Cancer Fighters Thrive is a quarterly print and online magazine bringing readers practical, innovative and inspirational information about cancer treatment and survivorship.
Issue link: http://cancerfightersthrive.epubxp.com/i/61344
SPECIAL FEATURE INSURANCE MATTERS "The last thing we want to do is bring pa- tients into treatment, help them through their illness, and then send them medi- cal bills that they can't afford," says Lisa Whiteside, director of the First Connections team at Cancer Treatment Centers of America® (CTCA) in Zion, Illinois. First Connections is a concierge service that welcomes new patients to CTCA and helps them begin treatment. "It's important that patients are informed up front about the financial aspect of their care so that they can avoid any unneces- sary surprises." Whiteside recommends that, before be- ginning treatment, patients review their medical insurance policies and consult their employee benefits administrator so that they understand out-of-pocket costs and coverage limitations. All health in- surance carriers are required to provide their members with a Summary Plan Description containing details about spe- cific coverage benefits. Patients should get to know this document well and should also carefully examine all "explanation of benefits" statements and other insurance documents they receive. Because these insurance documents aren't always patient-friendly, it's impor- tant to know that there is help available when it comes to deciphering the some- times-confusing insurance-speak; many hospitals and patient advocate groups have staff trained to help patients wade through the paperwork so that they can make informed decisions about their care. "The First Connections team has seasoned financial advocates who can help patients enroll in insurance plans and better un- derstand their policies," Whiteside says. 32 cancer fighters thrive | summer 2012 "They can also assist patients in discuss- ing denied claims with their insurance providers." Patient Advocate Foundation (PAF)—a nonprofit organization that provides case management services to people with chronic, debilitating, or life-threatening illnesses—also helps patients understand their insurance coverage and better an- ticipate potential medical expenses. "We don't want anyone to delay medical treat- ment out of fear," says Erin Moraratty, chief of external communications for PAF. "At any point in their diagnosis, pa- tients can call our case managers for as- sistance at no cost." The range of issues and concerns that patients face is broad, Moraratty says, but she encourages all patients to reach out because there is likely a suitable organi- zation or service that can help. "Some patients have insurance coverage, while others don't. Some need funds to buy medications; others have had insurance claims denied. We help connect patients to organizations that provide assistance." In addition to connecting patients with appropriate resources, Moraratty says PAF can help directly with insurance questions and appeals. "We empower pa- tients to make appeals to their insurance companies to resolve insurance matters," she says, adding, "In our past fiscal year, we handled more than 88,000 requests for assistance." DEDUCTIBLES, CO-PAYS, AND PRESCRIPTIONS In recent years employers have trimmed benefits and shifted higher insurance de- ductibles and co-pays onto their employ- ees. As a result, patients are facing higher up-front costs for treatment. "Group insurance coverage isn't what it used to be," Whiteside says. "Many peo- ple have annual deductibles of $2,500 or $5,000. Patients should be aware of these costs and find out if their plan requires them to use certain designated health care providers or if they can choose their own. Deductibles can vary depending on whether you choose an in-network or an out-of-network provider." CTCA offers a Financial Hardship program to help qualified patients who experience financial difficulties while un- dergoing treatment. "We look at factors such as income statements, account sum- maries, and financial history to create a customized payment plan for the patient," Whiteside says. Patient Advocate Foundation offers a Co-Pay Relief Program to help patients manage pharmaceutical co-payments. "Our case managers look at all resources and programs that might help patients absorb the cost of prescription expenses," Moraratty says. "That might include mail- order prescriptions, available state and federal funds, or prescription drug cards. Our program also includes a 12-month 'look-back' period that can help patients pay outstanding pharmaceutical bills." TRAVEL EXPENSES Cancer patients with complex cases often travel outside their local area to hospitals specializing in certain therapies or treat- ments. Patients may have to pay for air- fare, car rental, food, and lodging. These costs increase when a family member or companion accompanies the patient. Like many destination hospitals, CTCA offers travel-planning and coordination cfthrive.com