Understanding Insurance Coverage for Cancer Treatments

The financial realities of a cancer diagnosis often come as a second shock, right after the words “you have cancer.” Insurance can be a maze at the best of times, and when treatments, tests, and ongoing care start to add up, understanding exactly how your coverage works becomes critical. In this episode, I sit down with Renee Lemens, President of Informed Choice Insurance Agency, and Jordan Karwedsky, financial counselor at Green Bay Oncology, to demystify the insurance world for cancer patients. Together, we break down the most important insurance concepts, discuss common hurdles, and offer practical strategies for managing costs throughout your treatment journey.

Renee Lemens has more than 27 years of experience helping individuals and families across Wisconsin navigate their health insurance options with compassion and clarity. Renee, a trusted community resource, specializes in matching clients to plans that suit their medical needs and lifestyles, especially during major healthcare changes like a cancer diagnosis.

Jordan Karwedsky is a financial counselor with Green Bay Oncology, guiding patients through the intricacies of insurance coverage, authorizations, and the many programs designed to ease out-of-pocket costs. Jordan’s experience lies in translating complex insurance jargon into actionable steps, ensuring patients understand their financial obligations and the assistance available to them.

“If you have a really bad year for health…what is the most that you’re going to pay out of pocket for your care that year? That’s a really important number to know.” ~Renee Lemens

Today on Cancer Covered:

• Know your insurance basics: Understand terms like premiums, deductibles, coinsurance, and maximum out-of-pocket limit. This is the true cap on your annual medical spending.
• Network matters: In-network and out-of-network care can cost tens of thousands of dollars. Always verify that your providers and oncologists are in network before starting treatment.
• HMO vs PPO vs EPO: The more freedom you have to choose providers (PPO), the higher your premium typically is. HMOs and EPOs are more restrictive but may cost less.
• Government programs: Medicare and Medicaid offer broad coverage but have distinct qualifications and network restrictions. Dual eligibility can open up more plan options but may also increase complexity.
• Resources for help: Independent insurance agents and financial counselors can clarify coverage, help you choose the best plan, and troubleshoot barriers during care.
• Supplemental coverage: Specified-disease policies (like cancer insurance) can help cover hidden costs that your main policy doesn’t, like travel, lost wages, or house cleaning.
• Financial assistance: Hospital programs, copay cards from drug manufacturers, and national foundations can help cover out-of-pocket costs for treatment and medication.
• Keep records: A simple binder to organize explanations of benefits and doctor bills and a log of appointments can save you time and stress when sorting out bills and insurance claims.

Guest Contact Information

Informed Choice Insurance Agency (Renee Lemens)
Website: https://informedchoice.com

Green Bay Oncology (Jordan Karwedsky)
Website: https://gboncology.com
Financial counseling services are available via patient support at the clinic.

Resources Mentioned

• Triage Cancer: https://triagecancer.org (comprehensive info on insurance and cancer, legal rights, and advocacy)
• Aging and Disability Resource Centers (ADRCs): Local county-based support for insurance and Medicaid navigation
• Copay assistance programs through drug manufacturers and national foundations (search by disease or medication)
• Medicare Marketplace and local agents for plan comparisons and enrollment guidance

If you’re feeling lost in the insurance world, know it’s normal. There are people and resources ready to advocate for you. Whether you’re newly diagnosed or supporting a loved one, reaching out can lighten the load and help you focus on healing.

We’ve Got Cancer…Covered.

Thanks for tuning into this week’s Cancer Covered with Green Bay Oncology episode. If you enjoyed this episode, please subscribe and leave a review wherever you get your podcasts.

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