The second in a two-part series on breast cancer costs.

Molly MacDonald was diagnosed with Stage 0 breast cancer in 2005. The good news was that such cancers, caught early, are highly treatable and survivable. The bad news was that the diagnosis came while she was between jobs and without an income. Her family quickly went into a financial free fall.

“Our home went into foreclosure and I ended up standing in line at a local food bank. I was appalled when I realized how our family could become homeless over something like this,” says MacDonald, of Bloomfield Hills, Michigan, who had two surgeries and six weeks of daily radiation to rid herself of the cancer cells. “My early stage disease was not going to take my life, but believe me, there were times during the process when I thought I and my family would be better off if it did and they could collect the life insurance — at least that would have kept a roof over their heads and food on the table when I could not provide.”

“I was so angry when I realized that we spend hundreds of millions of dollars researching a cure, which is important, but nothing to help out families for whom the patient’s ability to work is absolutely critical to their ability to live. The American Cancer Society can help with transportation and there are a few programs that help with medical co-pays for prescriptions,” says MacDonald. But the needs totally outstrip the number of helping hands available.

MacDonald decided to put her anger and frustration to good use. In 2006, she founded The Pink Fund, which provides assistance to those afflicted with breast cancer. Its overarching goal is to prevent people from finding themselves homeless and without transportation as the cope with an average six-month breast cancer treatment protocol, explains MacDonald. Typically, The Pink Fund will write checks to cover expenses like rent, utilities and car insurance on behalf of the individual, typically offering about $1,800 per person, with a cap of $3,000.

“When I sat in that radiation cancer room and listened to the war stories of other women who were in far worse physical shape, facing their own mortality, I only could share what was happening to us financially, but when I told them I was determined to make a difference by creating a fund, I felt somewhat off the hook for not being quite so sick,” says MacDonald.

Filling a Financial Void

Organizations like The Pink Fund serve as a financial lifeline for those in danger of getting washed away by the financial tidal wave that so often follows the earthquake that is a breast cancer diagnosis. DailyFinance went in search of other places those women can turn for help.

Miles of Hope Breast Cancer Foundation in LaGrangeville, N.Y., gives about $100,000 a year — between $250-$1,000 per person — to people in treatment for breast cancer who live in the eight-county Hudson Valley region. “We stopped a woman from committing suicide last month when her husband left her after she was diagnosed,” says executive director Pari Forood. “She contacted us and we paid basic living expenses. Medical gap care helps people with a fundamental need and they are eternally grateful. When they get back on their feet, they usually volunteer for us.”

“The American Cancer Society, Komen and the other national organizations are mostly about funding research, which is great, but we want to help people cope and get through their treatment as quickly and harmless,” says Forood.

Sources of immediate aid are limited. “There are organizations that have a 10-page application and you find out in six to eight months if you’ve been helped,” says Erica Harvey, executive director of The Breast Cancer Charities of America. “Those are great, but ours is called Help Now Fund … we help, now. There’s a 10-day open application period, and within five business days after it’s closed, the patient and their social worker will be personally contacted regarding if they were funded.”

The organization provides counseling and emergency financial assistance in conjunction with cancer treatment centers nationwide. “Our commitment is adequate food, clothing and shelter for every woman going through breast cancer,” says Harvey.

Active breast cancer patients living anywhere in the U.S. may seek financial help from the Patient Advocate Foundation, which helps with co-pays for prescriptions and/or pharmaceutical treatments, and CancerCare’s Linking A.R.M.S. program, which gives financial assistance for treatment-related expenses including pain and anti-nausea medication. Susan G. Komen for the Cure will provide $2 million to support at least 1,675 breast cancer patients. Many Komen affiliates support local organizations that provide emergency financial support. Check with your local affiliate to find out if they offer such services, advises Mollie Williams, Komen’s managing director of community health programs.

Unusual Models for Charity

Barbara Hensley lost two sisters to breast cancer. In 2001, she left a corporate executive management job to start Hope Chest for Breast Cancer. “We are a very unique model in that we have an ongoing revenue stream from the Hope Chest for Breast Cancer Retail Stores that are indecently owned, for profit businesses,” says Hensley. “The stores’ mantra is: ‘Excellent quality, excellent experience, excellent buys … all for an excellent cause.’”

She describes her vision as “2-50-5-10″: two charity-owned stores, 50 franchised stores in five years, and — once everything is operational — contributing $10 million to provide emergency assistance to breast cancer patients.

If you want to try to raise money on your own to help breast cancer patients, consider GiveForward.com. You can set up your page, then promote it on Facebook, or wherever you choose. Friends, family and followers can donate using a credit or debit card.

Cate Conroy, director of marketing for the site, explains the model: “Often when someone is facing a medical crisis, there are numerous expenses that insurance simply won’t cover, like childcare when a parent is in treatment or travel to and from treatment. It is these kind of out-of-pocket expenses that GiveForward allows beneficiaries to raise money through their personal networks, so there’s no limit to the amount that you can raise every year.”

GiveForward has helped people raise nearly $7 million since 2008.

Assistance for the Uninsured

Those organizations may be able to help a patient deal with the fiscal side effects of cancer, but coping with a lack of health insurance is a whole different ball game.

Ankeny Minoux, president of The Foundation for Health Coverage Education, which helps people without insurance find coverage, says there are four basic options: “Know your state’s public options, programs like Medicaid, CHIP (Children’s Health Insurance Program) or other free or low-cost government-sponsored programs. Look into your state’s High Risk Pool. Research all private options offered by insurers — including both individual and group health plans. Use trusted resources like the American Cancer Society’s, www.cancer.org.”

Minoux highlights a few programs: Breast and Cervical Cancer Treatment Program (California, Massachusetts, Texas), Women’s Wellness Connection (Colorado), Breast and Cervical Cancer Early Detection Program (Connecticut, Indiana, New Mexico, Virginia, Wyoming), Screening for Life (Delaware), Breast and Cervical Cancer Prevention (Florida, Louisiana, Mississippi, Montana), Georgia Cancer Screening Program, Breast and Cervical Cancer Program (Hawaii, Illinois, Oregon), Women’s Health Check (Idaho), Healthy Women (Illinois, Pennsylvania), Early Detection Works (Kansas), Kentucky Women’s Cancer Screening Program, Maine Breast and Cervical Health Program, Breast Cancer Screening Program & the Breast and Cervical Diagnosis and Treatment Program (Maryland), Breast and Cervical Cancer Control Program (Michigan), Sage Screening Program (Minnesota), Show Me Healthy Women (Missouri), Every Woman Matters Program (Nebraska), Women’s Health Connection (Nevada), Let No Woman Be Overlooked Program (New Hampshire), Cancer Education and Early Detection (New Jersey), Medicaid Cancer Treatment Program (New York), Women’s Way (North Dakota), Breast and Cervical Cancer Protection Program (Ohio), Woman’s Cancer Screening (Rhode Island), Best Chance Network (South Carolina), All Women Count (South Dakota), Breast and Cervical Cancer Screening Program (Tennessee, West Virginia), Utah Cancer Control, Ladies First (Vermont), Washington Breast and Cervical Cancer Program, Project Wish (Washington D.C.), and Well Women Program (Wisconsin).

“The most important mistake to avoid is giving up and thinking there are no options,” says Minoux.

