The best resource is your member summary of benefits booklet. You may also contact the member services number on your insurance card for more detailed coverage information. Most plans cover a portion of the office visits, chemotherapy services, injectable drugs, and laboratory charges that will be billed to your insurance by your oncologist.
The amount you will need to pay depends on your insurance coverage as well as the services you receive. Please consult your insurance provider regarding coverage in an outpatient facility. When a treatment plan has been determined, you will be provided with an estimate for your out of pocket costs.
Not always. Some insurance plans may not cover certain injectable “specialty” drugs administered by the oncologist, so you should always check with your plan before these are ordered or administered in the office. Your plan may pay radiation oncology differently than chemotherapy. You may have a higher co-pay for a specialist than you would with your PCP, and you may have to meet a deductible or pay a higher “co-insurance” percentage for chemotherapy.
Each clinical trial is different, and cost depends upon the drug or therapy and diagnostic studies involved. The sponsor of the trial determines what is billed to insurance and what is provided by the study. All of those issues will be discussed in detail with you if you are eligible and choose to participate in a clinical trial.
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