How to Pay For Cancer Care

Investigating Health Insurance and Payment Options for Cancer Treatment
Monday, November 21, 2016 - 3:30pm

When Barbara Higley first learned she had been diagnosed with colon cancer, her attention turned first to learning about the treatment that was being recommended by her doctors, as well as learning about what she was likely to expect from those treatments. Then followed the important issue of treatment costs and payments.

“I wasn’t really stressing over the financial piece as I was more stressed about how I was going to feel with the treatments,” recalled Higley, a youthful, retired grandmother. “The cost of some of the drugs is very steep, but it helped that the pharmacy was willing to let me stretch out my chemotherapy billing over a few payments. Hospital staff was supportive in helping me figure out a payment plan which was easier to manage, once I knew what my medical insurance covered,” said Higley.

Planning ahead, choosing the right health insurance plan and negotiating the right network coverage will help you reduce stress and make the process towards recovery easier. No one plans for a diagnosis of cancer in his or her life, so it’s advisable to investigate options for health care coverage while you are healthy.

Keep in mind that advocating for your best case scenario will involve asking a lot of questions and making sure you understand the answers, with all the information you are likely to encounter. It may be helpful to write down questions ahead of time, keep a journal for reference and bring along a friend or family member to help you in this process.

Here are some questions to consider when you are determining how to pay for your cancer treatment:

  • What type of health insurance do I have and will it cover my cancer treatment?
  • Will I be able to change my health insurance after I have been diagnosed with cancer if I have a pre-existing condition?
  • What is Open Enrollment?
  • What are the deadlines for Open Enrollment? (Different plans will have different deadlines)
  • How do I know if my insurance covers the doctor/s I want to see?
  • What is the difference between in-network and out-of-network insurance?
  • Will I be able to receive services if my insurance plan is out-of-network?
  • What questions should I ask my insurance plan about my coverage?
  • What are some of the non-medical costs, such as transportation (gas, parking) and is there coverage for these costs?

“Direct out-of-pocket medical costs will typically include medical and pharmacy services, such as co-pays or deductibles,” says Stephanie Evans, manager for financial counseling at Roswell Park and part of the Managed Care Team that works with patients and insurance companies to negotiate in-network coverage of services. “In some circumstances, patients may have options to seek more comprehensive health insurance coverage to lower their out-of-pocket costs. Rather than only have Medicare, they may be able to pick up a Medicare supplement or enroll in a Medicare Managed Care plan. Patients may also qualify for Medicaid as a secondary payor. Even if the patient’s income exceeds the Medicaid limit, they may still qualify for a spenddown if they are disabled, over age 65, or have children in their household,” explains Evans.

While the cost of chemotherapy can be significant, there may also be options for copay assistance for drug treatments. Patients with commercial insurance coverage may be eligible for copay assistance for drugs through a drug company’s assistance program. Patients with Medicare coverage may be eligible for assistance through foundations such as the Patient Access Network Foundation.  

These programs do have eligibility requirements (diagnosis, income limits). Roswell Park also offers a financial assistance program to help patients sort out payment plans if necessary. To learn more about these options, Roswell Park's financial counselors are ready to assist patients with any of their open enrollment, health insurance and billing questions at 1-800-ROSWELL (1-800-767-9355).

“We realize that it’s often difficult to predict the costs of the treatment as payment methodologies and benefit structures are increasingly complex,” says Evans. “Patients can certainly have a conversation with their doctor about less expensive alternatives for treatment, such as one drug versus another drug.  But ultimately, we have to ask the question: Would a patient want to forgo the best treatment option to save money?”