Funding needs are huge, yet the organizations themselves are working to stay healthy at a time when donations are generally down. “We’ve seen a drastic hit, says Harvey. “People are saving rather than helping others. We do all that we can do — keep an extremely low overhead, pass on 80 cents of every dollar raised to our program services — but still the funds are down, which means we can’t help as many women as we’d like with basic things like keeping a roof over their heads, or water running in their homes. There’s nothing worse than the stories that we hear about single moms having to pick between keeping a roof over the heads of [their] children, or going to a doctor’s appointment.”

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Marci found a lump in her breast in April of last year. She went to the doctor the next day.

“The first doctor I saw told me that it was not life threatening, probably a cyst, and that I am too young to worry. I was 33 at the time,” recalls Marci. But when she went for her annual gynecologist visit in late May, that doctor examined her breast and sent her for an ultrasound and mammogram. Those lead to a biopsy of the lump and lymph nodes, both of which came back positive. In June, she was diagnosed with Stage 3 breast cancer.

Marci had worked in the finance industry for 15 years. “I ‘thought’ I had insurance which was provided by my company,” she says. However, after her biopsy, she realized her insurance had a cap of $10,000 a year. “Who reads the small print on that sort of stuff in an 18-page addendum?” asks Marci. “Before I had my first treatment, I was over the maximum benefit.”

She went uninsured for two months until she got coverage through the Ohio High Risk Pool.

“Thank God for some health care reform. In those two months, I paid $8,000 out of pocket and about $3,000 so far this year. I pay monthly on a $20,000 bill through my treatment center,” says Marci, who lives in Columbus, Ohio.

The financial toll has been huge. “I had to sell my pride and joy — a beautiful red corvette. I was able to use some of the cost as a tax deduction last year, but that doesn’t come close to helping very much. For someone who is single, with no children, you don’t get many write-offs. I was told I did not qualify for most financial aid — because I was employed,” says Marci.

“I am thankful for my life and in the grand scheme of things, I feel I’m worth the money,” she says. “But going through this experience — I feel bitter that folks living on the system, with no job, are entitled to better health care benefits than I have. Because I am in the financial industry, I feel I would be a hypocrite to turn my back on my financial obligations.”

The High Cost of Breast Cancer

According to the American Cancer Society, breast cancer is the second most common cancer among American women after skin cancers: A woman in the U.S. has about a 12% chance of developing invasive breast cancer at some time in her life. The American Cancer Society estimates that 230,480 new cases of invasive breast cancer will be diagnosed in women in the U.S. this year, and nearly 40,000 women will die from the disease. It’s the second leading cause of cancer deaths in women, exceeded only by lung cancer. According to the National Cancer Institute, cancer care cost the American public $104.1 billion in 2006, and the largest chunk of that was for breast cancer — $13.9 billion.

While these women are waging a fight for their lives, they often must battle on a second front as they deal with multiple threats to their finances. Jenny Saldana says she had a great corporate job at Procter & Gamble, but was forced to go on short-term disability due to breast cancer. “I was able to make my road to recovery my full-time job, but I earned 40% less, with 100% of the same bills.” She says she was scammed by a debt consolidation company, which cost her both money and a potential job at Bergdorf Goodman (she says the consolidation company ruined her credit). Then she had to file for bankruptcy. Five years later, she says, “I’m still broke, but have gone back to my passion of acting and writing.”

Ellen Baker estimates that her treatments for breast cancer, including chemotherapy, mastectomy and reconstructive surgery cost about $100,000, and her share after insurance was about $20,000. In addition, she shelled out $200 a week for “complimentary things, like acupuncture, hypnosis and Reiki, energy healing,” which helped get her through the ordeal.

But what really proved costly was what she called the collateral damage of breast cancer — divorce. “My husband of 22 years left after my last surgery,” says Baker, whose two daughters were teenagers at the time. “I wasn’t working and suddenly my husband’s $300,000 salary was gone. I faced foreclosure on our home and had cars repossessed. It’s because I contacted my senator, governor and others that I was able to save the house,” says Baker.

Five years later, she has not recovered financially. “I’m uninsurable now, and I have until July of next year to use COBRA from my husband’s company. COBRA cost me $1,000 a month, so along with my out-of-pocket expenses, health care costs me about $23,000 a year,” says Baker who sees an oncologist every three months.

Baker, an executive coach, still needs two more surgeries to complete the breast reconstruction process, but because doctors want $12,000 to $20,000 up front — which she would have to pay, then wait to get reimbursed from the insurance company — she continues to postpone them. She remains positive though. “What doesn’t kill you makes you stronger,” she says. “Every day is a gift. I’m starting my life over at 59.”

Know What Your Insurance Covers

C.J. just finished seven straight weeks of radiation. “I am waiting for the boom to fall and a giant bill to appear,” says C.J., who says her co-pay on an MRI is $250 each time. “I felt like I got mugged with the co-pay the day of surgery — $450. I call it breast cancer Mardi Gras — every time I flash the rack, I don’t get beads per se, but I do get co-pays.”

One of her prescriptions was for Biafine, a cream that helps heal seriously damaged skin. Her insurance company refused to cover it. “They said I didn’t ‘need’ it. My skin blistered and peeled away, so yes, I needed it. It was $100-plus for for each tube.”

Baker says her insurance company wouldn’t pay for the anesthesia when she had her mastectomy. “I fought them for nine months before they paid.”

Similarly, Heather St. Aubin-Stout, says her insurance company refused to pay for her MRI last year, which was how she found that her cancer had recurred. “I’ve been making payments on that bill for the last six months and I’m only halfway through,” she says. “Financially, we are struggling.”

With experiences like these all too common, it’s important to know what’s in your insurance policy — what’s covered, what’s not — and get an estimate about the price tag for your out-of-pocket expenses. “Experimental treatments are not covered,” explains Dr. Daniel Fass, a radiation oncologist and professor at Cornell Medical School. “For example, 10 years ago there was some use of bone marrow transplants for breast cancer. Insurance carriers considered this experimental and did not cover it. This treatment was eventually deemed ineffective and is no longer used. Also, patients participating in a clinical trial are not covered by insurance. Patients need to determine their coverage before proceeding with treatment.”

How to Reduce Expenses

Even with insurance, there can still be a huge hole in what you need to cover your expenses. Just as women successfully battle breast cancer, they can also claim some measure of victory by reducing their out-of-pocket expenses.

Rose Greene, a certified financial planner and president of Rose Greene Financial Services, is a breast cancer survivor. She says “Consider an HMO. They are not what they were decades ago. They have evolved. Co-pays and premiums are significantly lower with HMOs.”

View Poll

Greene compares HMO and PPO (Preferred Provider Organization) tax deductions, “PPOs have much larger out-of-pocket expenses than HMOs. Out-of-pocket medical expenses are tax deductible only if they exceed 7.5% of a person’s adjustable gross income, and that threshold is hard to meet. Even with chemotherapy, exams and other treatment, high-income earners are rarely able to take advantage of tax deductions if they use a PPO.”

For example, a family with an AGI of $100,000 and $10,000 in out-of-pocket expenses would only be able to deduct $2,500, explains Rob Seltzer, a certified public accountant and personal finance specialist. The poor and elderly are more likely to exceed the 7.5% threshold, he says.

What kind of expenses are likely to get you a deduction and which won’t? “Generally, things that are medically necessary, say breast construction,” says Seltzer. But something cosmetic like breast implants would not be.”

