Will I be able to stay on my employer’s insurance policy? 

If you are taking leave, look into how long you will be allowed to stay on your employer’s health insurance policy by contacting human resources. If you are terminated because leave time runs out, consider the following:

COBRA is a federal law that applies to employers with 20 or more employees that allows you to continue the same employment-based health insurance coverage that you had while they were employed, usually for 18 months. COBRA is available to an employee or family member after an employee has terminated their employment or has reduced their work hours to a point that they are no longer eligible to receive coverage from their employer. This termination or reduction in hours is referred to as a “qualifying event.” The good news about COBRA is that you do not have to change health care providers and will maintain the same coverage you previously had. The bad news is that the coverage is no longer subsidized by the employer and you have to pay the full premium, which can be expensive. There is a program in some states called the Health Insurance Premium Payment Program (HIPP), which can help pay for an individual’s health insurance premium. In addition, some states have mini-COBRA laws that require employers with between 2 and 19 employees to offer continued coverage.

What do I do if the time period to stay on my employer’s insurance through COBRA runs out? 

First, make sure you know exactly when your COBRA coverage ends, so you can plan for it. Getting on a Health Insurance Portability and Accountability Act (HIPAA) plan might be an option for you. 

HIPAA, as a law, does many things, including: 1) provides a federal right to an individual health insurance plan (called a guarantee issue plan); 2) reduces the maximum pre-existing condition exclusion period to 12 months; and 3) gives you credit for the time that you had health insurance coverage in the past to eliminate or reduce a pre-existing condition exclusion period. 

You must, however, meet three requirements to be eligible for a HIPAA plan: First, you must exhaust your COBRA coverage, meaning that you use all 18 or 36 months of COBRA coverage, or state COBRA coverage. Second, you cannot have a break in coverage longer than 63 days (which is why it is important to know when your COBRA coverage runs out and plan ahead when possible). Lastly, you must be ineligible for Medicare, Medicaid, or any other form of group coverage.

If you’re not able to get insurance through COBRA, and you’re not eligible for a HIPAA plan either because you did not exhaust the available COBRA coverage or if you had a break in coverage of more than 63 days, then you may be eligible for a state high risk insurance pool or a major risk plan. Some states that provide this form of high-risk medical insurance for people who are unable to obtain health insurance coverage in the individual insurance market due to a pre-existing condition. The type and availability of coverage that you receive varies depending on your state. 

In addition to state high risk insurance options, the Patient Protection and Affordable Care Act, otherwise known as healthcare reform, mandated that states create Pre-Existing Condition Insurance Plans. Some states opted not to create these plans. In those states, the federal government runs the plan. In order to be eligible for the federal program, you must: 1) be a U.S. citizen or in the US lawfully; 2) have a pre-existing illness or condition; and 3) have not had creditable coverage for six months.

Don’t take “no” for an answer if your insurance company denies coverage

Insurance coverage denials are unfortunately fairly common. Some denials stem from administrative errors, incorrect billing codes and errors on forms. It is important to check to see if any of those apply, and even if there is a more substantive reason for the denial, to then proceed through the internal appeals process. Internal appeals can take time and energy, but could be worth the hassle. Ask for patient navigation assistance or someone close to you for help. If you still aren’t getting the answer you want, you can move to the external medical review process, which is supposed to provide an independent review of your request. Many states have had external medical review for a number of years. Under health care reform, all states should now have an external appeals process. It can be worth going through the external appeal, since this decision is generally binding on the insurance company. For more information contact your state’s insurance agency.

The Cancer Legal Resource Center (CLRC), a 14 year old program of the Disability Rights Legal Center, offers free information and resources on cancer related legal issues to patients, caregivers, healthcare professionals and employers.  The CLRC provided this overview of the employment-related legal questions that often come up for patients, if you have specific questions about your legal rights in the workplace please contact the Cancer Legal Resource Center directly at 1-866-THE-CLRC or clrc@lls.edu for more information.

This material is designed to provide general information on the topics presented. It is provided with the understanding that Cancer and Careers and the Cancer Legal Resource Center (CLRC) are not engaged in rendering any legal or professional services by its publication or distribution. Although this material was reviewed by a professional, it should not be used as a substitute for professional services. Resources and referrals are provided solely for information and convenience.

(Source: cancerandcareers.org. 2011. http://www.cancerandcareers.org/en/at-work/Legal-and-Financial/top-three-insurance-questions)

This article answers legal questions about employment.

