Addressing the Financial Burden of Cancer


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When you were diagnosed with cancer, you were thrust into the fight of your life. But you may have quickly learned that the greater battle was surviving the hit that your cancer care delivered to your bank account.

You’re not alone. Bankruptcy rates are almost twice as high among cancer patients as the general population.

"Patients diagnosed with cancer may face significant financial stress, owing to income loss and out-of-pocket costs associated with their treatment," says Scott Ramsey, MD, PhD, a healthcare economist and internist at the Fred Hutchinson Cancer Research Center in Seattle, Washington. "On average, bankruptcy rates increased 4-fold within 5 years of diagnosis."

Join Fight Colorectal Cancer for a webinar that will detail what resources exist to help patients navigate the very expensive waters of cancer treatment. You will hear from a person who is on the front lines of the battle: Elaine Martinez, a case manager with the Colorectal CareLine at the Patient Advocate Foundation.

Elaine serves as an active liaison between patients and their insurers, employers and/or creditors to resolve insurance, job retention, and/or debt crisis matters relative to their diagnosis of colorectal cancer. Her responsibilities include: exploring reimbursement levels for prescribed colorectal cancer treatments, researching available clinical trials for this patient population and facilitating enrollment into appropriate patient resource programs for both the uninsured and underinsured colorectal patients.

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  • Co-Pay Relief (CPR) was established in April 2004. The program provides direct financial support to insured patients, including Medicare beneficiaries and pharmaceutical co-pay for those that are medically and financially qualified.
  • A comprehensive, national, on-line interactive tool intended to help the underinsured Americans faced with high out-of-pocket cost locate valuable resources and action steps to provide financial relief.
  • insureUStoday.orgis a collaborative effort of healthcare stakeholders to add clarity to the features and benefits following the passage of the Patient Protection and Affordable Care Act on March 23, 2010. The website features: Timeline of ImplementationHelpful Resources Frequently Asked Questions Informative Media Articles contact us at 866-207-8023
  • Addressing the Financial Burden of Cancer