If you want to contend that complimentary services like acupuncture or meditation, for example, are necessary for your healing and recovery, be sure to get backup — a letter from your doctor saying that he or she recommends them for your recovery. “That way if you claim it on your taxes and you get audited, you have something to hang your hat on,” says Seltzer.

Make a Case For Your Unique Needs

“My wife has cancer in one breast,” says Michael Kalscheur, senior financial consultant with Castle Wealth Advisors. “Our health coverage company will pay for everything for this cancer, but does not routinely cover preemptive surgery on the other side. ‘Routinely’ is the key phrase. We have already started to build the case that she must have surgery on both sides and that this is the best thing long-term. Otherwise, paying for it out-of-pocket would cost tens of thousands of dollars.”

How you manage your health care experience absolutely determines the quality of care you get, says Greene. “In a support group I was in, I saw that a lack of being proactive and frustration with HMOs led one woman to her death, while another woman loved her HMO because she made it her mission to take control of her medical care. She got as good of care, or arguably better care, than someone with a PPO.”

Medical debt one of the leading causes of personal bankruptcy. “Ask for a payment plan,” says Baker. ” There is usually no interest and it is a lot better than charging your medical bills on your credit card.”

Get Family and Friends Involved

Don’t just rely on family and friends for emotional support — get them on board to help you navigate the claims process. “It’s overwhelming. They will try any way they can to keep from paying you. You will have to fight,” says Baker.

Enlist them too, to help research doctors, treatment centers, etc. Good information can save you money. “Don’t be complacent about shopping and comparing medical costs,” says Jorie Johnson, a certified financial planner with Financial Futures. “I called three local radiology centers to compare prices and age of equipment. It took each center anywhere from 15 minutes to 3 hours to give me a quote for a simple mammogram and the quotes ranged from $750 to $1400! In addition, the center using the most up-to-date scanning machine was the least expensive price.”

Explore All Options

Find out whether your state offers a high-risk insurance pool. It may not be cheap, but at least you can get coverage. Baker says in her state, coverage is $500 monthly with a $5,000 a year deductible or $1,000 a month and a $1,000 a year deductible.

Ask your doctor about whether you can take generics, and if there are natural, less expensive herbs and supplements that might work instead of more expensive medicines.

“Talk to the drug companies if the drugs are too expensive,” recommends Kalscheur. “Due to our income and family size — we have 8 children — we were qualified for free or reduced cost drugs from two separate companies: Merck (MRK) and Genentech (RHHBY). This saved us thousands of dollars.”

Baker also advises getting long-term disability coverage while you’re healthy. “Don’t wait until you are diagnosed. Having disability issuance can make the difference between financial ruin and not.”

Keep cost-cutting in perspective, however. You don’t want to deny yourself what is best for your recovery and healing, says Faina Sechzer, a cancer recovery coach and CEO of Health Recovery Strategies. For example, do get a second or even a third medical opinion, and don’t skip important tests just because they might not be covered by insurance. When it comes to alternative, complementary care, she says don’t pass up yoga, massage or mediation because of the price. And she advises against buying cheap, unattractive wigs.

Be Proactive

“When I had breast cancer three years ago, I was looking for a plastic surgeon to do reconstruction,” says Patricia Buchanan. “I was horrified to find that in my area of New Jersey, there were basically no breast reconstruction experts who were in-network for my health plan [Blue Cross, Blue Shield]. I went to see a fancy plastic surgeon in Morristown, and after evaluating me, his finance woman said the most they’d charge me would be $5,000, outside of what my insurer gave them.”

“I was literally having a meltdown — how much is a new boob, seriously? I didn’t think I should have to pay a penny beyond my co-pays. This was no voluntary boob job, after all. Mine had been cut off to save my life. All I really wanted was to replace the one I’d lost. Luckily, a friend suggested I go in to Sloan Kettering, which is in-network for BCBS. You have to be adamant about not letting a breast cancer crisis ruin you financially.”

This is the first in a two-part story on breast cancer and finances. The next article will examine where breast cancer patients can go for financial assistance

Permalink | Email this | Comments

Marci found a lump in her breast in April of last year. She went to the doctor the next day.

“The first doctor I saw told me that it was not life threatening, probably a cyst, and that I am too young to worry. I was 33 at the time,” recalls Marci. But when she went for her annual gynecologist visit in late May, that doctor examined her breast and sent her for an ultrasound and mammogram. Those lead to a biopsy of the lump and lymph nodes, both of which came back positive. In June, she was diagnosed with Stage 3 breast cancer.

Marci had worked in the finance industry for 15 years. “I ‘thought’ I had insurance which was provided by my company,” she says. However, after her biopsy, she realized her insurance had a cap of $10,000 a year. “Who reads the small print on that sort of stuff in an 18-page addendum?” asks Marci. “Before I had my first treatment, I was over the maximum benefit.”

She went uninsured for two months until she got coverage through the Ohio High Risk Pool.

“Thank God for some health care reform. In those two months, I paid $8,000 out of pocket and about $3,000 so far this year. I pay monthly on a $20,000 bill through my treatment center,” says Marci, who lives in Columbus, Ohio.

The financial toll has been huge. “I had to sell my pride and joy — a beautiful red corvette. I was able to use some of the cost as a tax deduction last year, but that doesn’t come close to helping very much. For someone who is single, with no children, you don’t get many write-offs. I was told I did not qualify for most financial aid — because I was employed,” says Marci.

“I am thankful for my life and in the grand scheme of things, I feel I’m worth the money,” she says. “But going through this experience — I feel bitter that folks living on the system, with no job, are entitled to better health care benefits than I have. Because I am in the financial industry, I feel I would be a hypocrite to turn my back on my financial obligations.”

The High Cost of Breast Cancer

According to the American Cancer Society, breast cancer is the second most common cancer among American women after skin cancers: A woman in the U.S. has about a 12% chance of developing invasive breast cancer at some time in her life. The American Cancer Society estimates that 230,480 new cases of invasive breast cancer will be diagnosed in women in the U.S. this year, and nearly 40,000 women will die from the disease. It’s the second leading cause of cancer deaths in women, exceeded only by lung cancer. According to the National Cancer Institute, cancer care cost the American public $104.1 billion in 2006, and the largest chunk of that was for breast cancer — $13.9 billion.

While these women are waging a fight for their lives, they often must battle on a second front as they deal with multiple threats to their finances. Jenny Saldana says she had a great corporate job at Procter & Gamble, but was forced to go on short-term disability due to breast cancer. “I was able to make my road to recovery my full-time job, but I earned 40% less, with 100% of the same bills.” She says she was scammed by a debt consolidation company, which cost her both money and a potential job at Bergdorf Goodman (she says the consolidation company ruined her credit). Then she had to file for bankruptcy. Five years later, she says, “I’m still broke, but have gone back to my passion of acting and writing.”

Ellen Baker estimates that her treatments for breast cancer, including chemotherapy, mastectomy and reconstructive surgery cost about $100,000, and her share after insurance was about $20,000. In addition, she shelled out $200 a week for “complimentary things, like acupuncture, hypnosis and Reiki, energy healing,” which helped get her through the ordeal.

But what really proved costly was what she called the collateral damage of breast cancer — divorce. “My husband of 22 years left after my last surgery,” says Baker, whose two daughters were teenagers at the time. “I wasn’t working and suddenly my husband’s $300,000 salary was gone. I faced foreclosure on our home and had cars repossessed. It’s because I contacted my senator, governor and others that I was able to save the house,” says Baker.

