What Insurance Usually Covers
A plain-English overview of how PPO, HMO, and Medicare typically handle cancer care — referrals, prior authorizations, infusion coverage, and the questions to ask your plan today.
Physician video coming soon
We're producing this video with our physicians. Read the full guide below — it mirrors the script.
Why this video matters
Insurance confusion is the #2 reason patients delay starting treatment. A short, honest physician video removes that barrier.
Who this is for:
- Newly diagnosed patients
- Patients changing plans during open enrollment
- Family members helping with logistics
What you'll learn
PPO vs HMO
PPO members can usually self-refer to oncology. HMO members typically need a referral from their primary care physician.
Prior authorization
Most chemo, immunotherapy, and PET scans require prior auth. Our team handles the paperwork — most approvals take 3–10 business days.
Out-of-pocket costs
Once you hit your out-of-pocket maximum, the plan typically covers 100%. Many cancer patients hit this early in the year.
Financial assistance
Drug manufacturer programs, hospital charity care, and nonprofits cover what insurance doesn't for many patients.
Video script outline
This is the outline our physician follows. Use it as a transcript-style reference while reading.
1. Why this video
0:00 – 0:30- You shouldn't have to learn insurance to get cancer care
- We do most of this for you
2. The plan types in plain English
0:30 – 1:30- PPO
- HMO
- EPO
- Medicare Advantage vs traditional Medicare
3. What's almost always covered
1:30 – 2:30- Consultations
- Imaging
- Chemo, radiation, surgery, infusion
4. Where surprises happen
2:30 – 3:30- Out-of-network labs
- Specialty drug copays
- How we prevent these
5. Three questions to call your plan with today
3:30 – 4:00- Referral requirement
- Out-of-pocket max
- Specialty pharmacy
Common questions
- What if my plan denies a treatment?
- We appeal. Many initial denials are overturned. You should never accept a first 'no' as final.
- Will the hospital ever bill me out of the blue?
- We try to verify benefits and quote out-of-pocket costs before treatment starts. Surprises usually come from out-of-network labs we can often re-route.