addressing the financial burden of cancer
DESCRIPTION
When you were diagnosed with cancer, you were thrust into the fight of your life. But you may have quickly learned that the greater battle was surviving the hit that your cancer care delivered to your bank account. You’re not alone. Bankruptcy rates are almost twice as high among cancer patients as the general population. "Patients diagnosed with cancer may face significant financial stress, owing to income loss and out-of-pocket costs associated with their treatment," says Scott Ramsey, MD, PhD, a healthcare economist and internist at the Fred Hutchinson Cancer Research Center in Seattle, Washington. "On average, bankruptcy rates increased 4-fold within 5 years of diagnosis." Join Fight Colorectal Cancer for a webinar that will detail what resources exist to help patients navigate the very expensive waters of cancer treatment. You will hear from a person who is on the front lines of the battle: Elaine Martinez, a case manager with the Colorectal CareLine at the Patient Advocate Foundation. Elaine serves as an active liaison between patients and their insurers, employers and/or creditors to resolve insurance, job retention, and/or debt crisis matters relative to their diagnosis of colorectal cancer. Her responsibilities include: exploring reimbursement levels for prescribed colorectal cancer treatments, researching available clinical trials for this patient population and facilitating enrollment into appropriate patient resource programs for both the uninsured and underinsured colorectal patients.TRANSCRIPT
Welcome!
Addressing the Financial Burden of Cancer
Part of Fight Colorectal Cancer’s Monthly Patient Webinar Series
Our webinar will begin shortly
www.FightColorectalCancer.org877-427-2111
Fight Colorectal Cancer
1. Tonight’s speaker: Elaine Martinez, LPN
2. Archived webinars: Link.FightCRC.org/Webinars
3. Follow up survey to come via email. Get a free Blue Star of Hope pin when you tell us how we did tonight.
4. Ask a question in the panel on the right side of your screen
5. Or call the Fight Colorectal Cancer Answer Line at 877-427-2111
www.FightColorectalCancer.org877-427-2111
Fight Colorectal CancerUpcoming Webinar
The Latest in Colorectal Cancer ResearchTuesday, February 19th
8pm EST
Dr. Richard GoldbergPhysician-in-chief
Ohio State’s Comprehensive Cancer Center
Register at www.FightColorectalCancer.org
1-877-427-2111
Fight Colorectal Cancer
Funding Research DirectlyLisa Dubow Fund
http://fightcolorectalcancer.org/research/lisa-fund
Fight Colorectal CancerDisclaimer
The information and services provided by Fight Colorectal Cancer are for general informational purposes only.
The information and services are not intended to be substitutes for professional medical advice, diagnosis, or treatment.
If you are ill, or suspect that you are ill, see a doctor immediately. In an emergency, call 911 or go to the nearest emergency room.
Fight Colorectal Cancer never recommends or endorses any specific physicians, products or treatments for any condition.
www.FightColorectalCancer.org877-427-2111
Fight Colorectal Cancer
www.FightColorectalCancer.org877-427-2111
Elaine C. Martinez, LPNCase Manager, Colorectal CareLine
Patient Advocate Foundation
Financial and Insurance
Implications for the Cancer Patients
Elaine C. Martinez, LPNSenior Case Manager
Patient Advocate Foundation
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Our Mission: To Serve Patients
Our Mission
• Patient Advocate Foundation seeks to safeguard patients through effective mediation assuring access to care, maintenance of employment and preservation of their financial stability relative to their diagnosis of life threatening or debilitating diseases.
Our Impact
• Since our inception in 1996, PAF has provided direct, sustained patient assistance to more than 500,000 patients and touched millions more American lives through the PAF website, online chats and outreach events.
Direct Patient Services offered by PAF
• Brokering resources to supplement the limits of insurance and to assure access to care for the uninsured
• Resolving debt crisis relative to a diagnosis • Negotiating access to pharmaceutical agents, chemotherapy,
medical devices and surgical procedures• Resolving insurance issues in the public and private sector• Negotiating pre-authorization approvals• Providing assistance in facilitating and expediting the appeals
process• Health insurance denials• Social Security Disability
• Negotiating resolutions to coding and billing errors
The UNinsured
Public Benefits, Safety Nets & Charity Care
• County Indigent Medical Assistance/Community Hospital Charity/Sliding Scale fee discounts
• Medicaid (SSI linked and Share-of-Cost /Breast & Cervical/Medicare savings programs/Long-term care Medicaid)
• Pharmaceutical and Durable Medical Equipment and Supply Assistance for the uninsured
www.needymeds.org
Utilization of Hospital Support Staff
• If you need help, a good place to start is with the social worker, financial counselor or nurse at the hospital where you are being treated. (These people are the most knowledgeable about community resources who might offer help as well as internal programs funds the hospital may have to help cancer patients)
• Remember: Do not ignore the bill. If you receive a hospital bill, it is important that you do not ignore it. Hospitals have the right to refer your bill to a collections agency if it is not paid. Instead, make sure to call your hospital's billing office right away to ask about payment plan options and financial discounts.
