Addressing Financial Burden Up Front After Receiving a Cancer Diagnosis

April 1, 2021
Kristie L. Kahl
Kristie L. Kahl

Advocacy Groups | <b>Triage Cancer</b>

CURE spoke with a cancer rights attorney about what financial toxicity is and ways to address this burden before assistance is needed.

Cancer treatment is expensive, many already know this. However, resources are available to help address financial burdens before they happen.

CURE spoke with Joanna Morales, Esq., a cancer rights attorney, author, speaker and CEO of Triage Cancer, what financial toxicity is, and ways to address this burden before assistance is needed.

CURE: We often hear about financial toxicity. Can you shed light on what that actually means and if there are ways for patients to address it?

Morales: Financial toxicity is a term that was coined by researchers from Duke in 2013. And it not only reflects the financial burden that comes from the high costs of cancer care, but also the impact of that financial burden on an individual's physical and mental health. We know that individuals who are experiencing financial burden have a higher chance of being depressed or having anxiety. And so, it doesn't just impact someone's finances, it also can impact their health.

But there are ways to address financial toxicity. Part of the reason that's a hard thing to solve for everyone is because there are many contributors to financial toxicity. It's not just the high cost of cancer care, and the resulting out-of-pocket costs. But it's things like losing your job or not being able to replace wages when taking time off work. That lower income can lead to even more financial challenges and difficulty paying bills.

We think that one of the primary, and most effective ways to minimize financial toxicity is to make sure you understand all of your rights and your options, specifically, making sure that you have adequate health insurance coverage to lower your out-of-pocket costs.

CURE: Why is it important for patients to know their options to negate financial toxicity when they receive a diagnosis?

Morales: There's a lot of focus in the cancer community about trying to make sure patients are connected to financial assistance once they have a financial burden. And that's important, but we think that we can catch more people upstream and make sure that they understand their rights related to work, disability insurance, and health insurance, and how to effectively use their health insurance coverage so that we can lower their financial burden before they need financial assistance. We want to try to help avoid as much of the financial burden as possible.

CURE: What are some ways patients and caregivers can avoid higher medical bills before care?

Morales: Certainly making sure that you are using your health insurance coverage effectively: that you're going to health care providers who are in your insurance company's network, which will lower your out-of-pocket costs; making sure that you don't have to ask for prior approval from your insurance company before getting care; and then making sure you understand your appeal rights. So, if your insurance company says it will not cover a procedure, treatment, or a prescription drug, you have the right to appeal that decision. And not just inside the insurance company, but you also have the right to appeal that decision outside of the insurance company, if they still say no. That external or independent medical review process is one of the best kept secrets of our health care system.

Close to 42 million claims are denied each year, but only .2% of them are appealed. When someone does go through the external appeal process, on average, across the country, 50% of the time those denials are being overturned and patients are getting access to the care that was prescribed by their health care team. So, if you think about 42 million claims, half of those people could have gotten access to care if they'd gone through the external appeals process, which means that either patients are paying for that care out-of-pocket or they're not getting the care that their health care team prescribed for them. That's certainly something that contributes to the financial burden, if patients are paying for care out of pocket, and it impacts overall access to care.

CURE: Why is it important to review and organize medical bills throughout care?

Morales: Upto 80% of medical bills have errors in them and those could be simple errors like your name was spelled wrong or your patient number was incorrect, which might lead to a denial. But it could also be things like typos in the bill. So maybe the wrong code was used and your insurance company is going to pay less for your care. Or maybe there's a mistake like it said you received 11 (doses of a treatment, for example), as opposed to one and that increases your costs. So, making sure that your medical bills are correct before paying them is definitely a key step. One way to do that is by waiting until you've received the explanation of benefits from your insurance company and compare it to the medical bill and then make sure that there aren't any additional errors. Talk to your providers if you have questions about the way that it's been billed. You can talk to your insurance company to ask questions. Don't pay the bill until you're sure that it's correct and it represents what you were actually responsible for paying.

CURE: What is your biggest piece of advice for patients who are newly diagnosed with cancer?

Morales: Anyone who is newly diagnosed with cancer should understand what all of their rights and options are before making decisions, because sometimes quick decisions get made in a moment of crisis, but people find out down the road that it wasn't the best option for them or there were other things that could have been helpful. We want to try to make sure that people have all the information that they need to make the best decisions for themselves when they're newly diagnosed. We know it's a lot to process when someone is focusing on having to deal with their health and with all of these practical and financial issues. It is an additional burden, but if someone can make good decisions earlier on, it may help them down the road.