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Will My Insurance Cover This?


Will My Insurance Cover My Mesothelioma Cancer?

What is Malignant Mesothelioma?

Mesothelioma is a rare form of cancer that develops in the mesothelium, a two-layered membrane that shields the heart, lungs and abdomen. All forms of malignant mesothelioma primarily form from prolonged exposure to asbestos fibers; those who have worked or been in extended with asbestos are at significant risk of developing the disease.

When inhaled, the fibers adhere to the mesothelium and eat away at the protective layers. The destruction of the tissues leads to proliferation; when mesothelioma tumors metastasize to remote sites, the disease is regarded as inoperable.

When untouched, asbestos does not pose a significant risk to human beings; however, when the mineral is touched or disturbed, carcinogenic dust particles are released into the air. If chronically inhaled, the likelihood of developing the cancer becomes very real.

Although malignant mesothelioma is rare (only 2,000-3,000 mesothelioma cases are documented each year), individuals with a prolonged history exposure are at risks of contracting the disease. The majority of mesothelioma cancers form in the lining of the lungs or abdomen cavity. Common symptoms of the disease include: difficulty breathing, bowel obstruction, night sweats, difficulty swallowing, pleural effusion, painful coughing, horrible chest pains and severe or unexpected weight loss.

Mesothelioma cancer is very difficult to detect in its earliest stages. Complications regarding early detection stem from the disease’s slow-developing nature and innocuous cellular structure. The bulk of mesothelioma cases will not have tangible symptoms for 25-50 years following their initial exposure to asbestos.  

Mesothelioma cancer treatment is dependent on the cancer’s progression at the time of diagnosis. The stage of mesothelioma represents its degree of proliferation--the final stage of exhibits complete proliferation to several organs and areas beyond the origin point of the tumor. 

Because of late diagnosis, mesothelioma life expectancy commonly bleak; the median prognosis for mesothelioma patients is only 4 to 18 months. 

Mesothelioma can be observed in three different forms: pleural, peritoneum and pericardial. Pericardium mesothelioma forms in the layer of tissues that protects the lungs; peritoneum mesothelioma eats away at the tissues that surround the abdomen (the peritoneum); and the most common form of cancer, pleural mesothelioma destroys the pleura, which is the thin network of lubricating cells that lines the lungs and chest wall. 

Mesothelioma treatment methods are dependent on the stage or level of proliferation. Mesothelioma may be diagnosed in one of the following stages:

Stage I Mesothelioma: The beginning stage of mesothelioma cancer features a localized tumor that is often located in the lining of the lungs, the diaphragm or the sac surrounding the heart. Diagnosing the disease in the first stage is exceptionally rare. Patients lucky enough to achieve first stage diagnosis are typically eligible for curative mesothelioma surgeries. These operations will attempt to extract the cancerous tumors from the body.

Stage II Mesothelioma: At Stage II, the mesothelioma proliferates past the point of origin. The cancer at this stage may spread to the lymph nodes or chest wall. Although curative treatment options may be applied in this stage; however, life expectancy is greatly decreased in Stage II patients.

Stage III Mesothelioma: The most common stage for mesothelioma diagnosis. The cancer in this stage has progressed enough to yield tangible symptoms. Typically, stage III mesothelioma cancers will have spread to the mediastinum, the lining of the peritoneum, the heart or beyond to the chest wall and/or the diaphragm. Stage III patients face a grim prognosis. Because of the limited life expectancy, Stage III mesothelioma patients will only be eligible for palliative treatment options. These treatment methods are administered to ease the symptoms associated with the cancer. Palliative care is undertaken to boost the patient’s quality of life. 

Stage IV Mesothelioma: In the final stage of mesothelioma, the cancer spreads to remote locations in the body. Stage IV mesothelioma is inoperable. Symptoms of final stage mesothelioma cancer are extremely painful and only palliative treatment options are applied to ease the associated symptoms. Median stage IV life expectancy is approximately 4 to 18 months.

Seeking medical attention is of the utmost importance, if you or a loved one has a prolonged history of asbestos exposure. Even if symptoms are not present, seeking medical help is a necessary safety precaution with regards to accurate mesothelioma diagnosis. If the medical professional believes that your exposure to asbestos has altered your cellular formation, the individual will order imaging tests, including chest x-rays, CT scans and MRI’s. These diagnostic tests will take pictures of your abdomen, lungs and protective tissues to observe potential irregularities. If the medical professional senses an abnormality, you will undergo further medical examinations to secure a mesothelioma diagnosis

Will my Insurance Cover Mesothelioma Treatment?

Conventional medical insurance allows mesothelioma patients to choose any medical physician or hospital in the country for their treatment. Mesothelioma patients have the assurance that their doctor’s medical recommendations are rendered with the patient’s best interest in mind. 

A managed care health plan is typically offered by corporations who serve large groups of potential patients through a financing plan to deliver health care for set fees. These plans utilize an established network of health care providers and physicians. These networks coordinate and refer patients to their hospitals and health care providers to effectively monitor the patterns and amount of care delivered. These managed plans typically limit which services patients may receive through the administration of “gatekeepers” or primary care doctors to ensure services deemed unnecessary are kept to a minimum. 

Health Maintenance Organizations or HMO’s are the most common form of “managed care.” These types of insurance policies are groups that coordinate contracts with physicians, medical facilities, employers and individual patients to offer medical care to large groups of individuals. This care is typically paid for by corporations or employers at fixed prices per patient. A prospective mesothelioma patient typically does not pay significant “out of pocket expenses” for coverage. However, a Health Maintenance Organization may control the amount of mesothelioma treatment that a doctor is allowed to administer or provide. The bulk of HMOs require that the mesothelioma patient picks a primary care physician from their list. Unless the medical doctor decides the patient’s problem is outside his skill-set or expertise, the patient may not receive approval to seek an oncologist or mesothelioma specialist. In a similar fashion, a number of HMO’s will limit patients to select hospitals.

A Preferred Provider Organization or PPO is a managed care entity that develops contracts with a network of medical professionals, health care providers and hospitals who deliver services for fixed fees, typically at a discount to the organization. Under a PPO, a consumer must choose their primary health provider from an approved list and are required to pay extra for specialty services received beyond the group.A point of service plan or a POS is a healthcare plan whose participants are free to select their services when they need them. Under this insurance, the individual may choose a provider inside or outside the HMO. If the patient chooses a provider outside of the HMO, they will be forced to pay an additional cost. 

Under Medicare, which is a federal health insurance program for individuals over the age of 65 and certain people with disabilities under the age of 65 are eligible to receive mesothelioma treatment. Medicare has two distinct parts, Part A and Part B. Part A Medicare covers hospital insurance costs. The majority of Part A participants do not have to pay for treatment. This portion of Part A helps pay for care in hospitals, critical access hospitals, hospice care and skilled nursing facilities. Part B of Medicare covers medical insurance. The majority of participants under Part B will pay monthly for medical services rendered. This portion of Medicare helps pay for medical professionals, outpatient hospitals, services and other medical services that are not covered under Part A. Some forms of treatment not covered under Part A will be occupational therapy, home health care and physical therapy. Additionally, Part B also helps pay for said services when treatment is medically necessary. 

Medicaid is a jointly funded state/federal health insurance organization for needy or low-income people who qualify. Medicaid covers roughly 36 million United States citizens, including the elderly, children and/or the disabled.  

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