Patient Advocacy: Healthcare on your side
by Martine G. Brousse,
Healthcare
Specialist, Patient Advocate, Certified Mediator
ADVIMEDPRO
Five Questions for your Oncologist
that might save you
Money
When faced with a cancer diagnosis, patients and their loved
ones soon come to realize that their fight will likely involve substantial
costs, rapidly raising the level of uncertainty and anxiety. Looking for ways
to pay the bills can become overwhelming, especially in a complex, and too
often, unmerciful healthcare system.
While insurance policies dictate patient liability, choosing
an "in network" or contracted oncologist will reduce costs. But all
too often, patients assume they have no options as relevant information is not
communicated, and as they do not know what to ask.
Here are five questions to ask your oncologist, and that can
help you save money.
1. Is there an equivalent less costly alternative to the
prescribed treatment?
While I am, in no way, suggesting you question your oncologist's
expertise, it is often the case that, for early stages, more than one treatment
option can be considered. My previous boss once explained she based her
decision on three criteria: (a) effectiveness, (b) impact on the patient's
daily life and (c) cost to the patient. Not all oncologists take (b) or (c)
into account.
Explain that you must keep working to keep your insurance,
that you cannot afford a more expensive (and again equivalent) treatment, or
that you are the sole breadwinner, and get reassured that the prescribed
treatment is the most affordable.
2. Is the pharmacy cheaper?
Some growth factor treatments (Neupogen, Neulasta, Procrit,
Aranesp, etc.) can be safely self-administered at home. After checking with
your insurance, you may find it more economical to obtain the prescribed
pre-filled syringes through a pharmacy rather than getting a shot at the
office. The nurse can instruct you on how to do this safely.
Convenience and habit may lead to costly brand name prescriptions.
Always ask if a generic version is available.
3. What about samples?
There may not be samples for chemo agents or growth factors,
but there are for anti-nausea or other supportive oral drugs. Emend, for
example, can be priced at hundreds of dollars per month. Samples should be
available in the office.
Some offices may even accept unused oral or self-injectable
drugs from patients whose treatment ended, and who bring excess supplies for
others in need.
4. What about financial assistance?
Every major drug manufacturer offers financial assistance
for brand name drugs, especially chemo-related. Ask about programs and how to
apply. Offices can sign patients up, or at least direct you to a website.
You might be eligible for drug donations if you are
uninsured or underinsured, or if your insurance has denied an authorization.
Please note: By law, patients with a government issued
insurance (Medicare, Medicaid, Tricare) are not eligible for direct donations
or assistance from manufacturers.
Charitable organizations also offer financial assistance to
cover the cost of chemo or related drugs. Based on income, specific diagnoses
and clinical need, these grants can range from a few hundred to thousands of
dollars, and can be used to cover doctor or pharmacy bills. Above-mentioned
patients are eligible.
5. Are home treatments less costly?
Some simpler treatments, including B12 injections,
bone-building or iron infusions, are sometimes prescribed as part of specific
chemotherapy regimens.
Contact your insurance and compare the cost at home via a
home health agency versus in the office. Though a B12 injection is quite
inexpensive, the costs of the visit, parking and lost time from work can add
up. If a nurse can come to your home, at your convenience, and for less, why
not ask your oncologist to set it up?
Do get a list of contracted providers from your insurance
first, and make sure the order goes out to the right agency, in a timely
manner.
In conclusion:
Some oncologists may resist some of your requests, such as
setting up a home infusion or guiding you through a manufacturer assistance
program application. After all, these added tasks use up valuable staff time.
Others may not welcome you questioning their decision, and
may interpret this as a criticism or lack of confidence in their ability as a
physician.
Do reassure your doctor that your goal is to get the best, most
appropriate treatment but while making the process as cost-effective as
possible. After all, the lower his bill, the faster you can pay it off.
Remember: you have rights to the information and
explanations necessary to make informed, educated choices. Being an active
participant in your care can only help your oncologist help you.
©
[2016] Advimedpro.
©
[2016] Martine G. Brousse.
All rights reserved.
AdvimedPro (424) 999
4705 or (877) 658 9446 fax (424) 226 1330
My
objective is to offer you, the patient, concrete and beneficial
information, useful tips, proven and efficient tools as well as
trustworthy supportive advice as you deal with a system in the midst of sweeping adjustments, widespread misunderstandings and complex requirements.
AdvimedPro (424) 999 4705 or (877) 658 9446 fax (424) 226 1330
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