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  • My wife was diagnosed with stage IV non-small cell lung cancer (NSCLC) and we have health insurance. One of her chemotherapy drugs is very expensive and insurance only pays $1000 per chemo treatment. She is 63 and does not qualify for Medicare. We are looking at co-payment debt of over $100,000. Any suggestions?

    We often find that the private health insurance we have is fine when you are healthy, but not sufficient enough when diagnosed with cancer. Unfortunately, you are correct that she must either be 65 years old or determined to be disabled by the Social Security Administration for 24 months before qualifying for Medicare. I suggest you begin the disability application process if you have not already. Certain cancer diagnoses qualify for expediting the application process (called Compassionate Allowances). You can find out more about the qualifications and can apply online or call to speak with a Social Security representative about your specific situation.

    Co-pay foundations are independent charities that assist insured patients who qualify with the co-pay costs of their pharmaceutical products. Current charities that assist non small-cell lung cancer (NSCLC) patients are:

    CancerCare also offers limited assistance for transportation, homecare, and childcare for patients who qualify. Some local divisions of the American Cancer Society may also have help with transportation to treatment as well as assistance with wigs.

    The Patient Advocate Foundation’s trained case managers provide guidance and support and can intervene on your behalf regarding medical debt. They also maintain a network of volunteer attorneys.

    Lawhelp.org provides referrals for affordable and/or free legal assistance programs in one’s area and advice about bankruptcy protection and other financial issues.

    And finally, you may read our fact sheets about finding financial assistance in your community for further suggestions:

  • My son owes one hospital over $100,000 for surgeries, chemotherapy and radiation treatments. He has recently been approved for Medicare but it will be impossible for him to pay the remaining costs, after Medicare pays, for any future treatment. Is there any legal help for him?

    The consequences of medical debt are staggering and unfortunately all too common. Medical debt is a major burden and a source of continuing stress for many cancer patients, especially those who are younger, have lower incomes, and lack insurance, according to a recent report by the Kaiser Family Foundation.

    If he hasn’t already, your son should approach the medical centers where he has been treated to find out whether they will either lower his bill or work with him to address this sizeable debt. Some facilities provide funding to offset any care that isn’t covered by his insurance, though he will be expected to provide proof of his financial situation. Your son should also explore supplemental coverage plans such as Medicaid that could help with the amounts not covered by Medicare.

    The Patient Advocate Foundation’s case managers provide guidance and support and can intervene on your son’s behalf regarding his medical debt. They also maintain a network of volunteer attorneys.

    Lawhelp.org provides referrals for affordable and/or free legal assistance programs in one’s area and advice about bankruptcy protection and other financial issues.

  • I have insurance, but I still have bills that are stressing me out. I thought I'd be covered, but I don't know how I'm going to pay the part I'm being told I owe.

    If you are insured and struggling with outstanding medical bills, consider the following options:

    • Read your insurance policy and understand the terms of your contract. If you have questions, ask your insurance company, insurance broker, or the human resources staff at your employer to explain it to you. Your insurer may have denied a claim even though you are entitled to coverage. The Kaiser Family Foundation has an excellent guide on how to dispute claims with your insurer.
    • Double check all bills and EOBs (explanation of benefits). You’d be surprised how often billing mistakes are made. Look for incorrect dates of service (you shouldn’t be billed for the room on the day you were discharged) and duplicate fees for tests and procedures.
    • Ask the hospital or doctor to consider the insurance payment as “payment in full.” Many people don’t think to do this, and it is often more successful than expected. Some hospitals have funds to offset medical services that aren’t fully covered by insurance.
    • Negotiate the outstanding balance by asking for a discount. According to a Wall Street Journal survey, 70% of adults who talked with a hospital say they were successful in negotiating a lower price for their medical bills; 61% were successful with their doctor. You will likely get a greater discount (sometimes as high as 50%) if you pay the outstanding balance in a lump sum. You can also set up a payment plan.
    • The Volunteer Lawyers Project of the Boston Bar Association offers good advice on medical debt. Although some of the information is specific to Massachusetts, sections like “deciphering a medical bill” and “negotiating tips” are useful wherever you live. Healthinsuranceinfo.net also has a concise guide on managing medical debt.
    • Explore the resources for co-payment and other medical cost assistance.

    Remember to reach out for help—medical debt understandably causes emotional stress and it’s important to get as much support as you can. Speaking with a counselor can help you manage some of your stress and come up with a plan so that you feel more in control.

  • I've been having trouble paying my co-pays. I am self employed and with the downturn in the economy my business is way down. Where can I go to find some help?

    Direct financial assistance for co-pays is limited, but it does exist. The following non-profit organizations provide help for expenses such as drug co-payments, deductibles, and other medical costs. Each program has its own eligibility requirements, so please contact them to learn more.

