When you or someone you care about are facing cancer, you may find yourself focused on the disease, treatment and doctors. Many people forget to ask questions that can help them manage the costs associated with cancer or even know what questions to ask or who to ask.
Ruth Van Gerpen, Bryan oncology clinical nurse specialist discusses financial questions you may have after a cancer diagnosis.
Selected Podcast
How to Deal With the Financial Side of Cancer Treatment
Featured Speaker:
Ruth Van Gerpen, RN, Bryan oncology clinical nurse specialist
Ruth Van Gerpen is an oncology clinical nurse specialist at Bryan. Transcription:
How to Deal With the Financial Side of Cancer Treatment
Melanie Cole (Host): When you or someone you love is facing cancer, you find yourself focused on the disease, treatments and physicians, and you don’t always think about the questions that could help manage the costs associated with cancer treatment. My guest today is Ruth Van Gerpen. She’s an oncology clinical nurse specialist at Bryan Health. Ruth, let’s just start with that diagnosis, because then a million things go through people’s heads. They are really freaked out, they don’t even think about the financial impact at that point. What do you want them to put in their mind? Or if it is someone they love, maybe the clearer thinking person can think about the financial aspect? What is the first thing you want people to know?
Ruth Van Gerpen, Oncology Clinical Nurse Specialist (Guest): The thing that I think is important is for them to learn initially about the diagnosis. That will help them be able to ask more questions when they learn about the diagnosis and especially the treatment options that are present. The oncologist will make sure and go through that with you and in many cases, there will be options as far as different choices. So, the more you know, the more you can truly take an active part in making those decisions that actually may affect costs for you. Some people are afraid that if they think about the costs, that it’s going to impact what their treatment is or the outcome of that. But those again, need to be important conversations and questions that you ask. So, don’t hesitate to ask the doctor, the oncologist, how much a certain treatment that they are recommending will cost and in some cases, is there a less expensive option.
Now there are so many new drugs that we have that are available for treatment. Some of them are much more expensive. We read about those in the paper. We hear others talk about it. And it’s important that you are aware of what the cost is of the treatment that is being offered and is that the only option that you might have. It doesn’t necessarily mean just because it costs more that it’s actually going to work better. And it’s also important to know what results they would expect with each of the different options and as well as how they compare.
I think the next thing that each person needs to do is to review your health insurance coverage. Know what it covers. Are there certain doctors that it will cover? Are there certain hospitals or medical centers or clinics in which you need to receive your care? What types of tests and scans as well as even the variety of drugs that are going to be ahead for you during this time of treatment? It’s also important that you know what your deductibles are. What kind of copays do you have? What are your out-of-pocket expenses? Once you have met your deductible, what are you going to be paying? Your insurance pays 80%, then you will have to pay 20%. That sounds good, but when you start looking at overall expense, sometimes that can be overwhelming. One of the people who can help you look at that is your employer’s benefits department. Find somebody there that will sit down with you and go through your benefits, your specific insurance plan that you have and how it relates to where you are now with your health, with your diagnosis, what the treatment is that is planned and how your health insurance benefits can help you the most so that you can actually maximize those benefits.
Host: Talking about health insurance is confusing and some people don’t even understand when you say 80-20. Who can they get clarification and also Ruth, sometimes you ask a doctor for a cost on something and they say we won’t know until we’ve coded it – you can’t always get a straight answer on the cost.
Ruth: No, you can’t. And I think one of the individuals and especially at your oncology offices that are extremely helpful is that they have individuals there that one of the primary things they do is to help people with those financial needs, the financial questions, and help them understand what this may cost. And some of it may be this amount, but sometimes just even if it’s an average or kind of a range I guess, is going to be more helpful than not knowing anything at all. So, insurance can impact what that final amount might be, but in the offices, the physician offices, the oncology offices, they do this so much they're very familiar with many of the insurance plans that people have, what typically the reimbursement is going to be and how much out-of-pocket it might be. They also know other avenues to help them try to get the medications, especially the chemotherapy drugs at a lesser cost depending again on what their overall income level is and what might be available to them.
So, I think one of the most important things is to utilize those resources in the oncology offices. Sit down with them and make an appointment. Ask to talk to one of them. Sometimes they're called a financial counselor. Sometimes they may call them a financial navigator. But these can help you look at what options are available from a cost standpoint. They will also be very helpful especially for people whose income is lower, even honestly for people that don’t have health insurance.
Host: Well that was going to be my next question. What if someone doesn’t have health insurance? What should they do?