Know your rights under the Fair Debt Collections Act!
www.ftc.gov/bcp/edu/pubs/consumer/credit/cre27.pdf
Medicaid
Government-sponsored medical insurance program based on financial need. To receive Medicaid, your income and assets must be below a certain level. It covers hospital care, physician’s fees, prescription drugs, home care and many other services. In order to qualify, you must be aUS resident. Medicaid is only valid in the state in which it is issued. You can go to your local county Department of Social Services for an application.
Work transitions and the Self-employed
COBRA : Group policy extension of 18 months + 11 months = 29 months (Medicare eligibility) – for those deemed disabled within the initial 2 months of the COBRA
extension.
HIPAA portability : Guarantees that certain individuals will have access to, and can renew, individual health
insurance policies.
Guaranteed Issue : Group insurance in which all members of a small group who meet certain conditions automatically receive coverage without individual underwriting (in most states groups of 2-50 employees)
www.statehealthfacts.org
Your medical expenses may be tax-deductible.
Medical costs that are not covered by insurance policies sometimes can be deducted from annual income before taxes. Currently, they must exceed 7.5% of your adjusted gross income to be deductible. So, if your income is $30,000, then you could deduct out-of-pocket medical costs that exceed $2,250. Medical costs include doctor’s bills, drugs, medical supplies and anything related, including transportation and lodging. Your local IRS office, tax consultants or certified public accountants can help you with the specifics; or see www.irs.gov and download Publication 502, Medical and Dental Expenses
Social Security Disability Benefits
Disability Evaluation under Social Security:Factors: Age, Education, Work Background, Disability (inability to
perform gainful work activity). Requires that the applicant be unable to perform gainful work activity for 12 months from the onset date of
disability.
http://www.ssa.gov/disability/professionals/bluebook/
165 medical conditions (47 are forms of Cancers) currently qualify for expedited processing of Social Security Disability benefits:
http://www.ssa.gov/compassionateallowances/conditions.htm
Social Security Disability Evaluation
Initial
applicatio
n
• Local Social Security office (in person, telephone or on-line)
Phone
interview
• Local Social Security office (non-medical eligibility check – work credits, age, marital status, etc..)
DDS offic
e
• Disability Determination Services (evaluates disability)
Timeline for evaluation (approval/denial/appeals process)
Approval
• Expedited processing (8-10 days for “flagged” cases) – QDD processing
• Standard processing (4-6 months)
Denial
and recourse
• Reconsideration (1st level) – appellant submits with added medical records/assessments
• Some states will allow the appellant to skip to a 2nd level Hearing with an Administrative Law Judge (ALJ)
ALJ Hearing
• Appellant may hire a Disability attorney, represent him/herself and/or appoint an unpaid 3rd party to assist in furthering his/her case (Patient Advocate Foundation)
Medicare
• A government-sponsored medical insurance program usually for people who are aged 65 or older. People of any age who have been disabled and have received Social Security Disability payments for 24 months are also eligible. Benefits vary from person to person. Medicare provides basic health coverage, but it doesn’t pay for all health expenses. Call 1.800.MEDICARE (1.800.633.4227) or visit www.medicare.gov.
The Underinsured & Patient Assistance
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Co-Payment Assistance:
Non-profit and pharmaceutical funding exists: privately and governmentally insured (Medicare); disease specific funds ever-changing
***Premium Assistance: www.healthwellfoundation.org www.lls.org ***
Disease-specific charity:
Diagnosis specific and usually need-basedPatients typically must be in active care or limited post-treatment timeframeFunding for medical expense assistance and household stabilization National charities for families with children or pediatric cancer patientsMonies for special populations: musicians, artists, flight attendants,
Registered Nurses, truckdrivers, federal employees, etc…
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CPR Mission
• The PAF Co-Pay Relief Program (CPR) exists to provide direct financial assistance to insured patients who cannot afford the co-payments and co-insurance required to access prescribed pharmaceutical therapies.
Our Mission: Supplement the limits of health insurance
Professional CPR Call Counselors assist patients in completing application forms and securing authorizations needed to verify medical and financial necessity to qualify patients.
Upon Approval, payments are made directly to the doctor, pharmacy or patient.
CPR provides assistance to both commercially and government insured patients including Medicare Part D beneficiaries.
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CPR provides cash co-payment assistance for insured patients unable to use their prescription drug benefits due to inability to pay their co-payments.
Patients, physicians, and pharmacies can contact CPR™ directly to initiate a request for assistance.
