Tips for Managing the Cost of Cancer and Related Procedures

There is no doubt that cancer can be costly. For some, this might be the first major medical diagnosis ever faced, and it can be both emotionally and financially overwhelming.

If there has been one time in my life I was grateful to have insurance, it was when I was diagnosed with cancer. I had no idea how my policy would kick in for medical procedures related to cancer, but I dove in to reading about my benefits. I was relieved to learn about some of the details regarding coverage. First, I had to learn and understand what my annual catastrophic deductible was, just in case. Essentially, a catastrophic deductible means that once you met the limit for out-of-pocket expenses for a calendar year, then, per some policies, all other procedures, copayments and expenses are covered for the remainder of the year. I kept track of the in-network expenses, and once I met a catastrophic deductible, I was no longer charged for any in-network appointment or procedures. I tried to use in-network providers I felt comfortable with whenever possible.

During my journey, I learned that some providers or tests and treatments were not provided by my in-network benefits. I reached out to the providers and asked if they would lower the treatment to what it would be if it was in-network. I did not find a single provider who was not willing to adjust an expense. Trust me, I received some startling numbers on the initial bills, but had them changed with a simple phone call. I say call and ask. The worst that could happen is that a provider will say no, but I did not find this to happen in my case. The adjustments can potentially save thousands of dollars.

When it comes to end-of-year taxes, keep all your medical receipts. You never know if you will spend enough so that you can use the expenses as a deduction. It might also be a good idea to work with an accountant to develop a financial strategy early on, and in some cases, if you can afford it, possibly divert more of your income to your retirement account for the year. This can lower your base income, which may occur anyway if you are not working. Lowering your base income can help you meet the criteria to deduct your medical expenses at the end of the year.

Do you own any disability policies you may have forgotten about? I have owned a couple of policies in my lifetime, and I once benefitted from a policy when I experienced a longer-than-expected maternity leave. So, when diagnosed with cancer, I remembered to check in on my policies, knowing I would be on medical leave for a long enough period. You may have taken a policy out when you took your home mortgage, or maybe you own a separate policy on your own or with your employer. You might have even taken one out as an option when you financed your vehicle. To use your benefits, contact the insurance provider of the policy. You often only need a letter from your physician for benefits to kick in once you have met your policy's criteria for leave from active employment. Some policies even allow you to work a limited number of hours, and you can still receive benefits if not working full-time.

Do you have medications and copayments based on a tier copayment system? There is something called a tier exception which, if approved, can lower the cost of a copayment on expensive medications with your medical insurance provider. If you have tried less costly medications and your specialist is willing to document that the more expensive medication is the only one which is working for you, then you might be eligible to apply for a tier exception. The tier exception lowers the cost of the copayment for a top-of-the-line medication to a more generic tier and cost. While you may still have a copayment, it will at least lower cost and make the medication or treatment more financially accessible.

Another way to reduce treatment costs is to contact the manufacturer of a more expensive treatment that you are receiving. Maybe a medical social worker is helping with this, but if not, you can contact companies on your own behalf and ask if there are programs which can help with the cost of treatments. They are often called copayment assistance programs. Companies who manufacture the drugs are still getting paid from the insurance company, but the copayment assistance program helps to ensure individuals can afford the medication. Some programs might be based on income, but others might just require you to sign up for the copayment assistance.

If you are still having a hard time with the expense of treatments, you might want to talk to your health care team about the benefit or availability of clinical trials. Clinical trials are often offered for new advancements in medications which are coming down the pipeline. They need patients to help with the research and final documentation comparing the effectiveness of new medications to older treatment options. Some clinical trials may even pay for your time and travel, while you are still potentially benefitting from new top-of-the-line advancements.

Last, but not least, review your explanation of benefit forms for each procedure, treatment and provider you see. It was not uncommon for me to find that I paid a provider and then am billed a few months later for that same procedure. I kept my receipts handy and had to sometimes send the receipt to the billing company to prove my bills were already paid in full. I also found that I sometimes overpaid, and once I received my explanation of benefits, I would contact the provider for a refund of what my insurance stated was my acceptable portion or copayment. I know this is a lot to manage in addition to fatigue and not feeling well in other ways, but finances are something to monitor or to assign to someone you trust. After all, it is your money. The goal is to get better and get back on track financially.

Have I missed any tips that helped you manage financial costs? Please feel free to comment or share!