Know Your Options

CURE’s Editor-at-Large, Kathy LaTour, interviewed Carol Marcusen, a licensed clinical social worker and director of social services at the University of Southern California Keck Medical Center and Norris Comprehensive Cancer Center, about the financial challenges facing cancer patients.

KATHY LaTOUR: Is there a dominant financial issue for cancer patients?

CAROL MARCUSEN: One of the dominant issues we see is that people are either underinsured or uninsured. Right now, people can’t afford coverage because it’s so expensive. On the West Coast, we have been affected by managed care for quite some time now, which means the insurance group can limit the choice of healthcare provider and choose whether treatments are approved. In cancer care, patients struggle with, “OK, I am covered, but I want to do an option like a clinical trial, and they won’t let me.” So, they come to the social worker or the healthcare provider and ask how they get coverage.

Patients who have nothing might qualify for coverage in medical emergencies. Right now, the very, very poor get treatment. But there is a whole part of our community making it from paycheck to paycheck who don’t have $500 to $1,000 extra a month for healthcare insurance. So, they fall in that crack. They aren’t going to be turned away, but the hospital will look for a payment plan for them.

KL: What does that look like?

CM: We explore all the options, including cancer legal resources. Every case is unique. Some patients may qualify for a state catastrophic health plan, but it depends on the state. We meet with the managed-care company and negotiate to see if the company will agree to go with a specific amount. We look at the person’s situation and all their options, and then educate them and give them information and resources.

KL: Give an example of a recent situation you dealt with. Perhaps a spouse who didn’t want therapy because of cost?

CM: Family members will often have differing opinions, and it may not really be based on financial issues but actually on other underlying factors, such as feelings about quality of life. Our hope is that we can get the family to agree on what is important to them and what they want to do.

Recently we had a wonderful patient with lung cancer who had a medical background. She was single and lived away from her family, but they had come and wanted to be sure they were doing everything they could to provide for her. The family had some great conversations about hiring people, dealing with hospice and how much more surgery and chemotherapy might be required. The conversations helped everyone come to an agreement about what was going to happen. The patient recently passed away peacefully. She had managed that care and made decisions that met her needs and helped her to remain in control at all times.

KL: How did finances play into those discussions?

CM: The family wanted her to live longer. She had limited resources. She had one income and adequate insurance coverage, but it didn’t offer extended care. She didn’t want to go into a nursing home/assisted living situation because she was in her 50s and that was not what she planned for.

Lots of people need help with the bureaucracy around insurance benefits, government benefits and obtaining benefits.

KL: What areas do you educate about?

CM: Many people don’t know about catastrophic health plans. Education of the public is important in the area of access because it’s different for each state. Also, a lot of people don’t understand or have limited knowledge about their disability benefits. They don’t understand Medicaid (state-funded health care). Lots of people need help with the bureaucracy around insurance benefits, government benefits and obtaining benefits. Also, many people don’t understand their insurance plans. Lots of hospitals and providers have charity care available, and many foundations, community organizations and even drug companies have financial assistance programs, but people don’t know to ask for them.