A 24 hour secured web based patient portal to allow patients another option to enroll.
ramHow the Program Operates
• Breast Cancer• Chemotherapy Induced
Anemia/Neutropenia• Colon Cancer• Cutaneous T-Cell Lymphoma• Hepatitis C• Kidney Cancer• Lung Cancer (Non-small cell
Lung Cancers)
• Multiple Myeloma
• Myelodysplastic Syndrome (MDS, and other pre-leukemia diseases)
• Osteoporosis• Pain• Prostate Cancer • Rheumatoid Arthritis• Sarcoma
CPR currently offers assistance in 19 disease funds including:
CPR Open Disease Funds
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• Assistance Fund• Cancer Care• Chronic Disease Fund, Inc.• Healthwell Foundation• Leukemia and Lymphoma Society• National Organization for Rare Disorders• Patient Access Network Foundation • Patient Advocate Foundation Co-Pay Relief• Patient Services Incorporated
National Co-Payment Programs
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Partnership for Prescription Access http://www.pparx.org/en/prescription_assistance_programs
Patient Assistance Programs Co-Payment Programs/Diagnostic or
Testing Assistance Free/Low-Cost Clinic Finder Discount Saving Cards by State
NeedyMeds www.needymeds.com
Patient Assistance Programs Disease Based Assistance Free/Low Cost Clinics Discount Drug Cards Drug Coupons Brand/Generic Assistance
National Underinsured Resource Directoryhttp://www.patientadvocate.org/help4u.php
Intended to help underinsured individuals and families locate valuable resources and seek alternative coverage options or methods for better reimbursement.
National Financial Resource Guidehttp://www.patientadvocate.org/report.php
The National Financial Resources Guidebook for Patients: A State by State Directory of information for patients seeking financial relief for a broad range of needs including housing, utilities, food, transportation to medical treatment, and children's resources.
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Medication Website Resources
National Underinsured Resource Directory
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http://patientadvocate.org/help4u.php
National Underinsured Resource Directory Pull Out Cards
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Seven pull out cards were created based on the topics commonly addressed by PAF patients based on needs and issues of the underinsured population. Each card offers action steps or suggestions to compliment the resources they will be provided.
http://link.brightcove.com/services/player/bcpid1875349721?bctid=608833805001
Health Care Reform
Uninsured Adults ages 19-64
Texas: 30% Travis: 25.5% Austin: 27% U.S. uninsured: 19.5%
The Uninsurable – High Risk Pools
FEDERAL Pre-Existing Condition Insurance Plan (PCIP) Qualifying health condition; uninsured 6 mos prior to enrollment Comprehensive benefits; capped out-of-pocket costs; plan options
https://www.pcip.gov/StatePlans.html
www.healthcare.gov
State Issued HIGH RISK INSURANCE POOL Viable option when COBRA expires (19th month) Comprehensive benefits; plan options For the insured with high deductible/catastrophic coverage‼ COST PROHIBITIVE PREMIUMS
www.naship.org
Risk Pool Implementation
¡Cover the Uninsured!
Premium rates for Texas2011 monthly PCIP premium rates by age enrollee, effective 7/1/2011. Benefits are effective the 1st day of the following month upon enrollment.
www.pcip.gov/StatePlans
Age Standard Option Extended Option
HSA Option
0 to 18 $133 $179 $138
19 to 34 $199 $268 $207
35 to 44 $239 $323 $248
45 to 54 $306 $412 $318
55+ $426 $572 $442
Looking forward - ACA
• Health Insurance Exchanges (2014)The Healthcare Reform Act requires that health insurance exchanges be established in each state. Individuals and small employers will be able to enroll into the exchange. Small employers are defined as those with no more than 100 employees. Larger employers will be able to enroll into the exchange in 2017.
• Premium Subsidies (2014)Premium and cost-sharing subsidies will make health insurance more affordable for every family with annual incomes between 133% and 200% Federal Poverty Level that purchase plans through the exchange.
www.insureustoday.org
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contact us at 866-207-8023
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421 Butler Farm Road Hampton, VA 23666
Phone: 1-866-512-3861
Fax: (757) 952-0118 Internet: www.copays.org
E-Mail: [email protected]
Contact Us
421 Butler Farm Road Hampton, VA 23666
Phone: 1-800-532-5274
Fax: (757) 873-8999
Internet:
www.patientadvocate.org
Fight Colorectal Cancer
www.FightColorectalCancer.org877-427-2111
Fight Colorectal CancerCONTACT US
Fight Colorectal Cancer1414 Prince Street, Suite 204
Alexandria, VA 22314(703) 548-1225
Toll-Free Answer Line: 1-877-427-2111www.FightColorectalCancer.org
Email us: [email protected]