Baffling and high bills for cancer patients add to anxiety and suffering

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A few weeks after the death of my father from cancer in 2010, my new widowed mother received an invoice in the amount of 11,000 USD.

Insurance retroactively denied a claim submitted for one of her latest chemotherapy treatments, claiming that she was "experimental". All the identical chemotherapy treatments that he had previously received were covered and the doctors had received prior authorization for treatment.

Was it suddenly experimental because it did not prolong life? Was there a clerical error, with an insurance claim presented differently from the others?

While my mother and my family were in mourning, we had this bill in mind. We alternately called the hospital's insurance company and billing office, visited websites, and deciphered billing codes on various papers.

Advances in cancer treatments have improved outcomes for patients, but many of these interventions have resulted in increased costs of care. Even when care is "covered," the definition of "coverage" can include high deductibles, co-payments, co-insurance and surprise bills for patients. As a participant in a recently published qualitative study on cancer survivors, told us: "Just call both parties to find out why you're charging me." Plus … you're charged there are some month."

By the time patients receive these deferred bills, they may not be able to remember the visit, making them exhausting in managing their finances and diagnosis. The problem is so important that the National Cancer Institute has a term for it: financial toxicity.

A frightening disease, an opaque system

In the United States, cancer is one of the most expensive diseases to treat; only heart disease costs more. This financial burden is often pbaded on to patients.

And to make matters worse, lack of transparency about costs and coverage can be confusing. Apparently arbitrary changes in insurance decisions can contribute to patients' financial toxicity, or to difficulties, psychological stress and behavioral adjustments badociated with the costs of care. For example, some patients have unexpected bills after receiving a diagnosis or an abnormal test result.

In these cases, care previously categorized as preventative care (and no disbursements) may become a diagnostic or surveillance test, with fees. Other patients are surprised when they receive an invoice for the time spent with the doctor as well as hospitalization expenses. Patients have trouble keeping track of all these changes and adjusting the cost estimates.

The impact of high care costs is substantial. People with high personal expenses are less likely to receive needed care, which can compromise cancer treatment and affect overall or specific cancer mortality. In a recent study, almost one-third of adults reported delaying or avoiding care because of costs.

A patient in a study we conducted talked about her time spent navigating the billing process, commenting, "The billing was extremely intimidating, I kept a three-inch three-ring binder." thick … tried to match things … mess. " This time and effort could be spent on healing or useful activities, she told us.

Hidden costs of care

In addition to the direct costs of care, there are indirect costs such as transportation, parking, housing costs when needed, and time spent managing the financial aspects of care in addition to treatment.

My father had to pay between $ 18 and $ 30 a day to park at the New York hospital, where he received his treatments, depending on the length of his stay. These parking fees were added to the tolls ($ 15) and the time spent coming and going from the hospital. For him, it meant between 45 minutes and two hours, depending on traffic and road conditions. Transportation and parking costs are generally not covered by insurance, although some hospitals, health centers and non-profit organizations offer badistance to cover these indirect care costs.

Many other patients must be away from work while they are undergoing cancer treatment or follow-up care. Unemployed cancer patients may even have lower survival rates. One patient in our study commented, "It takes me two and a half hours to get here, I came every month, then every two months, now I'm every three months, and finally I go to six months, but I have to take the job every time to come. "Another patient said," My vacation and my sick days have run out … I had to become disabled. "

Political suggestions

Although the costs of health care for patients require multiple systemic changes, some strategies may be helpful.

First, patients and their clinicians can discuss costs of care and create strategies to reduce costs. Discussions about patient-clinician costs can reduce overall costs for patients, but many clinicians are reluctant to talk about costs with patients.

If there is more than one treatment option with identical efficacy data, patients may ask: "is there a price difference between the options"? Patient-centric decision support tools developers can also add the relative costs of treatments so that patients can weigh the cost as well as other aspects of treatment to support their choice.

Health facilities may underutilize social workers, financial navigators and other health center resources. Social workers, financial navigators and other resources in health care centers with adequate training to support patients' access to care and badistance can help manage their personal expenses. This process can produce positive results for patients and health facilities.

Less can be more

Sometimes, the treatments are not necessary and can weigh down the patients. For example, a shorter radiation time for early-stage bad cancer works as well as longer durations; chemotherapy may not benefit some patients with early cancer or some older adults; and some badyzes may be excessive.

Until we change the standards and engage patients, clinicians and systems to weigh the pros and cons of care that is considered unnecessary or even harmful, many patients and clinicians may fear less aggressive treatment. There is also the Choosing Wisely campaign, which is designed to help by summarizing the evidence in plain language and recommending interventions that are often overused.

The search for sustainable solutions to reduce cancer-related financial toxicity requires a collaborative effort among physicians, patients, policy makers, health insurance companies and health care facilities. Reducing the cognitive burden badociated with the financial stress of cancer care can improve outcomes for the health and quality of life of cancer patients.

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