Financial Considerations

Once melanoma is diagnosed, peoples’ first thoughts may not be financial. They want and need to focus on their treatments and getting back to a healthy life. But the financial aspect has an impact on their overall health, happiness and well-being.

The cancer-related expenses they experience will be unique to them, dependent on their diagnosis, recommended treatment plan, follow-up care and level of insurance coverage. Managing these expenses is crucial. Many patients need help understanding their insurance, planning their budget and seeking financial assistance.

Types of Cancer-related Costs

Cancer-related costs can be grouped into two types of expenses: medical and lifestyle. The medical expenses include medical office visits, tests, treatments, drugs and caregiving.

Less obvious are the lifestyle costs, or the increases in routine living expenses related indirectly to treatment. For example, after a melanoma diagnosis, patients may spend more money on transportation and travel, legal help and financial services. They may also need to hire help for child or elder care, meal preparation or housecleaning. These additional expenses are a burden on their own but are even more substantial when combined with the possibility that income may be reduced if the patient and/or partner are unable to work the same number of hours during treatment.Financial_sidebar.jpg

Cancer-related costs can add up quickly, so it’s important for the health care team to talk to the patient about the cost of cancer care as early as possible. Patients may be embarrassed to bring up costs with the health care team. One study found that although more than half of the patient participants wanted to talk to their doctors about costs, only 19 percent actually did—and it paid off. Fifty-seven percent of the patients who had conversations with their doctors about their financial concerns felt that it helped significantly decrease their costs, and even more felt it decreased their anxiety during the course of their treatment.

Many people are hesitant to ask about cutting costs because they fear their treatment will suffer. However, depending on a patient’s specific insurance coverage, alternative treatment options that are less expensive but just as effective may be possible.

In one survey by the American Cancer Society, about 5 percent of insured people with cancer said they delayed or opted against treatment because of cost.

Coverage Basics

Health insurance helps patients afford the care provided by their doctors. Health insurance ultimately helps patients pay the cost of their medical care by contributing financially toward a portion of the total bills.

As part of the Affordable Care Act, everyone is required to purchase a health insurance plan to cover their medical needs or they must pay a financial tax penalty. Under the Affordable Care Act, the government must maintain an exchange in each state, also known as a Health Insurance Marketplace, which allows people to compare and select an affordable health insurance plan to meet their needs. These marketplaces are a central point for those who do not have employer-sponsored insurance, those who have previously been denied coverage because of a pre-existing condition (such as cancer) or those who are interested in switching from their current plan.

Some patients may qualify for government-assisted health insurance, including Medicaid or Medicare. Medicaid programs are designed to help people with limited means gain high-quality care, and these programs are managed at the state level. Medicare is a federal health system designed for those age 65 or older or those who are disabled.

Help for Those Who Can’t Pay

Despite the best planning and intentions, some patients may find some bills are too big to pay. Assure them that they are not alone in their struggle. In fact, one study showed that 68 percent of people with cancer and caregivers experience financial hardship during treatment.

Many organizations, such as the Patient Advocate Foundation, provide free counseling to patients burdened by medical debt. The Foundation can help patients apply for financial assistance and communicate with their doctors, insurers and creditors.

As part of your patients’ health care team, you can provide them with an application for a charity care program, begin the process for requesting a discount or a reduced bill, or arrange an affordable payment plan for the remaining balance.

Many nonprofit groups have programs to help patients who can’t pay their bills, including services like co-pay assistance, travel aid and child care.

Remind patients that no matter what their financial situation is, they should never alter or stop their treatment without talking to their health care team. Many people with cancer avoid filling prescriptions or receiving treatment when they’re worried about paying the bills, but doing this can seriously damage their health. You can work with your patients to find a better solution for them.

Paying for Clinical Trials

Although clinical trials are crucial for advancing cancer research and treatment, patient participation is low. Cost concerns may be one reason patients decline to volunteer. Research shows that many people with cancer believe their insurance company won’t provide reimbursement and choose not to participate to avoid adding to their out-of-pocket expenses. Health care professionals can help educate patients about available resources, such as the Affordable Care Act.

Through the Affordable Care Act, all private insurance companies are required to cover routine patient-care costs from in-network providers associated with an approved clinical trial. An approved trial is defined as a trial in any phase that is aimed at preventing, detecting or treating cancer. Patient-care costs include those related to doctor visits, hospital stays and some testing procedures that are part of standard care, which would be incurred in a clinical trial and in standard treatment. Research costs, which are directly related to the clinical trial and include drugs and procedures, are typically covered by the trial sponsor.

For example, a patient’s insurance company may not consider follow-up tests and imaging studies done solely for data collection and analysis as part of routine patient-care costs. Participation in an unapproved trial may result in the insurance company declining coverage. Even though clinical trial coverage has expanded, patients should still be encouraged to discuss costs with the clinical trial administrators and reach out to their insurance company for an explanation of coverage. Remind patients that before they sign the consent form, it is extremely important to address all of their cost and payment questions and concerns up front.

Some federal programs help pay the costs of care during clinical trials: Medicare, TRICARE and the Department of Veterans Affairs (VA).

Health care professionals should be familiar with resources that offer financial assistance for patients who incur costs not covered by their health insurance and for those who have no insurance coverage at all. These resources may include local or national advocacy groups, other cancer-related fundraising organizations and the trial sponsor. Talk with the insurance representative on your team to help field patient questions. Have the resources available so that your team can pass the information on to the patient.

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