    1. 1. Welcome! Addressing the Financial Burden of Cancer Part of Fight Colorectal Cancer’s Monthly Patient Webinar Series Our webinar will begin shortlywww.FightColorectalCancer.org877-427-2111
    2. 2. Fight Colorectal Cancer1. Tonight’s speaker: Elaine Martinez, LPN2. Archived webinars: Follow up survey to come via email. Get a free Blue Star of Hopepin when you tell us how we did tonight.4. Ask a question in the panel on the right side of your screen5. Or call the Fight Colorectal Cancer Answer Line at 877-427-2111 877-427-2111
    3. 3. Fight Colorectal Cancer Upcoming WebinarThe Latest in Colorectal Cancer Research Tuesday, February 19th 8pm EST Dr. Richard Goldberg Physician-in-chief Ohio State’s Comprehensive Cancer Center Register at 1-877-427-2111
    4. 4. Fight Colorectal Cancer Funding Research Directly Lisa Dubow Fund
    5. 5. Fight Colorectal CancerDisclaimerThe information and services provided by Fight Colorectal Cancerare for general informational purposes only.The information and services are not intended to be substitutes forprofessional medical advice, diagnosis, or treatment.If you are ill, or suspect that you are ill, see a doctor immediately.In an emergency, call 911 or go to the nearest emergency room.Fight Colorectal Cancer never recommends or endorses anyspecific physicians, products or treatments for any condition.www.FightColorectalCancer.org877-427-2111
    6. 6. Fight Colorectal Cancer Elaine C. Martinez, LPN Case Manager, Colorectal CareLine Patient Advocate Foundationwww.FightColorectalCancer.org877-427-2111
    7. 7. Financial and Insurance Elaine C. Martinez, LPNImplications for Senior Case Manager the Cancer Patient Advocate Foundation Patients
    8. 8. Our Mission: To Serve Patients • Patient Advocate Foundation seeks to safeguard patients through effective mediation assuring access to care, maintenance of employment and preservation of their Our financial stability relative to their diagnosis of life threateningMission or debilitating diseases. • Since our inception in 1996, PAF has provided direct, sustained patient assistance to more than 500,000 patients and touched millions more American lives through the PAF Our website, online chats and outreach events.Impact 8
    9. 9. Direct Patient Services offered by PAF• Brokering resources to supplement the limits of insurance and to assure access to care for the uninsured• Resolving debt crisis relative to a diagnosis• Negotiating access to pharmaceutical agents, chemotherapy, medical devices and surgical procedures• Resolving insurance issues in the public and private sector• Negotiating pre-authorization approvals• Providing assistance in facilitating and expediting the appeals process • Health insurance denials • Social Security Disability• Negotiating resolutions to coding and billing errors
    10. 10. The UNinsured Public Benefits, Safety Nets & Charity Care • County Indigent Medical Assistance/Community Hospital Charity/Sliding Scale fee discounts• Medicaid (SSI linked and Share-of-Cost /Breast & Cervical/Medicare savings programs/Long-term care Medicaid) • Pharmaceutical and Durable Medical Equipment and Supply Assistance for the uninsured
    11. 11. Utilization of Hospital Support Staff• If you need help, a good place to start is with the social worker, financial counselor or nurse at the hospital where you are being treated. (These people are the most knowledgeable about community resources who might offer help as well as internal programs funds the hospital may have to help cancer patients)• Remember: Do not ignore the bill. If you receive a hospital bill, it is important that you do not ignore it. Hospitals have the right to refer your bill to a collections agency if it is not paid. Instead, make sure to call your hospitals billing office right away to ask about payment plan options and financial discounts. Know your rights under the Fair Debt Collections Act!
    12. 12. Medicaid Government-sponsored medical insuranceprogram based on financial need. To receiveMedicaid, your income and assets must be belowa certain level. It covers hospital care, physician’sfees, prescription drugs, home care and manyother services. In order to qualify, you must be aUS resident. Medicaid is only valid in the state inwhich it is issued. You can go to your local countyDepartment of Social Services for an application.
    13. 13. Work transitions and the Self-employedCOBRA : Group policy extension of 18 months + 11 months = 29 months (Medicare eligibility) – for those deemed disabled within the initial 2 months of the COBRA extension.HIPAA portability : Guarantees that certain individuals will have access to, and can renew, individual health insurance policies.Guaranteed Issue : Group insurance in which all members of a small group who meet certain conditions automatically receive coverage without individual underwriting (in most states groups of 2-50 employees)
    14. 14. Your medical expenses may be tax-deductible. Medical costs that are not covered by insurance policies sometimes can be deducted from annual income before taxes. Currently, they must exceed 7.5% of your adjusted gross income to be deductible. So, if your income is $30,000, then you could deduct out-of-pocket medical costs that exceed $2,250. Medical costs include doctor’s bills, drugs, medical supplies and anything related, including transportation and lodging. Your local IRS office, tax consultants or certified public accountants can help you with the specifics; or see and download Publication 502, Medical and Dental Expenses
    15. 15. Social Security Disability Benefits Disability Evaluation under Social Security:Factors: Age, Education, Work Background, Disability (inability to perform gainful work activity). Requires that the applicant be unable to perform gainful work activity for 12 months from the onset date of disability. medical conditions (47 are forms of Cancers) currently qualify for expedited processing of Social Security Disability benefits:
    16. 16. Social Security Disability Evaluation • Local Social Security office (in person, Initial telephone or on-line) application • Local Social Security office (non- medical eligibility check – work credits, Phone interview age, marital status, etc..) • Disability Determination Services DDS office (evaluates disability)