Top Three Legal Questions About Employment

Predicting your chance for developing breast cancer seems futuristic, but for some women, the future is now and it’s lifesaving. For a select group of breast cancer patients, the cause can be traced to inherited genetic mutation called the BRCA 1 and 2 (pronounced “bra-ca”). Knowing whether you’re at risk for having the mutation can help you and your physician create a prevention strategy specifically for you.

“Everyone has the BRCA genes, but not everyone carries the harmful mutation that increases the risk for breast and ovarian cancers,” explains Donald Sweet, Medical Director of Cancer Services on staff at Adventist Bolingbrook Hospital. Men can also have this mutation. For them, it means an increased risk for colon and prostate cancer, as well as an increase in the risk for breast cancer.

Since genetically determined breast cancer is relatively rare, most women won’t need to worry about whether they are carriers of the BRCA mutation. But, according to Dr. Sweet, there are some factors to be aware of:

• Having a mother or sister who was diagnosed with breast or ovarian cancer before age 50.
• Having Ashkenazi (Eastern European) Jewish heritage.
• Having family members who had more than one cancer develop at the same time.

If one or both of your parents carried the BRCA mutation, chances are higher that you inherited it as well. However, having the mutation doesn’t mean you will definitely develop breast cancer.

Genetic counseling helps determine your risk for breast cancer
Talking to a genetic counselor – a health care professional trained in genetics and cancer – if you meet one or more of the criteria for carrying the BRCA mutation can help you understand your risk and your options.

“During genetic counseling, we go into great detail about your family history on your mother and father’s side, especially where breast and ovarian cancers are concerned,” says Dr. Sweet. “Gathering that information allows us to calculate your risk for having the genetic mutation.”

If your genetic counselor thinks your risk is 10 percent or more, a blood test may be ordered to pinpoint whether you are carrying the BRCA mutation. Then, if you do have the BRCA mutation, your doctor will explain your personal risk for breast and ovarian cancers.

Once your risk has been assessed you have a few options:
• Monitoring your breast tissue using mammography or MRI.
• Drug therapy (also called chemoprevention) with drugs like tamoxifen.
• Prophylactic mastectomy (removal of the breasts as a preventive measure).

“Even though a woman may have up to a 50 percent risk of developing breast cancer, there is still a chance she may never develop it. That’s why we take time to talk to women about options and make sure they’re making an informed decision about prevention,” says Dr. Sweet.

What’s best for you depends on your stress level, whether you can handle the emotional impact of mastectomy and your ability to cope with uncertainty. “It’s not at all easy to find out you’re at a higher risk for cancer,” Dr. Sweet says. “I always recommend genetic counseling before genetic testing. If counseling shows you’re only at a 2 percent higher risk, you may not want to go through genetic testing.”

What every woman can do to decrease her breast cancer risk
“A family history doesn’t always mean you’re going to be BRCA positive,” cautions Dr. Sweet. Because 11–12 percent of all women will develop breast cancer, there’s a chance of developing the disease regardless of whether you have a genetic predisposition.

All women can help reduce their risk for breast cancer by:
• Eating a low-fat diet.
• Getting 30 minutes of exercise 3-5 days per week
• Maintaining a healthy weight.
• Avoiding hormone replacement therapy.
• Getting regular mammograms starting at age 40.

If you think you might be at risk for carrying the BRCA mutation, talk with a qualified genetic counselor like the kind on staff with Adventist Midwest Health. “We help put your risk in perspective and help you make the decision that’s right for you,” says Dr. Sweet.  

Why Breast Self-Exams Still Matter (with Dr. Schneiderman)

A no-cost, low-risk method to detect breast cancer may seem too good to be true, but there really is such a method: monthly self-exams. You may have heard the debate over the effectiveness of self-exams, but the fact is up to 20 percent of women with breast cancer identified their own lump using this method.

“Being familiar with your breast makes it easier for you to notice when something is out of the ordinary, helping you detect early stage breast cancer,” says Elyse Schneiderman, MD, Hematologist and Medical Oncologist on staff at Adventist Hinsdale Hospital.  “It’s very common to feel some lumps when you do your exam; the key is to recognize what’s normal and what’s changed.”

Breast self-exams for every stage of your life
Starting monthly self-exams in your 20s will familiarize you with how your breasts look and feel. As you age, these exams will help you recognize natural changes in your breast tissue. It’s never too late to start, especially if you won’t be getting your first mammogram until you turn 40.

