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Financial Fix: Developing a Plan to Pay for Cancer Care

A cancer diagnosis could break the bank, but it doesn’t have to.

BY ERIK NESS
PUBLISHED MONDAY, DECEMBER 23, 2013
In the midst of being treated for breast cancer, Glenda Chambers developed a problem: her immunity crashed. Her doctors prescribed Neupogen (filgrastim), a drug that boosts white blood cell production, and sent her home. A two-week supply of the drug was delivered to her home in Mobile, Ala., with a bill—Chambers’ 20 percent co-pay. It was Christmas Eve in 2011.

“I didn’t have $899,” she says, recalling her panic at seeing the invoice. “Everything was closed by the time I received it.” And so began a holiday frenzy to cover the unexpected balance. She scraped together her checking and savings accounts. She sold a few pieces of jewelry and borrowed the rest from friends and family members.

An events coordinator for the Mobile Police Department, Chambers had a good job with health insurance. But the nickels and dimes quickly added up. “When you’re going to see your doctor two and three times a month, a $40 co-pay mounts up,” she says. Moreover, she had gas expenses and food costs to feed the people who came to help her out. The situation was complicated by the fact that she couldn’t work her second job—it was just too demanding.

Now that she’s in the home stretch of reconstructive procedures, she still sees her oncologist regularly and receives a heart scan every three months (which includes a $40 office visit co-pay). Add to that the $20 monthly out-of-pocket expense of Arimidex (anastrozole), which she’ll be taking for the next five years.

It’s no surprise that patients are worried about how much their cancer experience will cost them. According to a 2006 analysis by the global think tank RAND, the annual out-of-pocket costs for more than one out of 10 cancer patients exceeded $18,000. Overall, medical costs are believed to be a factor in about 60 percent of personal bankruptcies in the U.S.

“One of the first things that pops into a patient’s head is, ‘I’m going to be broke,’” says patient financial services manager James Carey of the Huntsman Cancer Institute in Salt Lake City. And, he adds, in the short-term, it’s likely to get more difficult, as soaring costs and uncertainty about healthcare reform intensifies competition for every penny. Still, he holds out hope: “We have programs available. You just have to work with us."

It is really gutwrenching to realize that you have hope in a certain kind of treatment, but you can’t afford it without bankrupting your family. 

Regardless of a patient’s cancer diagnosis or personal circumstances, experts universally caution against dodging the money question. For those who are good with money, the challenge of paying for cancer care may be met more easily. But those who have never been very good with finances should find someone they trust who has the necessary management skills, says Amy Horyna, patient and family support manager at Huntsman. Cancer treatments and recovery can be debilitating, and “it’s easy to lose periods of time and lose track of things,” she says.

“The IRS website has some great free publications on deducting medical costs if you can’t afford a professional,” says Martin Shenkman, an attorney who specializes in planning for chronic care. “Figure out what costs are tax deductible—if you’ve never itemized before, this may be the year to start,” he adds. “Tax savings may come in handy as you try to budget for the new costs you face, and you may have to move some financial assets around if the possibility of a big bill is on the horizon.”

But patients should carefully consider which funds they use in order to minimize tax costs, Shenkman cautions. For example, with strict requirements about using funds from an individual retirement account (IRA), patients will likely want to avoid triggering an income tax, or worse, a penalty. “If you have to sell stocks, try to match gains and losses to avoid having a tax cost added to your budget worries,” he adds.

If the money’s not there, patients still need to research cost implications. Meg Gaines, director of the Center for Patient Partnerships, a patient advocacy organization, argues that this is all part of patients being captains of their own healthcare ships: Patients need to understand their diagnoses and their treatment options.

“You don’t have to understand them at the genetic, molecular level. You just have to understand them at the level necessary for you to apply your values,” she explains. That challenge comes quickly into focus for patients with a rare or advanced cancer diagnosis who’ve found a treatment that they feel good about. “It is really gut-wrenching to realize that you have hope in a certain kind of treatment, but you can’t afford it without bankrupting your family.”

How much an individual’s cancer will cost is ultimately driven by many factors: the patient’s insurance, who treats the patient, the type of treatment the patient receives, and how the patient’s cancer and body respond to the treatment. Most of these are beyond a patient’s control, but that doesn’t mean patients have to passively accept them.

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