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FAQ: Insurance

I don't have any insurance. Is there any help available?
Yes. There are health coverage programs offered to County residents such as the Breast and Cervical Cancer Treatment Program, the Medically Indigent Adult Program, Medi-Cal and the TSAC program. The Cancer Center of Santa Barbara also offers a patient assistance program for services rendered at our clinics. You must meet the income and property guidelines for these programs. If you are 65 and older and have paid into Social Security program, you may be eligible for Medicare. There are programs that protect coverage for those who are about to lose their health coverage or who may have lost their insurance recently due to life changing event such as illness, disability, job loss or divorce. Some of these programs are: COBRA, Cal-COBRA, HIPP, MRMIP and HIPPA. Details about many of these programs can be found on the Disability Benefits 101 website located at http://www.disabilitybenefits101.org/.

For more information, please contact a Cancer Center of Santa Barbara Support Services staff member at 1 (877) 755-7300.
Will my insurance plan pay for treatment? What if it will not?

Your health plan may pay if benefits are available. It is a good idea to check with your health plan to confirm coverage. In addition, some health plans require prior authorization and this is very important to find out if this is necessary, as it may increase the patient’s responsibility. Usually referring physicians will do this; however it’s always a good idea to confirm with your health plan.
 If your health plan does not pay for services, contact the Patient Finance Office to discuss payment options.

How do I know if my health plan includes the Cancer Center of Santa Barbara?

Contact your health plan to confirm whether or not the Cancer Center of Santa Barbara is included.

What is the difference between an HMO and a PPO?
Health Maintenance Organizations (HMOs) require a patient to select a Primary Care Physician to coordinate his or her care. Most HMOs provide care through a network of hospitals, doctors and other medical professionals, that as a patient, you must use to be covered for that service. Preferred Provider Organizations (PPOs) provide care through a network of hospitals, doctors and other medical professionals. When patients utilize health care providers within the network, they receive a higher benefit and pay less money out of their pocket. Services received by a non-participating hospital or doctor may still be covered, but often at a reduced benefit level.
What does "in-network" and "out-of-network" mean?
If you receive your health care services from a hospital, physician or other health care provider that participates in your health plan, they are often referred to as “in-network.” Hospitals, physicians or other health care providers who do not participate in your health plan may be referred to as “out-of-network.”
How do I know if my health plan requires a referral or pre-certification for a service?
Your benefit book or provider directory should provide this for you. If not, call the customer service phone number listed on your identification card.
What should I do if my health plan includes the Cancer Center of Santa Barbara as a participating provider, but I receive an explanation of benefits stating I am out-of-network?
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I belong to a managed care plan. What should I do before I begin treatment?
Read your insurance plan booklet to be sure you have followed all the guidelines for referrals and authorizations, or call your insurance carrier for assistance. Failure to follow your plan requirements may result in greater out-of-pocket expenses for you. Your primary care physician plays a very important role in this process. If you receive a verbal authorization number, please provide us with this information at registration.
My insurance is going to end soon. Can you help me?
Yes. The type of help available to you or your family member depends on the reason the insurance is going to terminate. Usually there is a qualifying event which occurs to cause the insurance coverage to end. A qualifying event means that the health insurance is lost because:
  • The employee's job ends
  • The employee's hours are cut
  • You divorce or legally separate from the employee
  • You are no longer a dependent of the employee
  • The employee enrolls in Medicare
  • The employee dies
  • If you leave your job or your hours are cut, you should receive a notice that says you can enroll in Federal COBRA or Cal-COBRA. Within 60 days of the date of the notice, you must tell the health plan in writing that you want to sign up.
  • If you divorce, legally separate, or you can no longer be considered a dependent, you should tell the employer and the health plan to send you the forms you need. Within 60 days of being notified of your right to Federal COBRA or Cal-COBRA, you must tell the health plan in writing that you want to sign up.
  • The health plan must then send you a notice that tells you how much the premium is and how to sign up.
    There is a program called HIPPP (Health Insurance Premium Payment Program) which can help to pay your medical premiums. You can apply with the Medi-Cal Office in your community.
    If you need help contacting your employer about your health plan or finding out what type of transitional plan you are eligible for, please call the Cancer Center of Santa Barbara Support Services staff at 1(877) 755-7300.

I don't have prescription coverage, can you help me?
Yes. Prescription drug coverage is available with most health plans, but you may need to enroll in the correct drug plan for your insurance policy and health condition. Plan availability may depend on if you have Medicare, Medi-Cal, other types of coverage.

If you don’t have any prescription coverage due to lack of insurance then there are hundreds of free drug programs offered by the pharmaceutical companies if you meet the income and property guidelines. There are several websites that can link you to the correct assistance programs:

http://www.needymeds.com/

https://www.pparx.org/Intro.php
http://www.rxhelpforca.org/

If you need help finding a prescription drug program or finding free drug programs, please contact our Support Services Department at 1-877-755-7300.
What is Medicare Part D?
Medicare Part D is prescription drug coverage insurance that covers both brand-name and generic prescription drugs at participating pharmacies in your area. Everyone with Medicare is eligible for this coverage, regardless of income and resources, health status, or current prescription expenses. You may sign up when you first become eligible for Medicare (three months before the month you turn age 65 until three months after you turn age 65). If you get Medicare due to a disability, you can join from three months before to three months after your 25th month of cash disability payments.
If you have limited income and resources, and you qualify for extra help, you may not have to pay a premium or deductible. You can apply or get more information about the extra help by calling Social Security at 1(800) 772-1213 (TTY 1(800) 325-0778) or by visiting www.socialsecurity.gov on the web.

If your question wasn’t answered, please call 805-682-7300.