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RECOVERING YOUR HEALTH should be all that requires your stamina and concentration after being diagnosed with and treated for lung cancer. Unfortunately, the side effects of cancer go beyond the physical, impacting your social, professional, and financial well-being. If you're an American with lung cancer, you're likely to become an instant, but unwilling, expert on finances, insurance, and workplace issues.

You can ease the nonmedical aspects of your cancer experience in some ways. By becoming familiar with the somewhat harsh business side of cancer, following the progress of tobacco industry settlements, keeping careful records, and anticipating problems, you may avoid hospital billing convolutions, insurance payment denials, employment pitfalls, and financial degradation.

This chapter discusses some of the more common problems you may encounter, gives tips to avoid problems, and steers you to up-to-date resources that provide detailed solutions to these problems.
It is not the intent of this chapter to detail all issues concerning health insurance benefits; federal legislation, such as ERISA; Medicare and Medicaid coverage; unemployment insurance; and financial issues. The Notes and Appendix A, Resources, list many excellent books and other sources of information that much more thoroughly explore each of these topics. Some issues covered in this chapter, such as estate planning or declaring bankruptcy to protect your house and car, clearly require the aid of professionals, such as financial planners or tax attorneys.

Insurance issues
For lung cancer survivors, problems may arise with health insurance, unemployment insurance, or life insurance. Of these, health insurance is the most likely to cause heartache, frustration, and anger, but first, we'll discuss the main impediment to purchasing all kinds of health, life, disability, and care insurance: medical underwriting.

Restrictive medical underwriting
State and federal authorities have begun to address the problem of health insurance being denied to those with serious illnesses (see COBRA and HIPAA, discussed later in this section). Purchases of life, long-term care, and other insurance policies, though, are still impossible or expensive purchases for those with a cancer diagnosis.
The impediment is the medical examination or medical history questionnaire. If the policy is indeed offered to you after the actuaries have examined the statistics for your illness, it may be offered only with very high premiums. Moreover, employers who have no annual open enrollment period may refuse ever to insure you if you did not elect certain insurance options at time of hire, which is their only open enrollment period. The wife of a cancer survivor describes a frightening insurance problem:

When my husband changed jobs, we decided to just add his name to my employer's medical policy in order to save money and have one provider What we didn't realize was that his employer did not have annual "open enrollment"-so the only time he wouldn't be asked about his health was when he was hired.
After he was diagnosed with cancer; I wanted to change jobs. By then, I'd heard horror stories about changing jobs and losing coverage because pre-existing conditions were excluded. I asked him to follow up with his employer to see if he could enroll for their medical insurance. They referred him to the policy's underwriters. (That should have given us a hint of what was to come.) "We will never insure you," they said. This meant I could never leave my job.
Since then, his employer's policy has been renegotiated for more leniency, and federal laws have been passed to look after the medical insurance needs of people like us. But it was a bitter experience.

If your insurance needs are unrnet, you should consider any offer that states that medical underwriting-insurance jargon for a close scrutiny of your health-is not necessary Some advertisements state very clearly that a medical exam isn't necessary or that pre-existing conditions will not result in refusal. Some medical questionnaires for insurance enrollment ask health questions but do not mention cancer, not even in the section titled "Other." Its always worthwhile to ask for an application to see just how rigorous the medical scrutiny may be.
Of course, while most of these offers may be aboveboard, a proportion of these policies may be very expensive. The usual considerations for shopping wisely still apply, but if your insurance needs are great, or your estate planning justifies purchasing a whole-life policy that might bypass estate and inheritance taxes, for example, the additional cost may be worth it. Insurance companies are evaluated by A.M. Best, Moody's, and Standard and Poor. Choose only those with top ratings.