Cancer Debt: The Hidden Costs Beyond Insurance
Having health insurance is no guarantee that cancer won't bankrupt you. Even people with insurance can run up large debts for cancer care, according to a new report from the Kaiser Family Foundation and the American Cancer Society.
"It's not necessarily not having insurance — it's not having adequate insurance," says John Seffrin, CEO of the American Cancer Society. "Our best data would indicate that roughly 1 in 5 people in this room today think they have health insurance that will cover them, but if they get a diagnosis of cancer, it's inadequate," says Seffrin, speaking at the presentation of the report.
Treatment In The Doctor's Office
Susan Braig knows what Seffrin is talking about. The 59-year-old jewelry-maker and grant writer in Altadena, Calif., was diagnosed with breast cancer in 2004. She had bought the cheapest insurance she could find, a so-called "catastrophic" policy that just covered hospitalization.
When she learned she had cancer, she assumed her policy would cover all of her treatment. "A lot of it was my own inexperience, assuming every cancer treatment was a hospitalization or surgery," says Braig. "I didn't realize a lot of cancers are now being treated like chronic diseases."
Most of Braig's care was conducted out of the hospital. The MRIs, bone density scans, ultrasounds and chemotherapy were all done in her doctor's office. Her medical bills have now put her $40,000 in debt.
Braig has started making something she calls "prescription jewelry." She uses pills, capsules and medical supplies that have been sealed or glued so they're no longer usable. Her goal in making jewelry out of medical gear is "to show that health care, like jewelry, is a luxury."
Bills Looming, Surgery Incomplete
Nelda Lopez, age 48, had a different problem with her health insurance policy. The San Antonio resident was diagnosed with breast cancer in September 2007. She had a double mastectomy that October. Her insurer had a list of doctors it would cover, and her surgeon was on the list.
The surgeon had recommended a plastic surgeon to do the reconstructive work that immediately followed the mastectomy. Lopez remembers being told by the plastic surgeon's office that her insurer considered him to be on their list for the particular type of procedure she received.
But then, she says, "I started having excessive bills." She was shocked. "It was just such a high balance."
She expected to pay $800 for the surgery, but the insurer insisted the plastic surgeon was not in its network. She was stuck with a $2,100 bill that she's still paying off one-and-a-half years after the procedure. Meanwhile, she has postponed steps two to four of the reconstructive surgery, which would make her reconstructed breasts look more natural.
There's no clear count of how many people have had trouble getting their insurance to pay for their cancer care. But officials at the American Cancer Society say that with the bad economy and people buying cheaper insurance policies, the number is growing. The cancer society has set up a hotline for people having trouble paying for cancer treatment. Without much advertising, call volume was up 12 percent in January compared to the previous year, and up 37 percent in February.
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Dr. John Rowe, a health policy professor at Columbia University who headed health insurer Aetna for six years, has a few tips on how people can get the most out of their health insurance:
1. Call the number on the back of your insurance card and ask your insurer whether it has special programs for people with cancer. Some insurers have deals with doctors or hospital groups for low-cost care.
2. Get a list from your insurer of which doctors and hospitals are covered, and carry it with you on every doctor visit. Anytime your doctor refers you to another doctor, ask him or her to pick one off the list.
3. If you can't get your insurance to pay, negotiate with the doctor or hospital. You may be able to get the charge lowered or work out a monthly no-interest payment plan.
And this tip from insurance expert and cancer survivor Karen Pollitz of Georgetown University:
4. Buy the right insurance policy in the first place. High co-payments for doctors' visits, or a $10,000 or $20,000 annual limit on coverage, can be financially devastating to someone who gets cancer. Pollitz says to check for a comprehensive list of what's covered and pay attention to how much you have to spend before your policy will take over all expenses. Many policies make it difficult to reach that point.
--Joanne Silberner
STEVE INSKEEP, host:
It's MORNING EDITION from NPR News. I'm Steve Inskeep.
RENEE MONTAGNE, host:
And I'm Renee Montagne. Today in Your Health, how hard it can be to buy a health insurance policy on your own. But first: Just because you have insurance doesn't mean your cancer care will be covered. NPR's Joanne Silberner reports that you have to be very careful and very aware to get what you're due.
JOANNE SILBERNER: Susan Braig got the bad news five years ago.
Ms. SUSAN BRAIG (Cancer Patient): In July, 2004 a shadow on a mammogram indicated I had a Stage 2 invasive breast cancer tumor.
SILBERNER: She's a part-time artist and a part time grant proposal writer in Altadena, California. Braig had bought herself the lowest cost Blue Cross plan she could find. It just covered hospital care.
Ms. BRAIG: I thought that at least I would be covered for the big stuff, and the small stuff I would just have to take care of it myself. I thought cancer was the big stuff.
SILBERNER: Cancer is a big deal medically, but much of the care can be done in a doctor's office. Her hospital-only insurance didn't pay for her chemotherapy, MRIs, bone density scans, blood tests, doctors visits and more. As a result, Braig is now about $40,000 in debt.
In San Antonio, Nelda Lopez was diagnosed with breast cancer in September, 2007. Her insurance policy only covered certain doctors. She found a surgeon on the list to do the bilateral mastectomy. He recommended a plastic surgeon for the reconstructive work. Lopez thought the plastic surgeon was on the list too. The first physician had recommended him and the plastic surgeon's office had told her he was part of the network for this particular procedure. But…
Ms. NELDA LOPEZ (Cancer Patient): After my surgeries I started having excessive bills coming in and coming in. And I'm wondering, God, why, you know, there's just such a high balance now.
SILBERNER: Her insurer said her surgeon was not on the list and refused to pay. Lopez made countless call to the doctor's office and insurer during her lunch hour and breaks.
Ms. LOPEZ: You know, you fight one battle and then it's like I was fighting another battle.
SILBERNER: Lopez has given up, at least for the moment. She's paying off her $2,100 balance $50 a month. She's delaying the second stage of the surgery, routine patches to the scars and cosmetic restoration for the breasts.
Avoiding insurance pitfalls can be a challenge, says John Rowe. He headed insurance giant Aetna for six years. He says, though, that there are things you can do when your doctor tells you you have cancer.
Mr. JOHN ROWE (Former Aetna Executive): The first thing you should do is you should take out your insurance card and turn it over and call the number that says questions, help, call this number. Every insurance card has a number.
SILBERNER: Many insurance companies can point you to a hospital or program that's fully covered. Rowe's second suggestion would have helped Nelda Lopez. Get a list of in-network doctors from your insurer and bring it with you to every doctor's appointment. When all else fails, he says, negotiate.
Mr. ROWE: Many hospitals will be willing to work with you to reduce your exposure or to provide you with a payment schedule, a no-interest payment schedule. Just don't give up.
SILBERNER: All well and good, says health insurance expert Karen Pollitz of Georgetown University, except for one thing. It's tough to think clearly after hearing a cancer diagnosis. She recently told some cancer survivors how she felt when two weeks after her preauthorized mastectomy she got a claims statement.
Ms. KAREN POLLITZ (Cancer Patient): And it had been denied. And you know, it turned out to be a mistake. But there I was, you know, a health policy expert. I worked for the Secretary of Health of Human Services. I was pretty wired. You know, my husband worked for a Fortune 500 company. And I sat down on my kitchen floor and cried. I did.
SILBERNER: Her advice: be careful what you buy in the first place. Co-payments can add up when you have cancer. And a policy with a $10,000 annual cap won't even get you through your first surgery.
Joanne Silberner, NPR News. Transcript provided by NPR, Copyright National Public Radio.