    In addition, the Partnership for Prescription Assistance has a comprehensive database of pharmaceutical companies that offer their medications at little or no cost to those who qualify.

    Finally, find more information and resources through Cancer.Net’s patient guide, Managing the Cost of Cancer, and CancerCare’s Sources of Financial Assistance.

  • I think I may have cancer but I don't have any insurance and I'm not sure I can afford it. What can I do?

    I understand your concern about the cost, but if you think you have cancer, you can’t afford not to visit the doctor. Cancer responds to treatment better when it’s caught early, and if it turns out that you don’t have it, you will have peace of mind.

    There are 3 main ways to get health insurance:

    1. Through an employer, union, professional association or other job-related source. If you have a job and your employer offers health insurance, ask if you’re eligible to receive it or buy into it. If you had insurance but lost your job within the last 60 days, ask if you’re eligible for COBRA. COBRA is a law that lets you keep your insurance for 18 months, sometimes longer. You pay the full cost. If you are self-employed, see if there is a professional association in your state that offers group coverage at discounted rates. If you are a small business owner, check with your local Chamber of Commerce.
    2. Buy it on your own.Compare plans and prices by speaking with an insurance broker or visiting an online broker like www.ehealthinsurance.com. Please note that your rights as a consumer are different in every state: in most states, insurance companies can refuse to sell you insurance based on your age, gender, or medical history (but not in New York, New Jersey, Massachusetts, Maine, Vermont, and, with limitations, Washington); in all states they can exclude pre-existing conditions from coverage for a period of time (however, there might still be circumstances in which you would be eligible for coverage). You may also be protected by a law such as HIPAA. Before you buy anything, please visit The Kaiser Family Foundation for information on your rights.
    3. State and federal health care programs. You may be eligible for health care based on your age, income, or pre-existing disability. To see what programs are available in your state, visit The Foundation for Health Coverage Education.

    If you are unable to buy insurance and are ineligible for public programs, you have 2 main options:

    1. Pre-Existing Condition Insurance Plan. Those who have been uninsured for 6 months or more and have been denied coverage can receive insurance through the Pre-Existing Condition Insurance Program. Pre-existing conditions are covered upon enrollment, and premiums are capped at the average cost of private policies in your area. The federal government will operate the Pre-Existing Condition Insurance Program in those states who choose not to create their own program. In 2014, insurers will no longer be able to deny anyone coverage and this program will end.
    2. Hospitals and clinics. Ask about charity care and sliding scale programs (fees based on your income) at hospitals and clinics. Some hospitals are required to see patients who are uninsured. Contact your local department of public health, social services, or business office of your hospital of choice for more information.

    Finally, if you are concerned about either breast or cervical cancer, the National Breast and Cervical Cancer Early Detection Program provides low-income, uninsured women access to screening and diagnostic services to detect breast and cervical cancers. Women who are subsequently diagnosed with cancer may be immediately eligible for limited Medicaid.

  • I can't afford to pay for my cancer medication. Is there help to pay for them?

    The cost of your cancer medication may be a barrier to adherence or taking your pills on schedule. Because of these costs, some patients try to stretch out their supply of pills. Instead of taking them as the doctor prescribed, they take them every other day so that they do not run out of their pills so quickly. If you find yourself thinking of doing this or you are doing this, please speak with your doctor to get financial help. It is very important that you take your pills the way your doctor prescribed them. This way you will get the best results from your treatment.

    There are organizations that help cancer patients with the costs of their pills. Co-payment organizations and patient assistance programs help individuals who cannot afford their medications. The following resources may be able to help you:

    The website of the Cancer Financial Assistance Coalition (CFAC) has a searchable database of national and regional organizations that provide financial assistance and other services for people with cancer.

    NeedyMeds helps patients without prescription coverage by providing information about patient assistance programs that provide prescription medications at no cost.

    CancerCare Co-Payment Assistance Foundation (866-552-6729) provides co-payment assistance to patients who meet their guidelines as well as guidance and referrals for additional help.

    Patient Access Network (866-316-7263) assists patients who cannot access the treatments they need because of out-of-pocket health care costs like deductibles, co-payments and coinsurance.

    Patient Advocate Foundation (800-532-5274) offers a co-payment relief program and seeks to ensure patients’ access to care.

    Partnership for Prescription Assistance (888-477-2669) matches patients to programs offering free or low-cost prescription medicines.

    And finally, CancerCare’s professional oncology social workers can also refer patients for financial assistance and to organizations that offer free counseling services.

  • My husband has recently been diagnosed with stage 4 small cell lung cancer and can no longer work. How do we pay our bills? I still work, but I don't make enough money. Any advice would be appreciated.

    The onset of cancer is a very difficult time for many families financially, with loss of income and the costs of treatment adding to the stress they must cope with. To locate possible resources, I’d suggest the following:

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