Ruth: Oh, I’m sure one of the first things they are going to do is be a little bit on the scared side and a little bit fearful, probably a lot fearful. Because we know that this is going to cost, and they are going to be aware of that as well. I think one of the first things that I want them to know is to understand that they will still get the treatment that is best for them. It oftentimes accounts for more creativity from the staff especially to try to look at what resources are available as well as utilizing a variety of different programs to help provide drugs at discounts. It is also important to look at what type of payment plans might be available. In other words, at the doctor’s office, what kind of options might be there for them or even in the hospital. In the hospital, there are outpatient clinics that may find that the payment options at the hospital may be less expensive, it may be more expensive than doing it at the doctor’s office. So, check that out and again those can be provided through the benefits department at the hospital or through one of the financial individuals at the doctor’s office.
Host: One of the big problems that people face is managing the bills as they come in. And if you are trying to do as you say and keep track of how much something is going to cost or when you’ve reached your deductible and how much the certain coinsurance or copay is going to be, what’s your best advice for keeping track of them all?
Ruth: It is overwhelming and often very confusing. I think about the struggles I have and I’m not dealing with a cancer treatment. It’s just sometimes bills from having seen physicians and other providers. So, oftentimes what you will do is keep in mind what the bill says. You may get a bill that say do not pay because you don’t know yet what your insurance is going to cover. Then you will get bills that say pay this amount, but it doesn’t always really tell you for sure what you are paying for. So, one of the things that we recommend that you do is get yourself some type of a folder, whether it’s an accordion type folder or you just have different file folders and organize the bills either by month or by provider. Whatever works for you, so that you can categorize them and then kind of keep them separate. What you want to do then is the bills that go together, your initial bill and then the statement that you get telling you what insurance has paid and then the bill that will come back saying now this is what you owe. Keep it together. Staple it, paperclip it together so that you better know what has been paid, what insurance has been paid as well as then what you owe. One of the things too, that is very helpful to keep track of, are these explanation of benefits that you get from the insurance company because that should tell you specifically how much they paid, what they didn’t pay and the reason why. And if those don’t make sense, call the insurance company or again, if you are employed, talk to your benefits people there, the benefits staff. They can be immensely helpful in helping you understand those explanation of benefits papers. But keep all of those things together.
One of the things too, that I often encourage people to do is don’t try to do this alone. You are going to have family members or friends that say is there anything that I can help you with. And if you know that this is somebody who is organized, ask them to help and let them help you. They can help you organize it, review your bills so that you know what your insurance has paid, what you are expected to pay. Once you have paid it, write the date that you paid on it, how much you paid, the check number can be helpful as well, so that you can keep all of that together. But enlist the help and accept the help from others.
Some people will also find it helpful to put together a spreadsheet. It kind of depends on what you are used to doing in managing your current expenses outside of your health care. But it can help you know your treatment costs as well as other expenses. You’ve got your rent, or your mortgage is due, and you have got your utilities due and how is this impacting you and where you're coming up short. That will also help you know as far as how you can you manage some of this or take advantage of some of the other resources that are available in the community from different grants and foundations that actually can give you some money that may help you with utilities so that you can pay a medical bill. Also, one of the things that sometimes you can include on your taxes is some of your travel costs, or even some of your deductions that you have had to do related to your health care. So, trying to manage all of that can be overwhelming, but I would tell you probably the number one suggestion I would have for that is to accept the offer of help or ask somebody to help you.
Host: That’s great information and as you say it can be confusing and overwhelming and scary. You’ve given us such great advice about keeping track and who to go to and what resources can help you sort all of the financial questions you might have. Please give us your final thoughts and what you would like people to take away from this segment.
Ruth: Well I probably already said it once, but I will tell you I think it’s the most important piece of advice and that is for both the patients as well as the family members, is ask for help. This help can be available in so many places. If you call the insurance company, get their name and maybe this can be somebody you can talk to each time, so that it isn’t somebody new and this is somebody that gets to know you and you get to know and trust them. The doctors can be of help. There are benefits people at the hospital and again, find one person there, in the benefits or financial aid department, and always ask for that person as well. Enlist your family members. There are a number of support groups in the community and there may be somebody there that has been through this before and what it was that helped them do this.
Make sure you say yes when somebody asks you if there is something you need or something that they can do for you. Whether it’s helping you with the financial assistance or finding resources or in some cases, it’s the transportation. They may offer to bring you some food, which again can help out overall with your financial situation, or help out with shopping for you. Say yes. The most important thing is accept the offer of help that others are offering to you.
