Insurance Long-Term Planning
How will cancer treatment impact my finances and money?
I think when it comes to finances and cancer, this is a topic that has been getting a lot of attention in the lay press, in the newspapers and specifically in the Wall Street Journal, recently with regards to pharmaceutical companies charging exorbitant amounts of money for their particular medications and the biggest response from the pharmaceutical companies is that it cost $800 Billion to investigate a drug from the first investigation to an FDA approval, and they need to make up their money somehow. To some degree, I agree that it is very expensive to come up with a new drug and if it is going to help my patients, I don't care how much a company has to spend, I want my patients to get that drug. Now from a patient to patient basis, it doesn't bother me, I want my patients getting the best drug no matter how much their insurance company has to spend but ultimately patients have to pay a portion of that cost themselves, no matter what insurance they have. Whether they have an HMO, whether they have a PPO, whether they are on Medicare, they will have to pay some type of co-payment and that could severely impact their lives.
How can I get health insurance after being diagnosed with cancer?
Health insurance has an issue that has come up a lot lately with regards to the pre-existing conditions and the ability of health insurance companies to limit their, limit their coverage to patients without a known diagnosis or a known condition. This is mostly for patients or people getting health insurance on a private basis, so going out without an employer, going out to an insurance company or broker and trying to acquire health insurance for themselves or their families, if they have a pre-existing condition of any type, then that would limit their ability to get coverage. On the group coverage side, so if you are an employee of a company, then there, pre-existing conditions don't exist. There is no health denial, there's no health insurance denial for pre-existing conditions.
How can I get life insurance after being diagnosed with cancer?
It's completely different on the life insurance side. Because life insurance isn't regulated by law. It's a financial agreement. It's a financial agreement between a company and a person to identify their particular risk of dying and how much money they're going to pay out to the family or to this person's survivors. And pre-existing conditions, whether or not you smoke, and lots of other factors are put together in determining whether or not someone is going to be a candidate for life insurance. Where there are a lot of laws and regulations on the state level and on the national level for not restricting health insurance based on certain pre-existing conditions and certain situations, it doesn't exist for the life insurance policies and community.
Will my insurance pay for specialized cancer treatment?
Everyone needs to look back at their policy and see if this is a covered provision or not. For the most part, cancer-related therapies, chemotherapy and treatment for cancer is covered. Bone marrow transplantation usually is covered. It just depends where it gets covered and where the treatment is done. I have been to a lot of institutions in which certain institutions are contracted by particular insurance companies to provide their care but most insurance companies would cover most cancer therapeutics. When it comes to experimental therapies that is a completely different question and I think that depends on the different payers, different insurance companies. Certain insurance companies see experimental therapies as out of the standard of care for particular cancers and they would not cover that and in those situations, most pharmaceutical-sponsored clinical trials provide the drug for free. The bigger issues are related to professional fees from physicians that are participating in this clinical trial and may or may not be covered by your insurance.
How do I consider end-of-life matters when I'm battling cancer?
End-of-life care is never easy to talk about, which is exactly why we should talk about it. And, I became an Oncologist not so much because I hate cancer but because I love cancer patients. And, you have people around you that love you very much. Now, death, as far as I can tell, is universal. But a cancer patient may see it coming. And that's poignant. I think the best way to discuss end-of-life issues is to bring other people into the discussion that matter to you. Second, don't be afraid. You have rights, you have dignity that needs to be communicated while you can. I tell some of my patients, who may be near the end of their fight that I would rather talk about it in the calm of the office, when they're in full possession of their faculties, than in the middle of the night by the bedside in the middle of a crisis. Some of the things that matter in the end-of-life is how far do you want to go? There are practical concerns such as a "do not resuscitate" order. There are practical concerns about if the therapy is no longer working, do you want to pursue experimental treatment? Do you want to be hospitalized? Would you rather be at home? At all times, the priority will be to respect comfort and dignity. I'm afraid that end-of-life, even in oncology, is the 800 pound gorilla in the living room that we just don't want to talk about. But, because it's a universal experience, it deserves discussion. So, don't be afraid to talk about it. Bring the most important people of your life into the discussion, and if your doctor's not willing to bring it up, bring it up yourself.
How do I consider fertility before I start cancer treatment?
Considering fertility issues is especially relevant for the younger patient and several issues come to play. Number one it's a lot easier to preserve fertility for men because sperm banking is very easily done and is reasonably accessible at most centers and is very cost effective. So young men patients should always ask should I consider sperm banking. That is especially flexible because even if somebody is diagnosed before they have their life partner that is a way to preserve fertility and have children later. It becomes more complicated with female patients because procuring eggs to store is more difficult and may even be considered an experimental procedure. There are centers of excellence throughout the country that specialize in this or even harvesting eggs and then fertilizing eggs and preparing embryos. But again these are a few centers in the country that are specialized, they are often experimental procedures and they are often associated with costs that may or may not be covered by insurance. One difficulty for female patients is that this procedure takes time and needs to be timed with the ovulation cycle and some cancers may be able to wait for that type of planning. Other cancers such as aggressive leukemias and lymphomas can not wait and therapy should be started right away. The best thing to do is ask questions on an encouraging note the majority of chemotherapy offered to young people does not cost fertility. Your oncologists should be aware of the American Society of Clinical Oncology guidelines about fertility in young patients. What this document does is describe common chemotherapy regimens and the risk of preserving or losing fertility. Finally there are some excellent web resources which act as clearing houses about this issue. So I would encourage you to do your own research, ask your oncologists and don't be afraid to ask questions.
