Cancer is one of the most common diseases, and one of the most costly to treat. If you get it—and 1 in 3 women and half of all men will—you'd like to feel confident that having health insurance will ensure that you get the care you need without too much financial pain. But as a new report documents, our private health insurance system is riddled with holes that force many patients either to forgo or delay care or to rack up huge bills that put them and their families in financial jeopardy. I went looking for ways to mitigate the problems, and found precious few. This is no surprise; if there were easy, affordable solutions, there would be no need for this report.
"Spending to Survive: Cancer Patients Confront Holes in the Health Insurance System" is a report produced jointly by the American Cancer Society and the Kaiser Family Foundation. It describes the difficulties encountered by 20 cancer patients who had private health insurance and who should, by all rights, have been able to count on their health plans to cover most, if not all, of their care. It didn't work out that way. They ran into caps on coverage and bumped up against lifetime benefit limits. Their cancer forced them to quit working, but they couldn't afford to continue their former employers' coverage under COBRA. And so on. The specifics varied, but the outcome was often the same: treatment glitches and a mountain of debt to join the weight of worry they already faced over their health.
So, I asked experts what patients could do to avoid these pitfalls. Their response: Not much. Unfortunately, health insurance often doesn't work very well when people are sick and need it most. "There are things you can try, but brace yourself, because they may very well not work," says Karen Pollitz, a research professor at Georgetown University's Health Policy Institute. With those caveats in mind, here are ideas and resources for cancer patients that may reduce some of the bumps in the road to their hoped-for recovery:
- First stop: the American Cancer Society's Health Insurance Assistance Service (800-ACS-2345). Call-center staff have helped 21,000 callers in 36 states with insurance and other financial problems. "Our workers are experts in state law, so they know when there are other options in a state," says Christy Schmidt, senior director of policy for the ACS and one of the "Spending to Survive" report's authors. The HIAS also can refer you to national organizations of which you may not be aware, such as the CancerCare Co-payment Assistance Foundation, which helps patients cover the cost of medication copayments for certain cancers, or Healthwell Foundation, which helps patients cover their out-of-pocket medical expenses.
- Drug assistance programs. Much of cancer treatment today is drug therapy, and newer biologic drugs may cost tens of thousands annually. Such organizations as NeedyMeds and the Partnership for Prescription Assistance can help identify state, drug company, and disease-specific programs that may cover some of the cost.
- Provider discounts/charity care. Your doctor or hospital may be willing to give you a break if you ask for it. The state of California has a website with a searchable database of every hospital's discount and charity care policy. But often you'll have to ask a doctor or a hospital's billing office directly to learn about such policies. If you don't meet the income guidelines for reduced pricing, it's still worth having a one-on-one with providers to ask about discounted rates or a payment plan, says Nancy Davenport-Ennis, CEO of the Patient Advocate Foundation, which receives referrals from the American Cancer Society to help patients get the care they need. "Sometimes, just by asking the question, you can get a discount,"" she says.
- If, despite your best efforts, you find yourself with medical debt, there are organizations that may be able to help. The Access Project's Medical Debt Resolution Program works with patients to resolve problems.
Here are other suggestions for keeping a lid on medical bills.