    17. 17. Timeline for evaluation (approval/denial/appeals process) • Expedited processing (8-10 days for “flagged” cases) – QDD processing Approval • Standard processing (4-6 months) • Reconsideration (1st level) – appellant submits with added medical records/assessments Denial and • Some states will allow the appellant to skip to a 2 nd recourse level Hearing with an Administrative Law Judge (ALJ) • Appellant may hire a Disability attorney, represent him/herself and/or appoint an unpaid 3rd party to ALJ assist in furthering his/her case (Patient Advocate Hearing Foundation)
    18. 18. Medicare• A government-sponsored medical insurance program usually for people who are aged 65 or older. People of any age who have been disabled and have received Social Security Disability payments for 24 months are also eligible. Benefits vary from person to person. Medicare provides basic health coverage, but it doesn’t pay for all health expenses. Call 1.800.MEDICARE (1.800.633.4227) or visit
    19. 19. The Underinsured & Patient Assistance Co-Payment Assistance: Non-profit and pharmaceutical funding exists: privately and governmentally insured (Medicare); disease specific funds ever-changing ***Premium Assistance: *** Disease-specific charity: Diagnosis specific and usually need-based Patients typically must be in active care or limited post-treatment timeframe Funding for medical expense assistance and household stabilization National charities for families with children or pediatric cancer patients Monies for special populations: musicians, artists, flight attendants, Registered Nurses, truckdrivers, federal employees, etc… 19
    20. 20. Our Mission: Supplement the limits of health insurance • The PAF Co-Pay Relief Program (CPR) exists to provide direct financial CPR assistance to insured patients who cannot afford the co-payments and co-Mission insurance required to access prescribed pharmaceutical therapies. 20
    21. 21. How the Program Operates ramå CPR provides cash co- å Professional CPR Call payment assistance for Counselors assist patients in insured patients unable to completing application forms use their prescription drug and securing authorizations benefits due to inability to needed to verify medical and pay their co-payments. financial necessity to qualifyå Patients, physicians, and patients. pharmacies can contact å Upon Approval, payments are CPR™ directly to initiate a made directly to the doctor, request for assistance. pharmacy or patient.å A 24 hour secured web å CPR provides assistance to based patient portal to allow both commercially and patients another option to government insured patients enroll. including Medicare Part D beneficiaries. 21
    22. 22. CPR Open Disease Funds CPR currently offers assistance in 19 disease funds including:• Breast Cancer • Myelodysplastic Syndrome• Chemotherapy Induced (MDS, and other pre-leukemia Anemia/Neutropenia diseases)• Colon Cancer • Osteoporosis• Cutaneous T-Cell Lymphoma • Pain• Hepatitis C • Prostate Cancer• Kidney Cancer • Rheumatoid Arthritis• Lung Cancer (Non-small cell • Sarcoma Lung Cancers)• Multiple Myeloma 22
    23. 23. National Co-Payment Programs• Assistance Fund• Cancer Care• Chronic Disease Fund, Inc.• Healthwell Foundation• Leukemia and Lymphoma Society• National Organization for Rare Disorders• Patient Access Network Foundation• Patient Advocate Foundation Co-Pay Relief• Patient Services Incorporated 23
    24. 24. Medication Website ResourcesPartnership for Prescription Access NeedyMeds  Patient Assistance Programs  Patient Assistance Programs  Co-Payment Programs/Diagnostic  Disease Based Assistance or Testing Assistance  Free/Low Cost Clinics  Free/Low-Cost Clinic Finder  Discount Drug Cards  Discount Saving Cards by State  Drug Coupons  Brand/Generic AssistanceNational Underinsured Resource Directory National Financial Resource Guide  Intended to help underinsured  The National Financial Resources individuals and families locate Guidebook for Patients: A State by valuable resources and seek State Directory of information for alternative coverage options or patients seeking financial relief for a methods for better reimbursement. broad range of needs including housing, utilities, food, transportation to medical treatment, and childrens resources. 24
    25. 25. National Underinsured Resource Directory 25
    26. 26. National Underinsured Resource Directory Pull Out CardsSeven pull out cards werecreated based on thetopics commonlyaddressed by PAFpatients based on needsand issues of theunderinsured population.Each card offers actionsteps or suggestions tocompliment the resourcesthey will be provided. 26
    27. 27. Health Care ReformUninsured Adults ages 19-64Texas: 30% Travis: 25.5% Austin: 27% U.S. uninsured: 19.5%
    28. 28. The Uninsurable – High Risk PoolsFEDERAL Pre-Existing Condition Insurance Plan (PCIP) Qualifying health condition; uninsured 6 mos prior to enrollment Comprehensive benefits; capped out-of-pocket costs; plan options Issued HIGH RISK INSURANCE POOL Viable option when COBRA expires (19th month) Comprehensive benefits; plan options For the insured with high deductible/catastrophic coverage‼ COST PROHIBITIVE PREMIUMS
    29. 29. Risk Pool Implementation
    30. 30. ¡Cover the Uninsured! Premium rates for Texas2011 monthly PCIP premium rates by age enrollee, effective 7/1/2011.Benefits are effective the 1st day of the following month upon enrollment. Age Standard Option Extended HSA Option Option 0 to 18 $133 $179 $138 19 to 34 $199 $268 $207 35 to 44 $239 $323 $248 45 to 54 $306 $412 $318 55+ $426 $572 $442
    31. 31. Looking forward - ACA• Health Insurance Exchanges (2014) The Healthcare Reform Act requires that health insurance exchanges be established in each state. Individuals and small employers will be able to enroll into the exchange. Small employers are defined as those with no more than 100 employees. Larger employers will be able to enroll into the exchange in 2017.• Premium Subsidies (2014) Premium and cost-sharing subsidies will make health insurance more affordable for every family with annual incomes between 133% and 200% Federal Poverty Level that purchase plans through the exchange.
    32. 32. www.insureustoday.orgcontact us at 866-207-8023 32
    33. 33. Contact Us421 Butler Farm Road 421 Butler Farm RoadHampton, VA 23666 Hampton, VA 23666Phone: 1-800-532-5274 Phone: 1-866-512-3861Fax: (757) 873-8999 Fax: (757) 952-0118Internet: Internet: E-Mail: 33
    34. 34. Fight Colorectal Cancerwww.FightColorectalCancer.org877-427-2111
    35. 35. Fight Colorectal Cancer CONTACT US Fight Colorectal Cancer 1414 Prince Street, Suite 204 Alexandria, VA 22314 (703) 548-1225 Toll-Free Answer Line: 1-877-427-2111 www.FightColorectalCancer.orgEmail us: