How to Get Help Navigating the Cost of Cancer Treatment
- American cancer patients spent more than $21 billion on their care in 2019, a report shows.
- The financial burden of a cancer diagnosis can be debilitating. Besides costly treatments, it’s important to think about travel costs, time off of work, and sometimes, expenses for your caregiver.
- Having a medical advocate in your corner for insurance purposes and connecting with social workers and foundations may help alleviate some financial stress from a cancer journey.
- Social workers and/or patient advocates may be able to help get you on a payment plan and determine if you are eligible for financial assistance.
- They could also help direct you toward national organizations that may be able to help with medical bills.
That number includes out-of-pocket and “patient time” costs, which takes into account the time spent traveling for, waiting for and receiving care. No matter the final sum, the financial burden of a cancer diagnosis can be debilitating.
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The financial burden caused by the unexpected diagnosis of a harrowing disease can cause immense stress.
It’s important to know that individual costs do tend to vary greatly depending upon treatment intensity and duration, survival rates, and the stage of the cancer.
According to the Journal of the National Cancer Institute report, out-of-pocket costs in 2019 were the highest for breast ($3.14 billion), prostate ($2.26 billion), colon ($1.46 billion) and lung ($1.35 billion) cancer patients a reflection of the higher rates of these cancers.
Navigating the Cost of Treatment
Many people don't know where to turn when the medical bills start piling up. Some people look to various crowdfunding methods with online platforms such as GoFundMe, and others actually turn to spaces like the cryptocurrency world.
But crowdfunding, in general, can be a tough way to raise funds during a loved one's cancer battle. According to a study conducted by researchers at the University of California San Francisco, GoFundMe efforts often fall short.
The study found that the average "goal" for patients on their GoFundMe pages is $10,000, but the average amount raised is less than a quarter of the goal at $2,125.
Some people find great success with crowdfunding, but the success stories can be few and far between.
Speaking with social workers affiliated with your cancer center is an option for people who don't like the unpredictability of crowdfunding efforts.
“Social workers are generally the person in the clinic that can hook you up with all of the sources that are outside of the medical realm,” Sarah Stapleton, a licensed clinical social worker at Montefiore Medical Center, tells SurvivorNet.
“Someone within the clinic that can help you navigate what co-payments you can expect and what will be covered by your insurance.”
Oftentimes, they can help guide patients to helpful resources when the financial burden becomes too great. Patient assistance programs, for example, can be beneficial.
A social worker may be able to help patients get information on or access to:
- Payment plans
- Financial assistance a cancer center offers
- Grant funding
- National organizations that help pay for care
Reaching out to various foundations can also be a viable option for cancer patients. There are many nonprofit and advocacy organizations that offer programs to help financially support a patient's cost of care.
The Lazarex Cancer Foundation, for example, helps patients cover costs associated with clinical trials and other organizations like the American Cancer Society and the Cancer Support Community may help with travel costs for treatment.
Regardless, it's always a great idea to explore your options and talk to people who might be able to help.
Dr. Allyson Ocean, a medical oncologist at Weill Cornell Medical Center, recommends finding an advocate within the medical field.
Speaking from experience, Dr. Ocean knows having a medical advocate in your corner can make all the difference. She calls insurance companies all the time to help her patients get the treatment they need covered by insurance.
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“My best advice to work around the system of whether or not drugs or tests can be covered for cancer is to make sure you have an advocate in your field working for you,” Dr. Ocean says.
“The frustrating part for me is that sometimes we even have to educate the insurance companies and say, ‘There's a reason why I want to use this medicine.'”
Factoring Costs into the Treatment Plan
Cost of cancer care affects many things, including, unfortunately, therapy options. But it’s important to try to get multiple opinions after a doctor makes a treatment recommendation.
With an expensive option like proton beam therapy for prostate cancer, for instance, other cheaper alternatives might be better when factoring in financials. This relatively new form of radiation has its advantages, but Dr. Keith Cengel, a radiation oncologist at the Hospital of the University of Pennsylvania, says x-ray or traditional photon radiation “are pretty darn good” for small, early stage lung cancers.
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Certain therapies that might be the best option for your specific cancer, however, can sometimes seem out of reach for people simply because of the cost.
Take CAR T-cell therapy, for example. Custom-made from your genetically modified blood cells, this multiple myeloma treatment option is personalized for each specific cancer case in order to slow or stop the disease when other treatments have failed and it pays off. Some medical experts even call it “curative,” but that kind of reputation comes with a hefty price tag.
“These therapies are very expensive, in the order of $400,000 to $500,000 just for the product, just for the T-cells,” Dr. Thomas Martin, a hematologist at University of California San Francisco Medical Center, previously told SurvivorNet.
No matter the treatment, it’s important to know what kind of costs you’ll be looking at when all is said and done. To help with that, try connecting with someone from your cancer center (like a social worker or patient navigator) who can explain your share of the costs before you decide on a therapy.
When Can Doctors Help You Get Covered?
Medicare and private health insurance companies sometimes cover treatment costs for qualified cancer patients, but they might not cover everything. And when a claim is denied, Dr. Kristine Zanotti says it is “incumbent upon the clinician” to do something about it.
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“If they truly feel the care is warranted either genetic testing or some of these newer more expensive targeted agents or biologic agents such as PARP inhibitors then we can go through an appeal process,” she previously told SurvivorNet.
“If we think it’s clinically indicated for that patient, we anticipate it to be clinically beneficial for that patient and we want to appeal the insurance company’s decision, the clinician will then present evidence for it and undergo an appeal process that may take one week to 14 days.”
But if that still does not work and the insurance company continues to deny a claim, a compassionate use program can be a good alternative. When you’re first looking into these programs, a good place to begin is with the Food and Drug Administration Compassionate Use Resources page.
“Many commercial companies will have compassionate use programs for patients in need,” Dr. Zanotti explained.
“Again, the clinician will go through a process, an application with the assistance of the patient who often will have to provide financial information indicating need. And that program will then, many times, provide medication or testing free of charge in these circumstances provided we can demonstrate continued clinical benefit.”
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