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When you have breast cancer, you quickly realize that health insurance doesn’t cover all of your medical costs.
A 2013 study from Duke University, most of whose respondents were women battling breast cancer, found that even with insurance, cancer patients on average ended up paying more than $700 per month out of pocket. That total included co-pays, prescriptions, lost wages and travel.
High costs aren’t surprising, seeing as chemotherapy alone can cost thousands. But for many, the sum was financially devastating.
“Cancer’s like being on another planet,” says Susan Scherer, the founder of RN Cancer Guides, an organization that helps cancer patients navigate the health care system. “It’s very confusing. You don’t know if you’re going to the right doctor, you don’t know if you’re having the right treatment [and] you don’t know if you’re being billed too much.”
At first it might seem like paying every medical bill that comes your way is your only option, but that’s not the case. Here are some ways you can lower your medical bills for breast cancer:
Check for billing errors
In 2013, the Department of Health and Human Services reported an astonishing 77% error rate in Medicare claims for full multiuse vials of Herceptin, a drug commonly prescribed for breast cancer patients. Instead of being charged for how many milligrams of medicine were actually provided, patients were often billed for full vials. Between 2008 and 2011, this resulted in overcharges in excess of $24 million.
These errors aren’t unique to Herceptin, either.
“I have seen Benadryl being billed for almost $26,000 because of a coding issue,” says Scherer, who worked as an oncology nurse before founding RN Cancer Guides.
To catch these billing errors, it’s important to request an itemized receipt of your medical bill. Go through it to make sure you’re not being billed for medicines you’ve never received or procedures you’ve never undergone. If you find discrepancies, contact the hospital’s billing department and dispute the charges.
Appeal charges that aren’t covered
Billing errors don’t just happen on the hospital’s end; they can also come in the form of insurance denials.
“The insurance [provider] has just as many errors in their processing,” says Pat Palmer, founder of Medical Billing Advocates of America. “They might try to tell you something isn’t covered when it is.”
For breast cancer patients, one of the most common insurance disputes is with magnetic resonance imaging. In some cases, the insurance provider denies a claim for an MRI because it didn’t approve a prior authorization. The patient is left paying out of pocket for the bill—which, according to NerdWallet data, could cost about $2,600.
In the event you didn’t get prior authorization and your insurance refuses to cover a treatment or procedure, you can file an appeal with documentation of medical necessity from your physician. But make sure it’s reviewed by a third party, Palmer notes. Appeals that are reviewed by the same insurance provider that denied the claim might provide little help.
“It’s like the fox watching the henhouse,” says Palmer, who has 20 years of experience as a medical billing advocate. “[Patients] do have options to take the appeals to a second and third level, and I’d encourage them to do that.”
In the event your appeal is denied repeatedly, don’t be afraid to negotiate with the hospital for a lower price. Many offer cash discounts to patients struggling to pay their medical bills, but you won’t know whether your hospital does unless you ask.
Look for outside help
From screening to treatment, fighting breast cancer can get expensive quickly, especially for those with high deductibles.
Several nonprofit organizations, such as the Pink Fund and Breast Cancer Charities of America’s Help Now Fund, can offer financial support for breast cancer patients who are facing large medical bills and loss of income. And Medicare can provide additional help.
For situations where you feel like you’re in over your head, working with someone who’s familiar with the health care landscape can be a huge relief. This is where medical billing advocates come in. These professionals, many of whom have medical backgrounds, look for errors and negotiate with hospitals and insurance providers on your behalf, potentially saving you a lot of stress and money.
The importance of negotiation
Tackling huge medical bills can be frustrating. Once you get some experience talking to billing departments and insurance providers, though, it can be a little less daunting. Persistence is key, Scherer notes.
“Everything is negotiable,” she says.
Breast cancer screening image via Shutterstock.