Sorting the Financial and Legal Aspects of Cancer

Sorting the Financial and Legal Aspects of Cancer 

 

In a study done in cancer patients, over eighty percent surveyed stated that one of their main worries after finding out they indeed had cancer were the financial aspects and how their lives would continue with so much debt. As if fighting for your life against cancer was not enough, you will now need to learn and understand how the system works and what laws, regulations and organizations can help you on the path to being cancer free and living with medical bills.  

In each section, learn about the things you might consider doing or checking in to to ease the burden of your cancer journey. Cancer steals, borrows and takes whatever it wants from your life, whenever it thinks it needs to. Your job, your well-being, your emotions, your time, and your relationships are all at the mercy of this illness.  

Through this journey, there will be unexpected and unplanned costs and charges that your insurance company might not fully cover. The most important factor is not waiting until you are too deep in a debt-hole to receive help. Ask these important questions and educate yourself during the entire process so that you can keep your head above water. If you are too stressed or medically fragile to handle the stress of the financial side of your care, consider asking a family member or friend to be with you during appointments and discussions about funding your treatment. Patient advocates can also assist with this.  

 

Preparing for Treatment 

First thing first. Learn everything you can about the type of cancer you have and all accepted forms of treatment. Be prepared for unexpected costs by checking in with the financial office in your doctor’s office and have them check with your insurance company on anything that might not be fully covered. These are common things that can end up being an out-of-pocket expense: 

-Drug costs for inpatient, outpatient, prescription, non-prescription, and procedure related expenses 

-Clinic and medical visits 

-Procedures for diagnosis or treatment which could include room charges, equipment, specialists, doctor fees, and more 

-Lab tests and blood work, urine tests, organ function tests and more 

-Imaging tests like MRI scans, CT scans, x-rays and any medications or extras they need for these tests. Many times, these tests are billed separately than the facility where they were ordered or completed.  

-Radiation treatments including implants, external radiation therapy or both together. 

-Hospital stays for surgery, recovery, treatment, visits and more. This includes everything, and anything done for or to you while in the hospital.  

-Any surgical or surgery related expense: doctors, specialists, surgeon, anesthesiologist, pathologist, operating room fees, equipment and more. 

-After home care is also a great expense which includes all medical items and equipment needed, plus possible home nursing care.  

 

Important Questions to Ask your Doctors about Treatment 

-I know this treatment will be expensive. Where can I get an idea of the total cost of the treatment you have recommended?  

-Will my health insurance pay for this treatment or cover any part of it? How much will I owe myself? 

-I’m worried about covering the cost of treatment. Where can I seek assistance from? 

-If I cannot afford this treatment, are there less expensive alternatives or possibilities with the same quality of life outcomes? 

-Will my health insurance company require pre-authorizations for my treatments or needed therapies? 

-Where will my treatments be done? 

-How much will the chemo drug that I take by mouth cost me? What about the other necessary medications? 

-Are there programs to help me get the drugs I need? 

-Are there generic forms of these medications to help save on cost? 

-Does my insurance company need to give an approval for this treatment before we begin? 

-If I must be admitted in to the hospital, how much will my insurance cover and how much will I have to pay? 

-How much will this surgery cost in total? 

-If I need to plan for rehab or after care in a facility, how much will my insurance cover? 

 

Being Prepared with Health Insurance 

If you are a person with health insurance, you will want to spend some time getting to know their policies and requirements of cancer care. By knowing the terms of your policy, being aware of in-network doctors and specialists, and keeping careful, detailed records will help with your reimbursements and tax filing each year.  

If any of your treatments are done at other locations, with other doctors, or out-of-network doctors, be sure to get all documentation, receipts and bills. Having all of these pieces of information will make it easier for you when you need to appeal a denial or resubmitting an insurance claim. Most doctor’s offices have special staff that deal with insurance billing and patience assistance. Check in with them and allow them to help you get straightened out and informed.  

 

Understanding Informed Consent 

In many instances, family members end up playing a key role in our medical health and lives. When you go in for any type of medical care, you must consent to the recommended treatment given by your doctor or specialist. This is usually done by signing a paper or electronic consent that explains the procedure and reason for it. If you are an adult of sound mind and body, you can give your own consent. For children, their parent often signs a consent form and signs for them.  

In some cases, informed consent is filling the prescription that your doctor wrote for you, getting blood drawn for an ordered lab test, or seeing a specialist you were given a referral to. These forms are called ‘simple consent’ and is okay to be done for treatments that carry little risk to you. Most often, signed and informed consent must be done to have any sort of medical procedure done. If you cannot give consent, another family member or your power of attorney might need to sign the forms for you.  

 

Understanding Advanced Directives  

This is a legal document that tells your doctor your wishes about your health care. There are different types of advance health care directives called power of attorney, living will, do-not-resuscitate, and a few other types of agreements like those. These directives can be general with few directions, or full of many details with wants and desires. This form may name a proxy to make decisions for you if you cannot.  

If your health care directives are about your end of life care, they might clearly outline the different types of life sustaining treatments you want, or do not want at all. The most commonly addressed topics for these directives are the living will, organ and tissue donation, or your wishes to be revived or resuscitated if your heart stops or your stop breathing.  

No matter what type of directive you have, the health care advance directives do not allow anyone to be in control of your money or other property. That is another type of legal directive that can be done but is not directly tied to this.  

 

Knowing the Patient’s Bill of Rights 

A patient’s bill of rights is in place to ensure that patients get the quality care that they deserve. The main points of having such rights are to empower people to take an active role in their own health, strengthen the relationships people have with their medical care team, and establish patients’ rights in dealing with insurance companies another specific situation related to medical and health care.  

While there are a few different versions of patient’s bill of rights, these are some of the protections that apply to health plans under the law and regulations: 

- You have the right to an easy-to-understand summary of benefits and coverage. 

-Young adults can stay on a parent’s policy until age 26 if they meet certain requirements. 

-You’re entitled to certain preventive screening without paying extra fees or co-pays. 

- If your plan denies payment for a medical treatment or service, you must be told why it was refused, and how to appeal and fight that decision. 

-You have the right to appeal the payment decisions of private health plans, which is called an internal appeal. You also have the right to a review by an independent organization, called an outside review, if the company still doesn’t want to pay. 

-If a company does cancel your coverage, they must give you at least 30 days’ written notice with reasoning why you were dropped. 

-Premium increases of more than 10% must be explained and clearly justified. 

-People will be able to get health insurance with pre-existing medical conditions, which are conditions you had before getting medical insurance. Although, your premiums could be higher than others without preexisting conditions.  

-Annual and lifetime dollar limits to coverage of essential benefits have been removed.  

There are also patient bills of rights that cover mental health, a hospice patients’ bill of rights, and rights for people in hospitals.  

 

If you are struggling with the financial aspects of cancer care, there are many organizations you can reach out to for guidance, assistance and general help. Knowing your rights of care and the impending bills due will help you to ease stress by planning ahead and being ready for the billing bumps that often arise in the road. Cancer treatment and care is one of the most expensive types of treatment available and many people face difficult decisions of getting care or living while they can to survive. Do not wait to seek financial help! Reach out to your medical care team if this is an issue you are facing. There is no need to face it alone.  

 

Resources Used: 

ACS 

NIH 

Reclaiming Intimacy

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