Host: That’s great information Ruth. Thank you so much for coming on and sharing your expertise which is extensive in this area. Thank you again for all the great work you do. If you’d like to learn more about Bryan’s cancer nurse navigators and how they can help you through your cancer diagnosis, you can go to www.bryanhealth.org/cancernursenavigators, that’s www.bryanhealth.org/cancernursenavigators. Thank you again for being with us. This is Melanie Cole.
How to Deal With the Financial Side of Cancer Treatment
Melanie Cole (Host): When you or someone you love is facing cancer, you find yourself focused on the disease, treatments and physicians, and you don’t always think about the questions that could help manage the costs associated with cancer treatment. My guest today is Ruth Van Gerpen. She’s an oncology clinical nurse specialist at Bryan Health. Ruth, let’s just start with that diagnosis, because then a million things go through people’s heads. They are really freaked out, they don’t even think about the financial impact at that point. What do you want them to put in their mind? Or if it is someone they love, maybe the clearer thinking person can think about the financial aspect? What is the first thing you want people to know?
Ruth Van Gerpen, Oncology Clinical Nurse Specialist (Guest): The thing that I think is important is for them to learn initially about the diagnosis. That will help them be able to ask more questions when they learn about the diagnosis and especially the treatment options that are present. The oncologist will make sure and go through that with you and in many cases, there will be options as far as different choices. So, the more you know, the more you can truly take an active part in making those decisions that actually may affect costs for you. Some people are afraid that if they think about the costs, that it’s going to impact what their treatment is or the outcome of that. But those again, need to be important conversations and questions that you ask. So, don’t hesitate to ask the doctor, the oncologist, how much a certain treatment that they are recommending will cost and in some cases, is there a less expensive option.
Now there are so many new drugs that we have that are available for treatment. Some of them are much more expensive. We read about those in the paper. We hear others talk about it. And it’s important that you are aware of what the cost is of the treatment that is being offered and is that the only option that you might have. It doesn’t necessarily mean just because it costs more that it’s actually going to work better. And it’s also important to know what results they would expect with each of the different options and as well as how they compare.
I think the next thing that each person needs to do is to review your health insurance coverage. Know what it covers. Are there certain doctors that it will cover? Are there certain hospitals or medical centers or clinics in which you need to receive your care? What types of tests and scans as well as even the variety of drugs that are going to be ahead for you during this time of treatment? It’s also important that you know what your deductibles are. What kind of copays do you have? What are your out-of-pocket expenses? Once you have met your deductible, what are you going to be paying? Your insurance pays 80%, then you will have to pay 20%. That sounds good, but when you start looking at overall expense, sometimes that can be overwhelming. One of the people who can help you look at that is your employer’s benefits department. Find somebody there that will sit down with you and go through your benefits, your specific insurance plan that you have and how it relates to where you are now with your health, with your diagnosis, what the treatment is that is planned and how your health insurance benefits can help you the most so that you can actually maximize those benefits.
Host: Talking about health insurance is confusing and some people don’t even understand when you say 80-20. Who can they get clarification and also Ruth, sometimes you ask a doctor for a cost on something and they say we won’t know until we’ve coded it – you can’t always get a straight answer on the cost.
Ruth: No, you can’t. And I think one of the individuals and especially at your oncology offices that are extremely helpful is that they have individuals there that one of the primary things they do is to help people with those financial needs, the financial questions, and help them understand what this may cost. And some of it may be this amount, but sometimes just even if it’s an average or kind of a range I guess, is going to be more helpful than not knowing anything at all. So, insurance can impact what that final amount might be, but in the offices, the physician offices, the oncology offices, they do this so much they're very familiar with many of the insurance plans that people have, what typically the reimbursement is going to be and how much out-of-pocket it might be. They also know other avenues to help them try to get the medications, especially the chemotherapy drugs at a lesser cost depending again on what their overall income level is and what might be available to them.
So, I think one of the most important things is to utilize those resources in the oncology offices. Sit down with them and make an appointment. Ask to talk to one of them. Sometimes they're called a financial counselor. Sometimes they may call them a financial navigator. But these can help you look at what options are available from a cost standpoint. They will also be very helpful especially for people whose income is lower, even honestly for people that don’t have health insurance.
Host: Well that was going to be my next question. What if someone doesn’t have health insurance? What should they do?