Five years later, she has not recovered financially. “I’m uninsurable now, and I have until July of next year to use COBRA from my husband’s company. COBRA cost me $1,000 a month, so along with my out-of-pocket expenses, health care costs me about $23,000 a year,” says Baker who sees an oncologist every three months.

Baker, an executive coach, still needs two more surgeries to complete the breast reconstruction process, but because doctors want $12,000 to $20,000 up front — which she would have to pay, then wait to get reimbursed from the insurance company — she continues to postpone them. She remains positive though. “What doesn’t kill you makes you stronger,” she says. “Every day is a gift. I’m starting my life over at 59.”

Know What Your Insurance Covers

C.J. just finished seven straight weeks of radiation. “I am waiting for the boom to fall and a giant bill to appear,” says C.J., who says her co-pay on an MRI is $250 each time. “I felt like I got mugged with the co-pay the day of surgery — $450. I call it breast cancer Mardi Gras — every time I flash the rack, I don’t get beads per se, but I do get co-pays.”

One of her prescriptions was for Biafine, a cream that helps heal seriously damaged skin. Her insurance company refused to cover it. “They said I didn’t ‘need’ it. My skin blistered and peeled away, so yes, I needed it. It was $100-plus for for each tube.”

Baker says her insurance company wouldn’t pay for the anesthesia when she had her mastectomy. “I fought them for nine months before they paid.”

Similarly, Heather St. Aubin-Stout, says her insurance company refused to pay for her MRI last year, which was how she found that her cancer had recurred. “I’ve been making payments on that bill for the last six months and I’m only halfway through,” she says. “Financially, we are struggling.”

With experiences like these all too common, it’s important to know what’s in your insurance policy — what’s covered, what’s not — and get an estimate about the price tag for your out-of-pocket expenses. “Experimental treatments are not covered,” explains Dr. Daniel Fass, a radiation oncologist and professor at Cornell Medical School. “For example, 10 years ago there was some use of bone marrow transplants for breast cancer. Insurance carriers considered this experimental and did not cover it. This treatment was eventually deemed ineffective and is no longer used. Also, patients participating in a clinical trial are not covered by insurance. Patients need to determine their coverage before proceeding with treatment.”

How to Reduce Expenses

Even with insurance, there can still be a huge hole in what you need to cover your expenses. Just as women successfully battle breast cancer, they can also claim some measure of victory by reducing their out-of-pocket expenses.

Rose Greene, a certified financial planner and president of Rose Greene Financial Services, is a breast cancer survivor. She says “Consider an HMO. They are not what they were decades ago. They have evolved. Co-pays and premiums are significantly lower with HMOs.”

View Poll

Greene compares HMO and PPO (Preferred Provider Organization) tax deductions, “PPOs have much larger out-of-pocket expenses than HMOs. Out-of-pocket medical expenses are tax deductible only if they exceed 7.5% of a person’s adjustable gross income, and that threshold is hard to meet. Even with chemotherapy, exams and other treatment, high-income earners are rarely able to take advantage of tax deductions if they use a PPO.”

For example, a family with an AGI of $100,000 and $10,000 in out-of-pocket expenses would only be able to deduct $2,500, explains Rob Seltzer, a certified public accountant and personal finance specialist. The poor and elderly are more likely to exceed the 7.5% threshold, he says.

What kind of expenses are likely to get you a deduction and which won’t? “Generally, things that are medically necessary, say breast construction,” says Seltzer. But something cosmetic like breast implants would not be.”

If you want to contend that complimentary services like acupuncture or meditation, for example, are necessary for your healing and recovery, be sure to get backup — a letter from your doctor saying that he or she recommends them for your recovery. “That way if you claim it on your taxes and you get audited, you have something to hang your hat on,” says Seltzer.

Make a Case For Your Unique Needs

“My wife has cancer in one breast,” says Michael Kalscheur, senior financial consultant with Castle Wealth Advisors. “Our health coverage company will pay for everything for this cancer, but does not routinely cover preemptive surgery on the other side. ‘Routinely’ is the key phrase. We have already started to build the case that she must have surgery on both sides and that this is the best thing long-term. Otherwise, paying for it out-of-pocket would cost tens of thousands of dollars.”

How you manage your health care experience absolutely determines the quality of care you get, says Greene. “In a support group I was in, I saw that a lack of being proactive and frustration with HMOs led one woman to her death, while another woman loved her HMO because she made it her mission to take control of her medical care. She got as good of care, or arguably better care, than someone with a PPO.”

Medical debt one of the leading causes of personal bankruptcy. “Ask for a payment plan,” says Baker. ” There is usually no interest and it is a lot better than charging your medical bills on your credit card.”

Get Family and Friends Involved

Don’t just rely on family and friends for emotional support — get them on board to help you navigate the claims process. “It’s overwhelming. They will try any way they can to keep from paying you. You will have to fight,” says Baker.

Enlist them too, to help research doctors, treatment centers, etc. Good information can save you money. “Don’t be complacent about shopping and comparing medical costs,” says Jorie Johnson, a certified financial planner with Financial Futures. “I called three local radiology centers to compare prices and age of equipment. It took each center anywhere from 15 minutes to 3 hours to give me a quote for a simple mammogram and the quotes ranged from $750 to $1400! In addition, the center using the most up-to-date scanning machine was the least expensive price.”

Explore All Options

Find out whether your state offers a high-risk insurance pool. It may not be cheap, but at least you can get coverage. Baker says in her state, coverage is $500 monthly with a $5,000 a year deductible or $1,000 a month and a $1,000 a year deductible.

Ask your doctor about whether you can take generics, and if there are natural, less expensive herbs and supplements that might work instead of more expensive medicines.

“Talk to the drug companies if the drugs are too expensive,” recommends Kalscheur. “Due to our income and family size — we have 8 children — we were qualified for free or reduced cost drugs from two separate companies: Merck (MRK) and Genentech (RHHBY). This saved us thousands of dollars.”

Baker also advises getting long-term disability coverage while you’re healthy. “Don’t wait until you are diagnosed. Having disability issuance can make the difference between financial ruin and not.”

Keep cost-cutting in perspective, however. You don’t want to deny yourself what is best for your recovery and healing, says Faina Sechzer, a cancer recovery coach and CEO of Health Recovery Strategies. For example, do get a second or even a third medical opinion, and don’t skip important tests just because they might not be covered by insurance. When it comes to alternative, complementary care, she says don’t pass up yoga, massage or mediation because of the price. And she advises against buying cheap, unattractive wigs.

Be Proactive

“When I had breast cancer three years ago, I was looking for a plastic surgeon to do reconstruction,” says Patricia Buchanan. “I was horrified to find that in my area of New Jersey, there were basically no breast reconstruction experts who were in-network for my health plan [Blue Cross, Blue Shield]. I went to see a fancy plastic surgeon in Morristown, and after evaluating me, his finance woman said the most they’d charge me would be $5,000, outside of what my insurer gave them.”

“I was literally having a meltdown — how much is a new boob, seriously? I didn’t think I should have to pay a penny beyond my co-pays. This was no voluntary boob job, after all. Mine had been cut off to save my life. All I really wanted was to replace the one I’d lost. Luckily, a friend suggested I go in to Sloan Kettering, which is in-network for BCBS. You have to be adamant about not letting a breast cancer crisis ruin you financially.”

