, and how to manage financial toxicity. The Affordable Care Act has provisions that specifically help people with cancer, and understanding these can be beneficial.


As a person dealing with cancer, it’s important that one understands their coverage options well enough before proceeding forward towards medical aid. Consulting an attorney in the case of a denial is always an option besides appealing and relying on support systems such as advocacy groups. By knowing your rights, you can take steps to ensure that you receive the treatment you need without unnecessary roadblocks from insurance companies.


  1. Can my insurance company deny coverage for a cancer treatment recommended by my doctor? Answer: It depends on your insurance policy and the specific treatment in question. However, under the Affordable Care Act (ACA), insurers are required to cover essential health benefits, including cancer treatments such as chemotherapy and radiation therapy. If your doctor recommends a treatment that is considered medically necessary, your insurer must provide coverage.
  2. What should I do if my insurance company denies coverage for a cancer treatment? Answer: You have the right to appeal the decision made by your insurer if they deny coverage for a medical procedure or treatment recommended by your doctor. Work together with your healthcare provider and insurance company to understand their reasons for denying coverage and gather any relevant documentation or information that may support an appeal.
  3. Are there laws that protect me from being denied health care because of pre-existing conditions like cancer? Answer: Yes, under the ACA’s protections for individuals with pre-existing conditions, insurers cannot deny you coverage or charge you higher premiums based on current or past health issues like a history of cancer diagnosis. Furthermore, individuals who lose their jobs due to illness have protections against discrimination when it comes to finding new employer-provided group plans through COBRA continuation or other options available via state marketplaces established under the ACA.