Make the most of your self-exam by following Dr. Schneiderman’s tips:

• In your 20s, 30s and 40s: Perform your self-exam about a week after your period. “The week prior to your period causes swelling and tenderness in the breast which can change the feel of the exam. Waiting until the week after your period is over makes the exam more accurate,” Dr. Schneiderman explains.

• If you’ve gone through menopause: Perform your exam any time during the month, but be consistent.  “Pick a time of the month that’s easy for you to remember,” suggests Dr. Schneiderman.

• If you’re pregnant or breastfeeding: It’s more difficult to perform self-exams because your breasts are changing. This makes the exam more difficult to interpret because the normal landmarks are altered. “Breast cancer is rare in women of childbearing age, but if you’re concerned about anything, don’t hesitate to talk with your doctor,” says Dr. Schneiderman.

• If you have breast implants: Breast tissue may be obscured by your implants, but self-exams are still beneficial. “Lumps may be harder to feel, but it can be done,” Dr. Schneiderman says. “Women with breast implants should also pay close attention to changes in skin color and breast symmetry.”

When a lump is more than a lump
Since most breast tissue is naturally a little lumpy, knowing what to look for can save you some stress when performing your self-exam. If you notice any of the following conditions during your self-exam, it could be cause for concern:

• Hard or gritty feeling mass(es).
• Thick areas of tissue that don’t go away or seem to be growing.
• Inversion of the nipple (if that is atypical for your breast).
• Asymmetry in a way that is unusual for your breasts.
• Dimpling under the skin.
• Red skin or a rash, especially if it feels hot. (See a physician for an evaluation right away. This could be a symptom of a rare type of breast cancer).

“If you find something unusual during a self-exam and you are not sure what it is or it seems to have gotten worse during your next monthly self-exam, get evaluated by a physician,” urges Dr. Schneiderman.

Even if you’re getting mammograms or a yearly clinical exam by your physician, breast self-exams are a simple way to play an active role in your own breast health. After all, “A mammogram or doctor only examines your breasts once a year,” says Dr. Schneiderman. “You’re in a position to notice small changes from month to month and be an advocate for yourself.”

You don’t have to wait to get screened for breast cancer. Call 630-856-7061 today to schedule your next-day mammogram through Adventist Midwest Health.

The Self Breast-Exam
Step-By-Step

Source: Keeping Chicago Well. (2011). Retrieved from http://www.keepingchicagowell.com/taxonomy/term/35

It seems the more we know about prostate cancer, the more difficult it is to accurately predict who will develop it and who won’t. With the likelihood that one in six American men will be diagnosed in his lifetime, the odds are high – especially if you’re above age 60, African-American and/or have a family history of the disease. Even if you don’t fit those important risk factors, there are some wild cards, such as diet, exercise and early screenings, you can play to your advantage. 

Live a cleaner lifestyle
In his decades-long career of treating prostate cancer patients, Donald Sweet, MD, Medical Director on staff at the Adventist Hinsdale Hospital has studied the link between lifestyle and the disease. “Eating a healthy diet, limiting your alcohol use, and exercising are three things that could reduce your risk for prostate cancer and a host of other illnesses,” says Dr. Sweet.

In the gym
Exercise may not be a secret weapon against prostate cancer, but it can certainly keep your body fat down and give you more lean muscle mass. According to Dr. Sweet, 30 minutes of moderate exercise at least three times a week is all it takes to improve your immune system function, which could bolster your body’s ability to keep cancer-causing cells in check.

If you’re not already active, try running or jogging or high-cardio sports such as basketball or tennis. If you need something with less impact, swimming, biking and the elliptical machine can get your heart rate up without tearing down your knees.

In the fridge
There is no magic anti-prostate cancer food, but limiting red meat in favor of lean protein such as salmon is a good start. You should also add five to nine servings of fruits and vegetables to your diet each day.

Choosing fresh foods, such as spinach, asparagus, beans, broccoli, kale, cabbage and tomatoes could give your body a natural boost in B vitamins, antioxidants and other protective nutrients. Plus, it could save you from expensive supplements. “If you’re eating a healthy, balanced diet, chances are you’re already getting the vitamins you need through those foods. Put down the vitamins and pick up a tasty salad,” says Dr. Sweet. 

Before you wash it all down with a glass of milk, consider this: “Some research shows a link between dairy consumption and prostate cancer, so it may be beneficial to replace some of the dairy you eat with soy-based products,” says Dr. Sweet.

In the doctor’s office
While exercise and diet can help control some of the risk factors, nothing replaces a visit with your doctor. During a routine physical, your doctor can dispel some of the common myths around the role of stress, sexual activity and vasectomy. Here’s a hint: none of them increase the risk for prostate cancer. Even still, there is plenty to discuss with your doctor, such as when you should have your screening and which type of test you will need.

