Day 26 – HOW DO I PAY FOR LUNG CANCER TREATMENT?
What factors play a role in the staggering costs, particularly in the US? Who is at high risk of financial burden, and does this affect their quality of life and clinical outcome? Would your choice of treatment options change based on cost and the subsequent impact on your family’s future? Is there a price for life?
The National Cancer Institute’s Report on “Financial Toxicity and Cancer Treatment (PDQ®)–Health Professional Version”, outlines several risk factors for those patients and families most at risk of financial distress, including:
- “Wage-earner status of the household member affected by the cancer diagnosis, co-morbidities and general health of the affected, the influence of the illness and treatment on his ability to work, and the income of others in the household
- Pre-illness debt and assets
- Illness-associated costs
- The presence and terms of health care coverage
Patients and their families may be subsequently adversely affected by out-of-pocket medical costs, increased costs as a percentage of income, reduction of income and assets, medical debt, trouble paying for medical bills and for necessities (such as food, housing), and bankruptcy.”
The following chart was created by Scott Ramsey, MD, PhD as a visual aid for understanding some of the financial strain a family might endure with trying to keep up with treatment costs:
The report continues: “Components of these measures include material conditions that arise from increased out-of-pocket expenses, lower income from the inability to work, and psychological response to increased household expenses and reduced income.”
With the prevalence of rising pharmaceutical and diagnostic testing costs, private insurance companies disperse the burden to its payors by increasing premiums and out-of-pocket costs, in addition to increasing the charges directly to that family. Conversely, those in poverty who enter diagnosis without private health insurance are 100% covered financially through taxing other people to pay for their care; their income may decline even further if the affected member of the household is unable to work.
Patients on self-pay plans might have their bills reduced by 60% or more from what the care-facility charges an insurance company, though still a high burden when some estimate a $10,000+ per month out-of-pocket expenses for care. The intricacies of costs and payments are not as black and white as one might think. Being sick with lung cancer will likely mean that you work less and make less money. As your family stops vacationing, spends the money in your saved family emergency fund, then from other savings accounts, then takes a loan against the house and sells other assets to pay medical costs, stress is common.
Concerns regarding financial burdens can lead to a patient not adhering to his recommended course of treatment, such as not filling a prescribed medication in a timely manner or not going promptly for a diagnostic test, both of which can affect the clinical short- or long-term outcome for the patient. Some patients even make the choice to not treat their cancer at least partially for fear of wiping out their entire nest-egg and placing a lifelong financial burden on their family.
Navigating the world of private insurance, government coverage, and self-pay plans can be tricky on a day-to-day practical basis, too. How do you submit a claim? What documentation, referral paperwork, and care plan will you need? Will the pharmaceutical company cover your care if you participate in a clinical trial? Do you pay for the treatment, test or product when treated, or after settlement by the insurance company? Will you have enough money to complete your course of care if you start? Are there financial assistance programs available to help cover your treatment?
Some insurance companies, hospitals and oncology offices offer financial navigators, and some families choose a private advocate to help file necessary paperwork so they can focus on daily quality of life.
A variety of screening opportunities are also now available for some. Per the National Lung Screening Trial, a study found that low dose CT scans for those at high risk for lung cancer reduce the number of lung cancer deaths by 20 percent.
They go on: “The Centers for Medicare and Medicaid Services (CMS) decided low-dose CT will be reimbursed once a year for Medicare patients who are eligible for lung cancer screening. Patients must be ages 55 to 77, have at least a 30 pack per-year history of smoking, and currently smoke or have quit within the past 15 years.
Because lung screening is recommended by the US Preventive Services Task Force (USPSTF), private insurers have also begun covering the tests. However, the criteria for screening eligibility are slightly different. For example, USPSTF guidelines call for screening up to age 80.”
There are a variety of financial assistance options available, as well. Your major costs will be for things such as hospital and clinic visits, diagnostic tests, medicines, surgeries and procedures, home health and caregiving services, and the services of doctors and other professionals. Additional costs might add up for travel and short term housing near your treatment facility, caregiver expenses, and therapies and nutritional needs. The American Cancer Society, CancerCare, the Cancer Financial Assistance Coalition and Cancer.Net are but a few options within a myriad of resources that private individuals and foundations can help you meet your treatment goals financially. We hope that lessening a potential financial burden will create the opportunity to spend more quality time with your loved ones!