This is the first in a two-part story on breast cancer and finances. The next article will examine where breast cancer patients can go for financial assistance

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FedEx Corp. (FDX) cut its earnings expectations for the fiscal year ending in May due to slowing global economic growth.

The outlook from the world’s second biggest package delivery company may add to growing investor concern about the strength of the worldwide economy. It comes a day after the Federal Reserve gave a gloomy forecast for the U.S. economy.

The Memphis, Tenn. company said Thursday it now expects to earn between $6.25 and $6.75 per share for fiscal 2012, compared with a previous estimate of $6.35 to $6.85 per share. FactSet says analysts expect $6.39 per share.

For the fiscal first quarter that ended in August, FedEx Corp. says an increase in deliveries by truck offset a drop-off in shipments by air. Net income rose 22 percent to $464 million or $1.46 per share in the three-month period, compared with $380, or $1.20 per share, a year earlier.

Revenue rose 11 percent to $10.52 billion.

Analysts expected a profit of $1.46 per share on revenue of $10.32 billion.

Express shipments slowed most notably from Asia, where growth had been robust. FedEx said the slowdown in that segment outpaced its ability to cut costs, which it said it’s doing aggressively to balance demand. As a result, Express unit operating income fell 19 percent, even as revenue rose 12 percent. Average daily express volume in the U.S. fell 3 percent. But revenue per package rose 13 percent as packages weighed more on average and FedEx tacked on higher fuel surcharges.

Operating income in FedEx’s ground segment leaped 42 percent to $407 million. Revenue rose 16 percent to $2.28 billion. Average daily package volume grew 5 percent driven by an increase in shipments between businesses and FedEx home delivery service.

FedEx’s freight segment, which hauls heavier shipments like refrigerators and car parts, posted an operating profit of $42 million compared with a loss of $16 million a year earlier. Revenue rose 6 percent.

When consumers and businesses are concerned about the strength of the economy, they tend to choose slower shipping options – like switching from overnight express service to slower ground shipping – to save money. It’s the same move many made during the recession.

FedEx’s larger rival United Parcel Service Inc. said last week that although it acknowledges that global growth is slowing, it’s not forecasting another recession.

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Betty White’s endorsement can be a powerful boon for business. The former “Golden Girl” was recently named America’s most trusted celebrity. That’s good news for William Page and Associates: They’ve got White starring in a music video promoting “life settlements.”

The irony here is that White, 89, is probably as unfamiliar with the downside of life settlements as most senior citizens are when they get pitched these products. And while life settlements, also known as “viaticals,” are presented as win-win propositions, they can be anything but for the seniors who buy into them.

Viaticals 101

Here’s how viaticals work. Companies buy various people’s existing insurance policies, then sell them to other people. (Viaticals involve policies of people expected to die within a few years, while life settlements involve policies of those who are simply of a certain age, such as 60 or older.)

Here’s a simplified example that will make the concept clear: Imagine that Bob is very sick and isn’t expected to live for more than about two more years. He’s running low on funds, and has a life insurance policy that will pay off when he dies. Meanwhile, Jane is interested in investing some money effectively. She’s presented with the opportunity to essentially invest in Bob’s policy. If it’s set to pay $100,000 on his death, Jane might pay $75,000 for it. That way, Bob gets a lot of cash now, and Jane expects to get the $100,000 in about two years. At that rate, she’d be earning a solid return.

That arrangement seems great at first: Bob gets much-needed funds, and Jane gets a compelling investment.

And then the risks appear…

For starters, what if advancements in medicine help Bob live 10 more years, not two? Jane’s ultimate return on her investment will drop significantly — especially if she’s on the hook for making his premium payments. After all, it’s not inconceivable that Bob will end up outliving Jane.

And there’s bad news for Bob, too. If he ends up beating his disease, he’ll be living without the life insurance that he might have wanted and needed — and it’s very possible that his health history will prevent him from getting a new policy.

Life settlements that don’t involve terminally ill people can present similar risks. Some 65-year olds will live another 10 years, while others may hang on for 30 more. All of these arrangements may have tax implications, and depending on where you live, many of them may not be highly regulated.

Now, in reality, investors like Jane don’t buy policies directly from policyholders like Bob. But there is plenty of money to be made by middlemen, ranging from public companies such as Life Partners Holdings (LPHI) and Imperial Holdings (IFT) to smaller privately held ones. Even big banks such as Goldman Sachs (GS) and Credit Suisse (CS) have looked into entering the business, helping pension funds make life insurance-linked investments.

Middlemen often take a cut of each deal. The folks at the Lifeline Program, for example, are eager not only to sell investors on the concept, but also to buy life insurance policies. Signing up Betty White helps the company attract the attention of the many Baby Boomers who love her.

Drawing Attention

There have been lots of consumer complaints about these settlements over the years, prompting government entities to start taking a harder look at them.

Life Partners in particular now faces a Securities and Exchange Commission investigation for allegedly underestimating the life expectancies on its policies, and therefore suggesting that investors will earn more than they actually will. A Wall Street Journal investigation found that in 90% of its policies, people outlived Life Partners’ projections.

The North American Securities Administrators Association maintains a list of investments that “threaten” investors. As it noted, “Legitimate investments in life settlement contracts involve a high degree of risk, and investors may be responsible for routinely paying costly premiums for policies that insure people who outlive their life expectancies.” Fraudsters and scammers offer plenty of not-so-legitimate investments as well. Tread carefully.

I can imagine why Ms. White, 89, might have agreed to the deal. She’s well known as an animal lover and animal-rights advocate, and it seems that a portion of proceeds from the sale of the video will go to the Los Angeles Zoo. (She apparently didn’t know much about life settlements before being approached by William Page’s Lifeline Program.)

While her intentions may be pure, and while viaticals may make sense for some people, for most of us — probably including Betty White — there are better ways to raise or invest money.

Learn more about life settlements, their dangers, and how to be smart about them:

• The Federal Trade Commission
• The Securities and Exchange Commission
• Viatical and Life Settlements Consumer Info

Longtime Motley Fool contributor Selena Maranjian holds no position in any company mentioned. Click here to see her holdings and a short bio.

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Last week, Dallas County in Texas joined the growing ranks of employers that charge employees who smoke a higher monthly health insurance premium than employees who don’t light up. Beginning Jan. 1, smokers employed by the county will pay an additional $50 per month per person for not only the employee, but also any family member who smokes and is covered by the county’s health insurance plan. The county estimates that this “non-smokers’ discount” will reduce its medical costs by $500,000 as early as next year.

The idea of increasing insurance premiums on smokers has been around since the 1980s, when the National Association of Insurance Commissioners, the standard-setting organization representing the chief insurance regulators from the 50 states, calculated that roughly 60% to 80% of all of the health care expenses incurred in the United States were attributable to things that people could potentially control, such as failing to wear a seat belt, engaging in unsafe sex, ingesting drugs or alcohol, driving drunk, overeating or under-exercising, and smoking. Given that only some portion of the population was involved in these activities, but that everyone was essentially picking up the tab for the associated medical care, the NAIC wondered if it made sense to require people who made less healthy choices to pay more than those who didn’t.

To support this idea, researchers considered the standards around life insurance. By the 1980s, smokers were already paying more for life insurance than their nonsmoking counterparts. Why not apply that to health insurance, so long as the increased rates were only employed under appropriate conditions?

Roughly 20% of Americans smoke. “If you look at the number of people who are smokers,” argues John Banzhaf, a professor of public interest law at George Washington University Law School and also the retired founder of the nonprofit antismoking organization Action on Smoking and Health, “versus the great majority who aren’t, it’s much fairer to put the costs on the backs of those who cause them rather than on the backs of the great majority who don’t smoke.”

The Price We All Pay

The Centers for Disease Control and Prevention estimate that smoking costs the U.S. nearly $200 million annually, and that an employee who smokes costs the employer 18% more than a nonsmoker. It’s facts like these that Banzhaf and other supporters point to when asserting that a tiered premium structure is a reasonable way to hold Americans accountable for their actions.

According to ASH, “Such a smoker surcharge would be consistent with President Obama’s recent remarks [that] ‘we’ve got to have the American people doing something about their own [health] care.’ It would also put into practice the policy of HHS Secretary Kathleen Sebelius, [that] ‘personal responsibility extends to lifestyle; that in order to have a healthier America, a more productive America, we need to make some basic changes.’ … If adults should have the choice

But for every supporter, there is a detractor. “Right now, there is not enough evidence to support increasing the cost of health insurance, in terms of its impact on smokers quitting,” says Dr. Kurt M. Ribisl, associate professor at the UNC Gillings School of Global Public Health. “I am concerned when cities and states pursue untested and punitive approaches when they have not yet done what we already know is effective like raising cigarette taxes, and banning smoking in all workplaces, restaurants and bars.”

Ribisl is also concerned that “raising the cost of health insurance may get some smokers to quit, but it may backfire by making health insurance more costly and less available. This can push smokers out of the health care system when they need easy access to quit-smoking medications and doctors who will tell them to quit.”

Tiered Premiums Feel Fair … If You Don’t Smoke

Despite these concerns, the Obama administration has included the tiered health care premiums in its new health care legislation, allowing employers to raise smokers’ health care costs by over 100%. Supporters like Banzhaf argue that the increased fees could not only motivate smokers to quit, but will also generate revenue for the federal government without plunging into the onerous challenge of raising taxes.

Which sounds great. But to Ribisl’s point, there are other strategies known to work while this one remains unproven. We need data to confirm that such a rate increase would affect change.

The other complicating factor here remains the question of the degree to which smoking is a behavior individuals can control. On the surface, it looks like one: We aren’t born smoking. Rather, people opt to pick up that first cigarette. And this is the argument behind the tiered premiums. If you choose to engage in this behavior, you should take financial responsibility for it. In a similar way, the premiums on car insurance, and fire insurance on our homes, vary depending on whether or not we chose to take certain precautions.

But smoking is addictive, which is why so many who people try to quit fail. That very addictiveness muddies the waters around the idea that it’s reasonable to penalize people for the behavior — for actions they may no longer be able to effectively control. For similar reasons, many Americans are uncomfortable with the idea of applying a tiered insurance premium system based on weight. We recognize that obesity isn’t just about eating less, but also about a person’s metabolism and genes, areas over which we don’t have much control.

I believe strongly in personal responsibility, but I also know that not everyone has the same intrinsic ability to overcome an addictive habit. It’s not simply about willpower. It may also be about the person’s physical response. Either way, I know this: I don’t smoke. And I wish others wouldn’t — for my sake, but also for theirs.

Loren Berlin is a reporter with the AOL Huffington Post Media Group. She can be reached at loren.berlin@teamaol.com, on Twitter at @LorenBerlin, and on Facebook.

Gallery: What a Smoker’s Budget Could Purchase

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The numbers aren’t too pretty. Underinsured adults — those with health insurance all year and very high medical expenses relative to their incomes, rose by 80% between 2003-2010, from 16 million to 29 million. Nearly half of U.S. adults, 81 million people, were either underinsured or uninsured in 2010, up from 75 million in 2007 and 61 million in 2003.

The staggering stats come from the study, Affordable Care Act Reforms Could Reduce the Number of Underinsured U.S. Adults by 70 Percent, authored by staff of The Commonwealth Fund, and published in Health Affairs.

The study makes clear that merely having insurance is not enough. Having the right amount and type of coverage matters more. “Underinsured families are at nearly as high risk as the uninsured because, while they have health insurance, holes or limits in their plans expose them to often unaffordable medical costs,” says Mary Mahon, assistant vice president of public information at The Commonwealth Fund.

Other Study Highlights

Low-income families were most at risk of being underinsured. Three-quarters (77%) of those with incomes below 133 percent of the poverty level and more than half (58%) of those with incomes between 133 percent and 250 percent of the poverty level were either underinsured or uninsured.

The risk of being underinsured is rising up the income scale. In 2010, 16 percent of adults with incomes between $40,000 and $60,000 were underinsured and another 19 percent were uninsured. In 2003, only 5 percent of adults with incomes in this range were underinsured.

Rates of forgone care (e.g., not filling a prescription or not following up on recommended tests or treatment) were twice as high among the underinsured and three times as high among the uninsured as rates reported by adults with more adequate insurance.

View Poll

The good news, says Mahon, is that the study finds that in addition to covering the uninsured, Affordable Care Act (ACA) reforms will also provide significant relief for those who are underinsured, potentially reducing their numbers by as much as 70% once the law is fully implemented. Affordable Care Act reforms like premium assistance and reduced cost-sharing for lower and modest income families will provide significant support to those most likely to be underinsured-people with incomes below 250% of the federal poverty level, or $56,000 a year for a family of four, says Mahon. Seven out of 10 of the underinsured, and a similar share of those uninsured during the year, had incomes this low in the study.

However, she cautions, “To reduce the number of underinsured, it will be critical for the plans offered under the Affordable Care Act reforms to keep deductibles and out-of-pocket costs low for essential, effective health care.”

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There’s something about life insurance that just freaks some people out. For one thing, it forces them to confront the notion of dying. For another, it demands they think about tomorrow when they don’t know what to do about today. So instead, they stick their heads in the sand.

It’s not surprising then, that according to the Life and Health Insurance Foundation for Education (LIFE), 40% of adults in the U.S. have no life insurance.

“People procrastinate,” says Georgette Geller, divisional executive vice president at Axa Advisers. “They are in denial about thinking about their future. Death is not on their minds, buying life insurance doesn’t give them an immediate tangible return and most people are undereducated about the topic.”

Lack of knowledge fuels myths that take on a life of their own. September is life insurance awareness month, so let’s sort the fact from the fiction. Here are an even dozen myths and truths about life insurance.

IN PHOTOS: Dispelling the Top 12 Myths About Life Insurance

Myth No. 1: I don’t need a separate life insurance policy. It’s taken care of through my job.

Truth: Having a life insurance policy through work is a great benefit, but it’s also temporary coverage. If and when you leave that company, the coverage will end. So it makes sense to explore a life insurance policy that will stay with you no matter where you work, says Greg Blake, executive director of life insurance product management at USAA.

An employer-paid policy typically offers a coverage amount equal to one’s annual salary or a modest flat amount, says Butch Britton, CEO of ING U.S. Insurance (ING). That may prove insufficient: In addition to medical and funeral bills, your loved ones may need to pay off debts such as a mortgage and provide for other basic financial needs for years to come.

A good rule of thumb is that you might need 10 to 20 times your annual salary, and group benefits just won’t get you there, says Brian Ashe, past chairman of LIFE.

To figure out how much you need check out online calculators like this one.

Myth No. 2: Life insurance is too expensive.

Truth: In a study by LIFE and research and consulting firm LIMRA, 85% of participants said they thought coverage was too expensive. Not so, says Byron Udell, CEO of Accuquote.com, which helps people find affordable term insurance.

“The cost of simple level term insurance has come down by more than 60% in the past 16 years, so the prices today are so low, you can afford all you may ever need,” says Udell.

In fact, a healthy 40-year-old nonsmoker can buy $500,000 dollars of life insurance coverage, with a premium guaranteed not to change for 20 years, for less than $31 a month (about a dollar a day). “So, forego the $5 coffee and other daily luxury purchases to have the funds to budget for the protection of your family’s financial well being,” suggests Udell.

Myth No. 3: People in less than adequate health can’t get life insurance.

Truth: Many life insurance companies are willing to sell policies to people with a range of common medical problems, says Udell.

In fact, some carriers even specialize in high-risk classes. Yes, the coverage will probably be more costly than it would be for someone in perfect health, but companies will work with you in order to accommodate your needs. “The key is to be truthful about your health upfront, says Udell.

Myth No. 4: Term life insurance is always the right fit.

Truth: Term policies, by definition, last for a certain period of time, so if you die after that period and don’t renew your policy, it is not there anymore. The option that give the biggest bang for the buck is a combination of term and universal life, says Pete D’Arruda, founder of Capital Financial Advisory Group.

Term life insurance often gets more expensive as time goes on. Insurance companies make more money with term policies because most people don’t die during the terms they are paying for, says D’Arruda. By contrast, he explains: “Universal life insurance is one investment in life that is guaranteed to pay off, and you always pay the same premium.”

Term is perfect if one needs coverage for ten years or less, or when one has limited cash to dedicate to insurance. For estate planning, business planning or for longer term needs, one should consider cash value life insurance, says Bill Perryman, founder of Perryman Financial Advisory.

Know too, that the accumulated value in permanent life insurance grows tax-deferred. In other words, permanent life insurance protects your family in the event of your death, but it’s much more than that: It’s actually one of the most valuable assets in your financial portfolio, says Michael Ferik, senior vice president of individual life at Guardian Life Insurance, which offers its own take on insurance misconceptions at www.lifeinsurancemyths.com.

Glenn Stevick, assistant professor of insurance at The American College agrees, “Permanent insurance is not a ripoff.”

Term insurance is less expensive than permanent insurance only when considering the out-of-pocket premium payments, says Mike Roscoe, senior vice president of innovation and actuary at The Hartford. For a long-term perspective, certain permanent insurance products can be much less expensive than term.

Myth No. 5: Life insurance is only necessary for those with dependents.

Truth: Even if you’re not married and don’t have children, you should still consider whether you need life insurance. Others may still depend on you, such as parents, and life insurance can cover expenses such as funeral arrangements and potential debts, explains Blake.

Myth No. 6: My lifestyle doesn’t affect my insurance premiums.

Truth: Lifestyle has a direct impact on life insurance premiums. Typically the healthiest individuals see the lowest premiums, but other factors that affect cost include lifestyle choices like smoking, as well as your occupation and hobbies, says Blake.

Myth No. 7: I absolutely must have life insurance.

Truth: While insurance is a good idea for many people, those who have sizable assets and no debt or dependents may be better off self-insuring, says Frank Darras, a lawyer specializing in insurance.

Myth No. 8: At least the cost of my premium will be deductible.

Truth: The cost of personal life insurance is never deductible if you have an employer, says Darras. If the policyholder is self-employed and the coverage is used to insure the business, then the premiums are deductible on Schedule C of the Form 1040.

Myth No. 9: Only the family breadwinner needs life insurance.

Truth: There’s more to consider than a salary when it comes to determining how much insurance each spouse needs. Everything from housekeeping to extra-curricular activities would cost a family extra money if a non-employed parent was longer around to contribute.

“People don’t realize is even if you’re a stay-at-home mom or dad, you contribute to your family with the valuable services that you provide like cooking, cleaning and driving the kids around town. It all adds up! With more than one life insurance policy in place, your family would be protected if something devastating were to happen.”

Just as important is the fact that often, the surviving spouse has a loss of income due after their partner’s death. Parents often take time off work to be with their young children, which could negatively affect their careers. There is a financial cost, even if the deceased did not have any income.

Myth No. 10: I’m young, and not planning on dying any time soon. I can wait to get insurance.

Truth: You never know when your number will come up. When it does, you probably won’t get a telegram warning you in advance, says Udell.

Life insurance, like all insurance, is the type of product you have to buy before you need it. That means the time to purchase life insurance is when you’re young and healthy.

“If you wait, and you develop a serious medical problem, you may not be able to get the coverage you want. Further, even if you stay healthy, the rate for new life insurance is always based on your age … even just one year older means higher rates,” says Udell.

Myth No. 11: Your family can only benefit from your life insurance policy after you die.

Truth: Permanent life insurance policies offer a number of “living benefits,” including the ability to access the policy’s cash value through withdrawals or tax-free loans for other needs, such as funding a child’s education, a hard earned retirement or other lifelong savings need, says Ferik.

Myth No. 12: Once you buy a life insurance policy, you can stop thinking about it.

Truth: “You can’t buy a policy and then just forget about it,” says Dayle Axman, Supervisor of Life and Health, Consumer Affairs, for the Colorado Division of Insurance. “Things change. When you got the policy, maybe you had a young family. Twenty years later, your situation is likely very different. Review your policy periodically.”

Know too, that positive changes in your health can sometimes lower your premiums, and policies with loans and withdrawals should be monitored, points out Ferik.

“Life happens — a new family member, an inheritance, a promotion,” says Ferik, “and you need to make sure your policy still fits.”

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So, let’s assume you did the right thing in getting insurance to protect yourself against those times when Mother Nature comes knocking. Your next challenge may be getting the insurance company to pony up the cash instead of trying to deny your claim.

“Families will have to dig deeper into their pockets, because insurers have been steadily increasing hurricane wind coverage deductibles and imposing other policy limitations,” said J. Robert Hunter, director of insurance for the Consumer Federation of America and former federal insurance administrator and Texas insurance commissioner, in a prepared statement.

“This liability shift to consumers may take some by surprise, since disclosures are often buried in renewal paperwork that consumers may not understand or even read,” he said.

“Because so many consumers experienced claims problems in the wake of Hurricane Katrina, we urge homeowners dealing with losses caused by Hurricane Irene to be vigilant with their insurance companies to ensure that that they receive a full and fair settlement,” said Hunter.

How to Boost Your Odds of Getting Paid

If you want to increase the likelihood that your insurer writes that check, there is much to do.

Don’t dillydally when it comes to reporting your claim: Insurance companies generally handle them first come, first serve, warns Hunter.

Once your claim is reported, get your claim number and write it down. Having that number will make your life — and the insurance company’s — easier.

Find out a little about the adjuster who will come to your house to assess the damage. You want to know if he is an employee of the insurance company or an independent adjuster hired by your insurer. The answer matters: If the person is independent, get the name of the actual insurance company adjuster whom the independent adjuster is sending your information to, and find out whether they are authorized to make claim decisions and payments on behalf of your insurance company.

Beware of firms that demand up-front fees for services, regardless of the outcome they negotiate on your behalf with the insurance company. Public adjusters work purely on a contingency basis, ensuring that a homeowner does not pay anything unless he or she receives some form of settlement, says David Charles, president of Catastrophic Claims Consultants.

