By Martine G. Brousse
"The Medical Bill Whisperer... and insurance stuff too"
Patient Advocate, Certified Mediator
June 21, 2023
The major cause for the high cost of cancer treatment is that of chemotherapy drugs - oral, injected or infused. Many treatments, also called “regimens”, include generic options, but the promising outcomes of new patient-directed therapies, and the growing use of leading-edge targeted drugs often come at a hefty price.
The cost of one or two brand name drugs can often meet your deductible and/or out of pocket liability at the first cycle (the time between your first chemotherapy treatment and the next one). The facility or office providing the treatment will want your prompt payment...in full, as drug purchase is the number one expense in an oncology practice.
Even under the best insurance plans, you may come short when receiving the bills.
Financial assistance programs can help.
1. What is a financial assistance program?
These programs raise funds and apply grants to patients with financial needs: uninsured, underinsured or with large co-pays. Their sources of funding may be public, private or corporate.
2. The three major sources of financial assistance:
· Drug Donations: These brand-name (non-generic) drug donations are given out by manufacturers to uninsured or underinsured patients. Patients whose treatment was denied by their insurance may also qualify. Free samples and doses of drugs at no cost will be sent to the office for your use.
· Copay assistance: Brand-name drug manufacturers may help reduce the burden of insured patients with high shares of cost, in the form of direct payments to your pharmacy or medical office, discounts cards or reduced fees.
· Grants from charitable organizations, usually for a specific disease or condition. Once approved, payments are usually made to the office upon submission of an invoice showing your share of cost after insurance.
Please note: Medicare and government-issued insurance policy holders are prohibited by law from receiving direct assistance from manufacturers, so apply with private organizations.
The off-label (non FDA-approved) use of a drug is rarely eligible for donations or financial aid from any entity.
3. The Steps
· Get the list of your prescribed brand name drugs and the associated diagnosis code
· Check the large directories: http://www.nccn.org/reimbursement_resource_room/default.aspx or http://www.cancerfac.org/members.php
· Consult the manufacturer’s or drug’s website for information and an application
· Visit organizations dedicated to your diagnosis for their own grant, or a list of others
· Google all brand-name medications you have been prescribed, as even non-chemo drugs might have a fund or grant available.
4. Of utmost importance:
· Make sure your application is complete. Review eligibility guidelines, documentation requirements and application forms online, or call the toll-free number.
· Apply early! Many funds dispense funds monthly, based on what $ is available. Best to apply the first week of each month (or ask about a waiting list).
· If your financial circumstances have changed this year, a letter of explanation will help support your request.
· Apply, if possible, before you first cycle/treatment. It will ease your anxiety and that of the billing office.
· If you deductible or out of pocket are met before you are approved, and if you know your liability will be minimal, filing an application may be a waste of time.
· You may apply for assistance for the same drug or condition from more than one entity.
5. Talk to Billing
Do inform the billing manager about any approved grant. To insure reimbursement, the billing person will need to submit claims to the manufacturer or an organization, creating payment delays and extra work. This is the time to become best friends with the Billing Dept staff. Your financial fate may literally depend on their good will!
6. Keep on top of things
Grants expire after a certain number of months or $ amount. Keep track of and renew your application as needed. Don’t assume you will be notified, or that the grant will be automatically extended.
With decreasing available funds and a growing demand, notifying the program when you no longer need your grant money is must. Your unused funds can then be dispersed elsewhere. Another cancer patient in a needy situation will be grateful!
Martine Brousse was a long-time Billing Manager for Physicians before switching to the side of patients in 2013. The move has allowed her to apply her deep expertise and vast experience of the intricacies of resolving all types of medical bill and claim payment issues in ways that directly and positively impact her clientsʻ finances.
(424) 999 4705 - F (424) 226 1330
@martine brousse 2023
@ the medical bill whisperer 2023