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For many cancer patients, treatment takes a financial toll

Rochester Business Journal
June 20, 2014

Qualified patients can receive state and federal disability benefits, says Sandra Sabatka, senior social worker at the Wilmot Cancer Institute. (Photo by Kimberly McKinzie)

Much about cancer remains unknown, but not this fact: Treatment can be expensive, even for those who have top-notch medical insurance plans.

“Whatever economic level you’re at, you have these bills coming in,” says Mary Casselman, program director for Gilda’s Club Rochester, which provides information and support for local cancer patients. “How are you going to pay for it?”

Coming at a time when a patient needs to devote as much energy as possible to fighting the disease, the financial pressures can prove doubly difficult to take. Careful planning can reduce the stress, however.

Many factors determine the cost of fighting cancer, starting with the type of cancer involved, the stage at which it is diagnosed and the treatment prescribed. Some forms of the disease require a combination of immediate and aggressive treatments, while others can respond to more limited measures—especially if they are found early.

“Whether someone is going through chemotherapy and/or radiation oncology, the costs obviously could be very different,” explains Adam Anolik, chief financial officer for Strong Memorial Hospital.

Simple but no less important factors also can drive up costs. Several professionals can become involved in treatment, each of whom needs to be paid. More doctor visits means a higher number of co-payments, Casselman notes.

Cancer and other serious illnesses or conditions also can reveal the limits of some types of health care policies.

“There’s been a trend over the last few years (for) insurance to be a high-deductible plan,” says Therese O’Connor, oncology social worker at Rochester General Health System’s Lipson Cancer Center. “When you’re very healthy, those seem like a great deal, because the premium is so low.”

While such plans cost less initially, people who buy them may also have to shoulder as much as $9,000 a year in co-payments when a serious illness or injury occurs, O’Connor says.

As they face the buildup of co-pays, those in cancer treatment also could see their transportation costs rise as well, especially if they live far from the medical care they need. Further, some patients might need to hire child care providers or other service workers to meet their personal responsibilities during treatment. Overall, such financial concerns can sap a patient’s ability to fight the disease.

Local treatment providers, financial experts and non-profits offer a variety of means by which cancer patients can address their financial problems while undergoing treatment. Those receiving care at the University of Rochester Medical

Center’s Wilmot Cancer Institute can use its Health Care Cost Estimator service.

“What that is set up to do is to help patients to get a potential range of out-of-pocket costs that services will be for them,” says Karen Stein, manager of patient services for Strong Memorial Hospital.

To start the process, a patient need only call the service’s telephone number—(585) 758-7801—and provide the diagnosis and insurance information. The service then contacts the physicians involved and determines the potential costs of the therapies and drugs that could be used in treatment. A patient usually has a range of treatment costs in hand within 72 hours, Stein says.

Once a patient has some idea of what treatment could cost, he or she can begin planning to pay for it. Unfortunately, the disease or its treatment might cause the patient to experience a decrease in income right when it’s needed most.

“One of the big issues that come up financially is that often, when people are first diagnosed, they go on a period of disability,” O’Connor notes.

In such cases, those who are working should contact their employers to find out whether their companies have employee disability plans. They also can apply for compensation under New York’s disability benefits program and for federal Social Security disability benefits. Health care providers have trained social workers or financial case managers who can help patients apply for benefits.

“We would help you along with the process as best we can,” says Sandra Sabatka, senior social worker at the Wilmot Cancer Institute.

The two government programs dovetail in some ways. State disability benefits cover only 26 weeks, Sabatka says, but the application process is relatively simple. The application for Social Security benefits is much more complicated, and approval takes five months. The benefits are also more difficult to obtain.

“You qualify for that if you have a disability that’s likely to last a calendar year or is life-threatening,” O’Connor explains.

A qualified patient can receive Social Security disability benefits for the rest of his or her life. However, disability payments do not make up for the loss of a paycheck.

“It’s usually, maybe if you’re lucky, 60 percent,” says Bill Schoff, managing director of UBS Financial Services.

Health care providers and professionals in the financial sector can help those who have been diagnosed with cancer deal with the financial effects of the disease. Schoff always begins by sitting down for a frank discussion with his client about the illness and the individual’s financial condition. Spouses or other interested parties may sit in as well, at the client’s request.

“My role in this whole thing is to let people know that there are resources and send them in the right direction, but mostly to let them know that they’re not alone,” he says.

Schoff then sets out to develop an intricate financial picture of the situation. Working from a checklist, he goes over his client’s actual and potential income, assets and liabilities in detail. He also reviews the client’s health, disability and long-term medical care policies.

Though Schoff describes his clients as “fairly wealthy,” their assets can fall short of their liabilities while they are in cancer treatment. If that happens to a client, he might suggest that the person plug the holes by borrowing against life insurance or reallocating a portfolio.

“If you know you’re going to need $50,000 next month, it doesn’t make sense to have it invested in the stock market,” he explains. “It makes sense to have it in cash.”

Schoff also encourages his clients to stay on top of their medical bills and avoid going into debt if they can. By doing so, they could ease some of the financial pressure they might feel down the road as treatment proceeds.

Cancer patients whose wealth is more limited might take other measures. Those who lack medical insurance could sign up under the Affordable Care Act, also known as Obamacare.

“Our system has a lot of certified counselors to help apply for insurance through the Affordable Care Act,” O’Connor says. “We line that up.”

By federal law, no one can be denied medical insurance because of a pre-existing condition. Health care providers also will help their patients apply for Medicaid or Medicare, as well as for in-house financial assistance.

“Depending upon a patient’s annual household income, they could qualify for a reduction of their out-of-pocket costs for services of anywhere from 20 percent to 100 percent,” Stein says.

Those whose income is too high might still be able to work out an affordable monthly payment plan by which they can chip away at their debt—in essence, an interest-free loan. Rochester General Hospital also allows qualified patients to reduce their debts to the hospital, O’Connor says.

Cancer patients can make use of other benefits when confronting their treatment costs. Drug companies offer some medications free or at reduced cost to qualified patients.

“Every treatment patient gets a list of co-pay relief agencies that can help with the cost of medications,” O’Connor says.

Non-profits also stand ready with assistance. Cancer patients and survivors can turn to Gilda’s Club Rochester, for example, for information on financial assistance. The non-profit also has support groups and art and recreational programs for children and adults who have cancer or are recovering from it and for their families.

Whatever financial resources cancer patients bring to their struggle with the disease, they should note each step they take in treatment.

“Run it like a business,” Schoff says. “Keep files from a bill standpoint—bills that come in, bills that are paid, bills that you’re challenging, bills that are wrong.”

By using such steps to obtain a measure of control over their finances, patients can gain something that might be more valuable in the long run than the money they could save.

“You can’t control your health,” Schoff explains. “By controlling things that you can control, it actually empowers people who otherwise feel powerless.”

One other thought also might feel empowering for those who come to the Wilmot Cancer Institute or the Lipson Cancer Center. Whatever their financial circumstances, they will not be turned away.

Says Rochester General’s O’Connor: “What you owe us or what your insurance covers does not impact what we do as a system.”

Mike Costanza is a Rochester-area freelance writer.
Co-payment expenses can mount for patients with high-deductible insurance plans, says Therese O’Connor, oncology social worker at Rochester General Health System’s Lipson Cancer Center. (Photo by Kimberly McKinzie)
6/20/14 (c) 2014 Rochester Business Journal. To obtain permission to reprint this article, call 585-546-8303 or email service@rbj.net.


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