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For cancer patients, benefit caps can mean big bills

Case Management Weekly, September 25, 2007

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Employers and health plans are putting increased caps on the maximum benefits they will pay for cost-intensive cancer treatments, as well as other restrictions on coverage that greatly affect cancer patients.

The policy limits on coverage do not apply only to cancer, but cancer patients are most likely to hit annual limits on doctor visits or drugs because cancer treatment is often intensive in the months following diagnosis.

"Every year the caps are getting lower, and they're more diverse," says Nancy Davenport-Ennis, CEO and founder of Patient Advocate Foundation, according to U.S. News and World Report. "Now insurers are capping their exposure on a range of goods and services."
According to the Kaiser Family Foundation, about half of employer-sponsored health plans have lifetime benefit limits of $1 million or $2 million on health coverage. But in some cases, patient advocates report now seeing lifetime limits of just $50,000 or $100,000.

Source: Patient Access Weekly Advisor, HCPro, Inc.

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