Ruth: Oh, I’m sure one of the first things they are going to do is be a little bit on the scared side and a little bit fearful, probably a lot fearful. Because we know that this is going to cost, and they are going to be aware of that as well. I think one of the first things that I want them to know is to understand that they will still get the treatment that is best for them. It oftentimes accounts for more creativity from the staff especially to try to look at what resources are available as well as utilizing a variety of different programs to help provide drugs at discounts. It is also important to look at what type of payment plans might be available. In other words, at the doctor’s office, what kind of options might be there for them or even in the hospital. In the hospital, there are outpatient clinics that may find that the payment options at the hospital may be less expensive, it may be more expensive than doing it at the doctor’s office. So, check that out and again those can be provided through the benefits department at the hospital or through one of the financial individuals at the doctor’s office.
Host: One of the big problems that people face is managing the bills as they come in. And if you are trying to do as you say and keep track of how much something is going to cost or when you’ve reached your deductible and how much the certain coinsurance or copay is going to be, what’s your best advice for keeping track of them all?
Ruth: It is overwhelming and often very confusing. I think about the struggles I have and I’m not dealing with a cancer treatment. It’s just sometimes bills from having seen physicians and other providers. So, oftentimes what you will do is keep in mind what the bill says. You may get a bill that say do not pay because you don’t know yet what your insurance is going to cover. Then you will get bills that say pay this amount, but it doesn’t always really tell you for sure what you are paying for. So, one of the things that we recommend that you do is get yourself some type of a folder, whether it’s an accordion type folder or you just have different file folders and organize the bills either by month or by provider. Whatever works for you, so that you can categorize them and then kind of keep them separate. What you want to do then is the bills that go together, your initial bill and then the statement that you get telling you what insurance has paid and then the bill that will come back saying now this is what you owe. Keep it together. Staple it, paperclip it together so that you better know what has been paid, what insurance has been paid as well as then what you owe. One of the things too, that is very helpful to keep track of, are these explanation of benefits that you get from the insurance company because that should tell you specifically how much they paid, what they didn’t pay and the reason why. And if those don’t make sense, call the insurance company or again, if you are employed, talk to your benefits people there, the benefits staff. They can be immensely helpful in helping you understand those explanation of benefits papers. But keep all of those things together.
One of the things too, that I often encourage people to do is don’t try to do this alone. You are going to have family members or friends that say is there anything that I can help you with. And if you know that this is somebody who is organized, ask them to help and let them help you. They can help you organize it, review your bills so that you know what your insurance has paid, what you are expected to pay. Once you have paid it, write the date that you paid on it, how much you paid, the check number can be helpful as well, so that you can keep all of that together. But enlist the help and accept the help from others.
Some people will also find it helpful to put together a spreadsheet. It kind of depends on what you are used to doing in managing your current expenses outside of your health care. But it can help you know your treatment costs as well as other expenses. You’ve got your rent, or your mortgage is due, and you have got your utilities due and how is this impacting you and where you're coming up short. That will also help you know as far as how you can you manage some of this or take advantage of some of the other resources that are available in the community from different grants and foundations that actually can give you some money that may help you with utilities so that you can pay a medical bill. Also, one of the things that sometimes you can include on your taxes is some of your travel costs, or even some of your deductions that you have had to do related to your health care. So, trying to manage all of that can be overwhelming, but I would tell you probably the number one suggestion I would have for that is to accept the offer of help or ask somebody to help you.
Host: That’s great information and as you say it can be confusing and overwhelming and scary. You’ve given us such great advice about keeping track and who to go to and what resources can help you sort all of the financial questions you might have. Please give us your final thoughts and what you would like people to take away from this segment.
Ruth: Well I probably already said it once, but I will tell you I think it’s the most important piece of advice and that is for both the patients as well as the family members, is ask for help. This help can be available in so many places. If you call the insurance company, get their name and maybe this can be somebody you can talk to each time, so that it isn’t somebody new and this is somebody that gets to know you and you get to know and trust them. The doctors can be of help. There are benefits people at the hospital and again, find one person there, in the benefits or financial aid department, and always ask for that person as well. Enlist your family members. There are a number of support groups in the community and there may be somebody there that has been through this before and what it was that helped them do this.
Make sure you say yes when somebody asks you if there is something you need or something that they can do for you. Whether it’s helping you with the financial assistance or finding resources or in some cases, it’s the transportation. They may offer to bring you some food, which again can help out overall with your financial situation, or help out with shopping for you. Say yes. The most important thing is accept the offer of help that others are offering to you.
Host: That’s great information Ruth. Thank you so much for coming on and sharing your expertise which is extensive in this area. Thank you again for all the great work you do. If you’d like to learn more about Bryan’s cancer nurse navigators and how they can help you through your cancer diagnosis, you can go to www.bryanhealth.org/cancernursenavigators, that’s www.bryanhealth.org/cancernursenavigators. Thank you again for being with us. This is Melanie Cole.