The Cost of Ovarian Cancer: Dealing with “Financial Toxicity”
Navigating the Costs of Cancer Treatment
- Treatment for ovarian cancer can be extremely expensive
- Financial counselors and medical social workers at cancer centers can help patients navigate the costs
- Pre-authorization programs determine beforehand whether your insurance will cover a specific treatment
- Doctors can appeal denied claims to the insurance company by providing evidence that the treatment will be beneficial
You may have heard the term “toxicity” in reference to cancer treatments. Due to the potency of many cancer drugs, which is necessary to kill off cancerous tissue, treatments like chemotherapy or PARP inhibitors have toxicities that cause side effects like nausea and fatigue. However there’s another type of toxicity that can be associated with cancer treatment, and this one affects your wallet. . . and your health as well.
“There’s a term, ‘financial toxicity,’ that we use, along with describing other toxicities of cancer therapy,” says Dr. Kris Zanotti, gynecologic oncologist at University Hospitals in Cleveland, Ohio. “Financial toxicity is real, and it’s associated with poor quality of life and poorer cancer outcomes.”
Cancer therapies are notorious for their high price tags. Even with insurance, you might struggle to meet the co-pay — the amount you need to pay out of pocket for treatment. In other cases, your insurance company might not cover a specific treatment your doctor recommends. Your oncologist and cancer center can help you address any concerns you might have about affording your cancer drugs, and point you to programs that can help you pay for treatment.
Is Your Treatment Covered?
There are a lot of available cancer treatments, and not every insurance company will cover the cost for every available medication. Determining whether or not your insurance will cover your treatment is important to learn before you start on therapy, so you don’t end up with an unexpected bill afterward.
Dr. Zanotti says that when she or her colleagues prescribe an expensive treatment, they use something called a pre-authorization program. Required to prescribe many chemotherapy drugs, these are like pre-clearance checks with your insurance company to determine whether or not they will cover the cost of treatment, before the treatment begins.
There are several reasons why you might end up facing the full cost of your treatment without help from insurance. According to Dr. Zanotti, “Patients can be uninsured, they can be under-insured, or they can desire to pursue cancer therapies that simply aren’t approved by their insurance company. Financial toxicity comes in many forms.” In these cases, figuring out how to meet the cost of treatment can be a daunting task. Your cancer center or hospital can help.
“All comprehensive cancer centers will have financial counselors,” says Dr. Zanotti. Many have medical social workers as well. These professionals can help you determine what other payment avenues may be available to you, depending on your situation.
When a Claim is Denied
If an insurance company denies a claim for a treatment your doctor recommends, your doctor then has to find another treatment option, or begin an appeal process. This is particularly an issue with newer and more aggressive treatments, such as genetic testing or PARP inhibitor drugs.
If your doctor truly believes this treatment will benefit you and is the best available option, they can create a case to appeal to your insurance company for coverage. The appeal will argue that the treatment is medically necessary and that it will benefit you. “The clinician will then present evidence for it and undergo an appeal process that may take one week to fourteen days,” says Dr. Zanotti.
If that doesn’t work and the insurance company continues to deny the claim, a compassionate use program may be a good alternative. Many pharmaceutical companies have programs that provide medication or testing free of charge for patients in need. As long as your doctor can demonstrate that you are receiving continued clinical benefit from the drug, these programs can sometimes meet the entire cost of treatment.
Navigating the costs of ovarian cancer treatment can be stressful, and may be hard to do alone. A social worker and financial counselor at your cancer center can help you determine what your insurance company will cover, and how to pay for any costs that remain.
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Dr. Kristine Zanotti is a gynecologic oncologist at University Hospitals in Cleveland, Ohio. She’s also an associate professor at Case Western Reserve University School of Medicine, and director of the gynecologic oncology fellowship at University Hospitals Cleveland Medical Center. Read More
Source: Survivornet By: Dr. Kristine Zanotti
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