Build Your Evidence

Anticipate the possibility of push-back from the insurance company, and be ready to hit them with documentation. When you file a claim, CFA advises immediately starting a notebook detailing all your contacts with the insurance company. List the date, time and a brief description of what went down. If you need to amplify later, this will give you a leg to stand on. If an adjuster says he or she will not come out, for example, write it down. If an adjuster is a jerk, note that too.

You own a ton of stuff. Make a list of it all. Better still if you took photos of your possessions before the storm, but If you didn’t, don’t sweat it. “Those snapshots from a party may offer proof of your TV that was destroyed, or the rug that was ruined,” says Phillip Sanov, an attorney with The Lanier Law Firm.

Do, however, take photographs of the damage before doing any repair work to your home. Also, make an itemized list of all damage sustained during the storm and its aftermath, advises Frank Keaney, who specializes in homeowners insurance with Amity Insurance. Do all you can to minimize secondary damage: Your homeowner’s policy requires that you “mitigate damage,” says Kevin Lynch, an assistant professor of insurance at The American College.

You’ll want to do some homework by getting a repair estimate from a contractor to help you in talking with the adjuster. Hang on to receipts for any emergency repairs, and costs such as if you have to stay in a hotel. This may be reimbursable under the “additional living expense” portion of your homeowners’ policy, says Keaney.

If needed, you can use weather data provided by the Forensic Weather Consultants at www.weatherconsultants.com, a company of forensic meteorologists who can substantiate hurricane based insurance claims.

It should go without saying, but be honest. Claim inflation invites claim denial, says Michael Huber, partner with the law firm of Ver Ploeg & Lumpkin.

Fight Back

Make sure you follow up on your case: Don’t just file the claim, sit back and wait for your payment. Check in regularly with your insurance agent or company on the progress of your claim, says John Egan, managing editor of InsuranceQuotes.com.

If your insurer denies your claim or offers a piddly amount, don’t just accept it. CFA advises demanding that the company identify the language in your homeowners’ policy that served as the basis for denying your claim or offering so little. The company may be right and you may not know it. Once the company pinpoints the key language in the policy, you should be able to make this determination. Then too, it could be that the company has craftily put new limitations into the policy and didn’t make them clear to you. If you feel misled, weigh whether you want to contact an attorney.

For example, says Hunter, the introduction of percentage deductibles (up to 10% of the value of a home), will greatly shift the cost of Hurricane Irene from insurance companies to consumers, as compared to earlier storms. The practice of shifting the cost of previously insured events back to consumers is acceptable, as long as consumers are clearly given the option to select the level of coverage they want with fully informed consent.

Another new way insurers can pull a “gotcha” is by putting a limit on replacement cost payments, which might come into play in the event that a home is totally destroyed. A typical cap is 20% above the face value of the policy. According to CFA, if costs surge because of the spike in demand for materials or labor following a major storm like Hurricane Irene (or if the state does not monitor price gouging sufficiently) this limit might apply. For example, if a home was expected to cost $200,000 to replace and that amount was the limit on the policy, the insurance company would pay no more than 20% more, or $240,000. If the surge in construction costs due to extreme demand caused the price of replacing the home to jump to $300,000, the homeowner would be short $60,000.

Know Your Rights

The squeaky wheel gets the grease. Do complain to the powers that be in the insurance company if you feel like a denial was unwarranted or the reimbursement too little. Don’t stop there. Complain to your state insurance department: It will make an inquiry with your insurer. See a lawyer if you want to take it a step further.

Once the insurance company tells you the reasons for its action, it legally can’t produce new reasons for denying payment or making a low offer at a later time. You have locked them in — a major advantage for you.

If you review the policy and find that, without stretching your imagination, it seems plausible that you should get the full amount of your claim, you will likely win if you go to court. The CFA notes that courts consistently rule that if an insurance policy is ambiguous, the reasonable expectation of the insured party will prevail since the consumer played no part in writing the language of the insurance policy.

Expect the worst, but hope for the best. Said Hunter, “Not all insurance companies handle claims badly, so go into the claims process with an open mind. Be vigilant though, or you run the real risk of being shortchanged.”

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Hurricane Irene’s swath through the Caribbean this week probably left many of the no-longer paradise-bound wondering: Should I have taken out travel insurance?

Gabe Saglie, senior editor for the deal publishing site Travelzoo, doesn’t often buy travel insurance, but this time of year makes him think twice, he told DailyFinance.

Protection against weather-driven cancellations and delays emerges as a prominent option because it’s the peak of hurricane season. Cheap getaway packages in at-risk areas tend to pop up for sale. Tropical resorts want your business during slow periods. But no matter how attractive the discount, keep in mind that a storm could eat up large, nonrefundable portions of your travel budget. It doesn’t take a once-in-a-decade event like Irene to destroy your plans and take your money.

“Hopefully you never need it, but travel insurance is a cushion that could offset thousands of dollars [in losses],” Saglie said.

Of the 40 to 50 trips he took in the last year, he estimated that he purchased coverage three or four times — all for flights from Los Angeles to the East Coast in winter. As soon as spring arrived, insurance was “no longer on my radar,” he told DailyFinance.

Travel insurance is basically a bet without a bookie. Companies offer attractive odds so you bite on a policy. For instance, when I punched in hypothetical numbers this week at the aggregator Insuremytrip.com, a New York City couple in their mid to late 40s traveling to Puerto Rico from Sept. 2-9 would have to pay $172 to cover the cost of a $2,000 jet-and-hotel package.

In other words, the company would be paying you better than 10 to 1 in the event you didn’t take the trip for reasons specified in your policy. Of course, vendors offer those odds because chances are, your trip won’t be cancelled or you won’t qualify for compensation for other reasons stated by the carrier.

Saglie traveled to the Caribbean in June, the start of hurricane season. He didn’t buy insurance. But if he were planning that same trip for September, he said he would have considered it. A few days after this interview, he was scheduled to go to Maui. Faced with a $150 tab for insurance, he didn’t take it because the weather on the island tends to be stable at this time of year. “I took the gamble,” he said.

Whether to buy coverage comes down to perceived value. Saglie went with his gut and experience on offering guidelines. Honeymoons or other once-in-a-lifetime voyages that cost, say, $3500 or more, definitely merit coverage. Cruises in which you have to fly to the embarkation port can be insured, especially if the connection window is small and weather might be a factor. (Cruise companies are notorious for their strict refund rules.) Those planning a vacation far in advance ought to consider a policy as well, because a lot can happen in a year.

Among the reputable policy carriers that Saglie recommended were Travel Guard and Access America. But read the fine print, Saglie warned. Carriers get persnickety about weather-related payouts, not to mention policies that also cover terrorism, illness, baggage, and rescue for high-adrenaline vacations such as mountain-climbing.

Whatever the policy, it’s a good idea to choose a company that is not related to the airline or trip packager, advised Andrew Young, Travelzoo’s website editor. You can also decrease the chances you’ll need insurance at this time of year by picking one of the ABC islands — Aruba, Bonaire and Curacao, which tend not to be hit by hurricanes, he said.

Smartmoney.com suggests securing insurance just after booking, with the exception of cruises. And to avoid duplicate coverage, double-check with your credit card company to find out what it already indemnifies.

Then, the decision is yours. Nature will take its course.

Said Young: “It’s about weighing your capacity for risk.”

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