Kenneth E. Thorpe and Patricia J. Goldsmith
Special to Valley News
Liza Bernstein survived breast cancer three times, but it took all she had. She lost her home and savings to the cost of tests and treatments. She’s not technically bankrupt, but that’s only because she “couldn’t afford the fees” to file the claim.
Bernstein recently explained why her medical bills proved ruinous. Insurers “kept increasing my out-of-pocket costs and my deductible, and they kept reducing how much they would reimburse and the network so there was more chance I’d be out of network,” she said.
Sadly, Bernstein’s experience is common. Nearly eight in 10 Americans have had trouble or knew someone who had trouble using their health insurance in the past year. Major reforms are needed to ensure that bankruptcy doesn’t become a routine side effect of cancer treatment.
Patients’ out-of-pocket costs have risen to unsustainable levels. Cancer patients can end up spending tens of thousands of dollars, even if they have health insurance.
Hit with these costs, many patients significantly alter their spending habits to save money. Over 30 percent of patients cut back on groceries or borrowed money, according to a recent survey by CancerCare. About 20 percent skipped payments on rent, utilities or their mortgage to afford their medical bills.
Other patients turn to more dangerous techniques. Among cancer patients 25-54 years old, 30 to 40 percent missed doctor appointments or treatments, postponed filling prescriptions or cut back on oral medications to reduce their expenses.
Skipping appointments and medication may compromise patients’ health and often leads to even greater costs. One study found that prescription non-adherence alone adds an unnecessary $100 billion in medical expenses each year.
Fortunately, there are solutions, but they will require a change of mindset on the part of policymakers, health care providers and insurance companies.
First, providers and health insurance companies need to stop surprising patients with unexpected costs. Only half of cancer patients felt they understood what their insurance plans would cover. Requiring insurers to be transparent regarding the out-of-pocket costs would empower patients and their doctors to build a treatment plan that meets their needs and budgets.
Next, out-of-pocket costs need to be reduced. Each month, cancer patients between the ages of 25 to 64 spend more than $1,100 out-of-pocket for treatment. Insurance companies, health care providers and drug developers should work together, so patients aren’t forced to choose between their health and putting food on the table.
Finally, insurance companies need to be held accountable for denying or limiting patients’ care. Many insurance companies require cancer patients to try less expensive, older drugs for several months before they’ll approve the use of newer, more effective treatments.
It’s a tactic called “fail-first,” and nearly 40 percent of cancer patients in the 25-44 age group has been subjected to it. By interfering with recommended treatment plans, insurers jeopardize their customers’ lives to save a few dollars.
When patients receive word from their doctors that they have cancer, they know they’re in for the fight of their lives, but they rarely expect that fight to be against their own insurance companies.
Improving transparency, lowering out-of-pocket costs and holding insurance companies accountable for limiting care could help to make cancer patients’ experience a bit more humane.
Ken Thorpe is the chairman of the Partnership to Fight Chronic Disease. Patricia J. Goldsmith is the CEO of CancerCare.