Dr. Sweet recommends a baseline PSA test starting at age 50, unless you have increased risk factors. “Detecting cancer at an early stage is the best chance we have for controlling the disease,” says Dr. Sweet. “If you have any of the age, ethnicity or family history related risk factors, you should make sure to get screened for prostate cancer by age 45,” says Dr. Sweet.

Take advantage of a FREE prostate cancer screening offered through Adventist Midwest Health by calling 866-533-7968.

Source: Keeping Chicago Well. (2011). Retrieved from http://keepingchicagowell.com/library/cancer-care/prostate-cancer-play-cards-your-advantage

Prostate Cancer Treatments are as Unique as you are (With Dr. Madej)

Most traditional prostate cancer treatment plans consist of three main options: surgery, radiation and chemotherapy. While the majority of prostate cancer patients will still undergo some combination of those three treatments, there are alternative treatments available for select groups of patients. For patients with early stage prostate cancer, hormone therapy can often stall cancer cell production as a precursor to traditional treatment. Meanwhile, men with late stage prostate cancer may find hope in a new immunotherapy treatment.

New therapy uses your own cells to fight cancer
Turning your body’s immune system into a prostate cancer-fighting drug may sound like science fiction, but that’s precisely what immunotherapy can do for many men with advanced prostate cancer.

“Immunotherapy is a new, FDA-approved process for using a patient’s own T-cells – the immunologic cells in your body – and activating them against an antigen or cell that is in the prostate cancer,” explains Patricia Madej, MD, Medical Oncologist on staff at Adventist Bolingbrook Hospital.

Here’s how it works. Your blood is taken in the physician’s office. That blood is then sent to a special lab where the T-cells are combined with a protein to boost the disease fighting power of the cells. The combination creates a custom-made cancer drug made specifically for you from your own cells. Between 2-3 days later, the activated blood is sent back to your physician to be put back into your body so the enhanced cells can fight the cancerous cells. The result is prolonged survival and a halt to the disease’s progression.

“Right now immunotherapy treatment is limited to those men with advanced prostate cancer who have not responded to hormone therapy,” says Dr. Madej, “but it’s an exciting advance in the fight against prostate cancer.”

Hormone therapy slows the growth of cancer cells
Hormone therapy (also known as androgen deprivation) is a more traditional way to slow the progression of prostate cancer. For many men, it is their first line of treatment against the disease or is used in combination with other treatments. Hormone therapy limits the production of testosterone, which means the cancerous cells within the prostate gland can’t get the fuel they need to grow.

There are three types of hormone therapy for prostate cancer:
• Medications that stop the body from producing testosterone.
• Medications that block testosterone (but don’t halt its production).
• Surgery to remove the testicles.

“Prostate cancer is a little different than some other cancers,” Dr. Madej says. “For some men, it is a very slow growing cancer that lays low for quite some time. That’s why using therapy to slow the growth down even more can be effective.”

If the tumor doesn’t seem to be responding to hormone therapy, chemotherapy is a likely next step. When chemotherapy is introduced in a prostate cancer case, the goal is to control symptoms and enhance the patient’s quality of life rather than cure the disease. “In some cancers, chemotherapy can result in long-term remissions, but that is not true when it is used to treat prostate cancers,” explains Dr. Madej.

Personalized treatment plan key to success
Dr. Madej stresses that when deciding on a treatment plan, the patient’s quality of life has to be at the forefront of the decision-making process. That’s especially true for prostate cancer patients since the majority of men with this slow-growing cancer are diagnosed after age 60. “If a treatment seems to be fighting the cancer, but the patient simply cannot live comfortably with the treatment’s side effects, then we have to question whether continuing treatment is the best plan,” Dr. Madej says.

It’s the personal touch combined with technology and expertise that makes a difference for patients. Physicians at Adventist Midwest Health have access to sophisticated technology and clinical trials like you’d find at a university hospital, but have them available close to home.

“When you’re fighting a disease like cancer you don’t want to compromise care for convenience. At Adventist Bolingbrook Hospital, I think patients get the best of both worlds,” says Dr. Madej.

Take advantage of a FREE prostate cancer screening offered through Adventist Midwest Health by calling 866-533-7968.

Source: Keeping Chicago Well. (2011). Retrieved from http://keepingchicagowell.com/library/cancer-care/prostate-cancer-treatments-unique-you-are