Covering the Cost of Cancer Care

By Jeff Samoray

Battling cancer is hard enough, let alone worrying about co-pays, deductibles, medication costs, and sometimes travel expenses. In an era of soaring medical costs, patients often focus more on their bills than their health. Some patients even delay or forgo treatment due to mounting or unforeseen medical expenses. Cancer treatment costs can escalate quickly, and even if the insurance company covers the treatment or medication, a patient may have to absorb a large out-of-pocket expense. For some patients, exceeding their maximum annual or lifetime medical benefits is a real possibility.

There’s no question that medical expenses can be a burden, but resources are available to help patients manage the high cost of cancer care as they undergo treatment.

Insurance Matters

“The last thing we want to do is bring patients into treatment, help them through their illness, and then send them medical bills that they can’t afford,” says Lisa Whiteside, director of the First Connections team at Cancer Treatment Centers of America® (CTCA) in Zion, Illinois. First Connections is a concierge service that welcomes new patients to CTCA and helps them begin treatment. “It’s important that patients are informed up front about the financial aspect of their care so that they can avoid any unnecessary surprises.”

Whiteside recommends that, before beginning treatment, patients review their medical insurance policies and consult their employee benefits administrator so that they understand out-of-pocket costs and coverage limitations. All health insurance carriers are required to provide their members with a Summary Plan Description containing details about specific coverage benefits. Patients should get to know this document well and should also carefully examine all “explanation of benefits” statements and other insurance documents they receive.

Because these insurance documents aren’t always patient-friendly, it’s important to know that there is help available when it comes to deciphering the sometimes- confusing insurance-speak; many hospitals and patient advocate groupshave staff trained to help patients wade through the paperwork so that they can make informed decisions about their care. “The First Connections team has seasoned financial advocates who can help patients enroll in insurance plans and better understand their policies,” Whiteside says.“They can also assist patients in discussing denied claims with their insurance providers.”

Patient Advocate Foundation (PAF)—a nonprofit organization that provides case management services to people with chronic, debilitating, or life-threatening illnesses—also helps patients understand their insurance coverage and better anticipate potential medical expenses. “We don’t want anyone to delay medical treatment out of fear,” says Erin Moraratty, chief of external communications for PAF. “At any point in their diagnosis, patients can call our case managers for assistance at no cost.”

The range of issues and concerns that patients face is broad, Moraratty says, but she encourages all patients to reach out because there is likely a suitable organization or service that can help. “Some patients have insurance coverage, while others don’t. Some need funds to buy medications; others have had insurance claims denied. We help connect patients to organizations that provide assistance.”

In addition to connecting patients with appropriate resources, Moraratty says PAF can help directly with insurance questions and appeals. “We empower patients to make appeals to their insurance companies to resolve insurance matters,” she says, adding, “In our past fiscal year, we handled more than 88,000 requests for assistance.”

Deductibles, Co-pays, and Prescriptions

In recent years employers have trimmed benefits and shifted higher insurance deductibles and co-pays onto their employees. As a result, patients are facing higher up-front costs for treatment.

“Group insurance coverage isn’t what it used to be,” Whiteside says. “Many people have annual deductibles of $2,500 or $5,000. Patients should be aware of these costs and find out if their plan requires them to use certain designated health care providers or if they can choose their own. Deductibles can vary depending on whether you choose an in-network or an out-of-network provider.”

CTCA offers a Financial Hardship program to help qualified patients who experience financial difficulties while undergoing treatment. “We look at factors such as income statements, account summaries, and financial history to create a customized payment plan for the patient,” Whiteside says.

Patient Advocate Foundation offers a Co-Pay Relief Program to help patients manage pharmaceutical co-payments. “Our case managers look at all resources and programs that might help patients absorb the cost of prescription expenses,” Moraratty says. “That might include mailorder prescriptions, available state and federal funds, or prescription drug cards. Our program also includes a 12-month ‘look-back’ period that can help patients pay outstanding pharmaceutical bills.”

Travel Expenses

Cancer patients with complex cases often travel outside their local area to hospitals specializing in certain therapies or treatments. Patients may have to pay for airfare, car rental, food, and lodging. These costs increase when a family member or companion accompanies the patient.

Like many destination hospitals, CTCA offers travel-planning and coordination services. “For certain patients, we can cover airline or train costs and reimburse patients for miles driven,” Whiteside says. “We also offer on-site and off-site lodging at reduced rates, complimentary transportation services to and from the hospital, and discounted meal tickets.”

For cancer patients who don’t qualify for travel assistance programs, there are a number of air travel companies that offer free or reduced-fare transportation services. The Air Charity Network, for example, can help arrange flights for patients in all 50 states. The Corporate Angel Network helps patients fly for free in empty seats on corporate jets.

Remain Informed

Above all, Whiteside says, patients need to understand their medical coverage, contact their insurance providers when necessary, and know that assistance programs are available to help qualified patients manage their financial issues.

“Some cancer patients have policies with a $200,000 or $500,000 lifetime maximum, but that can be exhausted quickly,” she says. “Patients should take those numbers into consideration before starting treatment. Some patients have also been able to negotiate discounts off certain medical charges with their provider to help preserve their lifetime maximum.

“It’s all about being an informed patient— the more aware you are up front about the financial aspects of your care, the more comfortable you’ll be during treatment.”



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