7 Tips to Manage the Healthcare Costs of Metastatic Non-Small Cell Lung Cancer

Living with metastatic non-small cell lung cancer (NSCLC) can take a toll — on your body, your emotions, your family, and also your wallet. Even if you have “good” health insurance, you’ll probably need to pay something for each bill, and you might need to pay all the bills until they reach a certain amount (or deductible).

Medical costs associated with advanced NSCLC include fees for doctor visits, procedures, lab tests, scans, treatment, hospital stays, and medications. Cancer also comes with hidden costs, such as transportation, extra help at home, special dietary needs, complementary therapies, travel, and lodging. If you need to take time away from paid work during treatment, you may be facing the added financial strain of lost or reduced income.

It’s hard to predict exactly how much cancer and its treatment will cost. But you can minimize financial stress by planning ahead — and knowing where to turn for help. These tips can help you stay calm, even when yet another medical bill arrives in the mail.

1. Get an Overall Sense of Your Costs and Coverage

Talk to your doctor about what your treatment will consist of, where it will take place (in the office, the hospital, or an outpatient facility, for example), and who will be involved. Then call your insurance company and speak with a benefits coordinator to find out what’s covered under your plan and what you may have to pay for out of pocket. Here are some questions you may want to ask:

• Does my plan cover physician costs (including specialists), as well as inpatient and outpatient hospital services?
• Are all of my providers and the hospital in-network?
• What costs will I be responsible for if I go out-of-network?
• Are there any procedures, medications, scans, or treatments in my NSCLC treatment plan that require prior authorization or certification? How do I go about getting it?
• If a treatment my doctor says I need isn’t approved or a claim is denied, what is the appeals process?
• Does my policy have an out-of-pocket maximum? If I reach that maximum, will my insurance reimburse at 100 percent?
• Can you assign me a case manager so I can talk with the same person each time I call?

2. Stay In-Network

Insurance companies contract with certain medical providers to offer lower-cost services to insured patients. When you go outside this network, you generally have to pay more, or possibly pay for the full service with no help from your carrier. This gets tricky when some providers under the same roof are in-network and others are not. “There are times, for example, when the oncologist and hospital are in-network, but the radiologist is not,” explains Catherine Cassingham, MSW, LCSW, an oncology social worker who works with lung cancer patients at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University in Chicago. “In that case, you’ll want to see if you can switch to a different radiologist, or ask your insurer to make an exception because no in-network provider is available where you’re receiving treatment.”

3. Recruit an Ally

Ask your healthcare team whom you should contact with any questions about your treatment costs and insurance coverage. “This could be an oncology social worker, financial counselor or someone in the billing department,” says Cassingham. These professionals specialize in helping patients navigate the financial side of treatment. They can help you decode bills and estimation of benefits (EOBs) from your insurance company, get prior authorizations, as well as communicate with your doctor in the event that one of your medications isn’t covered and you need a different option. “I strongly recommend you take advantage of these professionals,” Cassingham adds. “You don’t need to figure all this stuff out on your own.”

Many hospitals also have a State Health Insurance and Assistance Programs (SHIP) counselor on site who can help you navigate Medicare and, if necessary, apply for any additional coverage programs. (SHIPs are only available to people with Medicare.)

4. Keep Track of All Your Medical Expenses

Being organized is one of the best ways to manage the costs of your treatment, and it can sometimes also help you save money. Whether you’re receiving bills and EOBs via snail mail or email, open them right away and come up with a filing system (such as by month or for each kind of paperwork). Match each medical bill with its corresponding EOB from your insurance company. This way you can tell what was and wasn’t covered and also spot any mistakes.

It’s also a good idea to take notes when you speak with your insurance company: jot down when you called, who you spoke with, and what was said. Keep these notes in your medical file. Also keep a file of receipts from all your miscellaneous medical expenses, including copays, medications, transportation, parking, lodging, and meals.

5. Save on Prescription Meds

Ask your doctor to prescribe generic medications whenever they are available. If generic isn’t an option, find out if there are any discount or financial assistance programs for that medication by going to sites like NeedyMeds, RxHope or GoodRx, as well as the drug maker’s website. “You can also find discounts programs and rebates just by searching the medication online,” notes Cassingham. It also pays to comparison shop: Different pharmacies often charge different prices for the same medication.

6. Get Help With Other Medical Costs, Too

Ask your oncology social worker or financial counselor if there are any foundations, organizations, or grants available in your area that can help cover some of your out-of-pocket expenses and if you might qualify. Some nonprofits also offer meal delivery services, groceries, and transportation for cancer patients.

Also tap into national organizations: The American Cancer Society offers services like free passes on public transportation, help with lodging, and free wigs in many parts of the country (go to American Cancer Society or call 800-227-2345 to find out what programs are available in your area). Also check out the National Cancer Institute’s list of organizations that offer support services to cancer patients.

In addition, you may be able to get complementary therapies, such as massages, yoga and relaxation classes, nutrition and psychological counseling, and art and music therapy, free of charge at your hospital or through a local community wellness center. Ask your social worker what’s available at your center as well as other centers in your area.

7. Let Uncle Sam Lend a Hand

You may be able to subtract (or deduct) some of your medical expenses from your income on your taxes, if your expenses exceed 7.5 percent of your adjusted gross income, according to the Internal Revenue Service. This includes any expenses that insurance does not cover, such as the cost of miles you drive to and from appointments, some costs of prescription drugs, and even the cost of meals if you stay at the hospital or doctor’s office for a long time. Subtracting these from your income lowers your total income so you may pay less federal income tax. Talk to an accountant or other tax advisor to find out if this is an option for you.