Uninsured and diagnosed with breast cancer (not me) any ideas??

[Running Mommy]

Hi all-
I'm hoping some of you awesome ladies can help me to help a friend.
One of our customer turned good friend's mom has just been diagnosed with an aggressive form of breast cancer. She is 63 years old, and has no health insurance.
We are trying to figure out a way to negotiate with the medical facilities to reduce their fee's.
So I'm wondering if anyone here has had success in something similar.

Just the other night I was looking at some old bills from running hubbys knee surgery. The bill was over 12k, but the doctor accepted only 3k, and wrote the rest off.

Why can't they help out someone in dire need?? It seems sad really.
So far they have gotten the MRI facility to give them a couple of hundred dollars, but the bill is over 2k!
I can't believe how much time all of this takes. Just to get someone to TALK to you! It's very frustrating.
And meanwhile this poor lady is just trying to fight for her life- all the while worrying about how she's going to pay for it.
Maddening!!
any advice on how to negotiate the medical mine field would be much appreciated!

[OakLeaf]

Is she working? Might she be eligible for a state Medicaid waiver/medically indigent program?

[Biciclista]

write to your congressmen?

tell her to go to her church, if she belongs to one?

Medical problems are the biggest source of Bankruptcy in the USA.
shame on us.

[Possegal]

regarding the meds - a lot of the companies have programs where they will supply the drugs at a reduced fee, or for free, depending on someone's financial situation. so once a chemo plan is in place, she should look into programs like that.

[jobob]

Or perhaps look into a clinical trial? Full treatment is often paid for in those. Possibly not ideal, but I thought I'd mention it.

Some listings can be found here.

http://www.bcrfcure.org/action_clinicaltrials.html

[Tuckervill]

They won't even see her unless she pays up? That's insane.

She should really be going through public health, if that's available. Surely she's old enough for Medicare?

My ex husband got cancer in his kidneys last year, uninsured. The hospital wrote off 80% and is letting him pay off the rest in small increments. The most important thing is not to sweat the bills. Who cares if they're asking for money, as long as she gets the treatment. Maybe she should find another place to do her treatments, as well.

Sending good vibes out to her.

Karen

[Running Mommy]

my friend mentioned that his parents have lived modestly on 30k a year. So I'm not sure if they qualify, I don't know what the cut off is. But I will have him check into it.
Thanks all for your input. I will pass it along, and hopefully we can get something done.
I think it comes down to finding a doctor who cares.
When I was facing the same thing, and knew my insurance was ending soon, my doctor told me she would help me. And that I didn't have to worry about it.
Lucky for me the MRI showed nothing... wheww. But I dodged a bullet for sure.

[Crankin]

I am pretty sure she would qualify for AHCCS, with those numbers. My MIL is now in assisted living and the whole thing is handled by them. And, it's a very nice place in Mesa.
Ditto on the hospital social worker. My husband and his siblings went to a social service agency that just deals with medical issues and the elderly. They got a very bad situation squared away in 3 days.

[roadie gal]

Definitely look into clinical trials.

Talk to the hospital folks. They should have someone who specializes in helping people get insurance/financial aid.

[katluvr]

Has she checked out some of the Breast Cancer foundations.
I have done the Susan G. Komen--Race for the Cure--and I thought part of what they funded was for women who needed help--financial.

I am so doing the 26.2 (but only 13.1) Run w/ Donna this weekend. I will check out that website.

I really thought part of what these charities raised was not just $$$ for awareness and research, but to help in the community.
So not sure what is around in your community!

I know it really sucks to try and navigate the health care system -- even if you have a job and insurance, much less without.

At the place (hospital) she is recieving treatment, there should be a Social Worker or Case Manager that SHOULD help her. That is there job at my hospital.

[denny]

The ladies have sited several viable options for your friend. I've had to negotiate/authorize discount agreements with patients before.

Clinical trials are iffy at best in providing assistance as you have to qualify and meet different criteria; your friend may not be able to wait.

Qualifying for Medicaid is a sensible option if she meets the income requirements for that state.

Just my opinion, but in the interest of time and expense, applying for charity care is your 1st best option. Try and make sure the surgeon, hospital and all other other providers of care (anesthesiologist, radiologist, pathology) will accept the agreement and write off the cost of services.

If the Charity Care application is declined- another option is to check if your surgeon works with a facility that has a pre-pay or self pay package. Usually these are performed in Ambulatory Surgery facilities and the cost of all services-surgeon, anesthesiologist, technical fees for OR time are all quoted as one fee and usually at a reduced rate. Some practices will try to make the fee at the same or slightly higher than the prevailing Medicare rate for your area. More than likely you will be asked to pay the fee up-front for the rate to be honored. Most patients like this option best as it beats paying the full rate up front or trying to pay off the bill for 6 months and ending up in collections.

Hope you guys find a great healthcare provider who will take the time to discuss your financial options.

[TxDoc]

Have you tried asking your local State Health Department about the BCCCP? They have restrictions but if she turns out to be eligible then her diagnostic tests AND the treatment would be covered. I think she is still in the age limits so she may qualify.

[Deborajen]

I work on the finance side of a group medical practice. We do take some non-paying and deep-discount patients, but we can only afford to absorb a limited number of them. Here are a few ideas I know of:

1. Try contacting your local medical society. Our county medical society has a program called Project Access which connects qualified uninsured patients (who have "slipped through the cracks" and don't qualify for Medicaid, etc.) with medical care. As I understand it, the patients apply for the program and are directed to medical providers who have agreed to accept a certain number of Project Access patients each month/year on a no-cost basis.

2. Check with pharmaceutical companies that manufacture cancer treatment drugs and see if they have a patient's advocate, or maybe even a program for uninsured patients. I just put one of our patients in touch with a patient's advocate - they can be a good source of information. I'm not very knowledgeable in cancer treatment meds, but try googling the name of a med and see who manufactures it - then find their website and search for a patient's advocate or a charity or hardship program.

3. Ditto the previous recommendations on getting in touch with a hospital social worker. They're trained in what resources are available locally, and the hospital might be able to arrange at least some treatment by medical students (who are, of course, supervised by a MD or a DO) - ?

4. Don't hesitate to negotiate with a doctor's office for a discount. Most medical practices do contract with insurance and, therefore, have to accept discounted insurance rates. In other words, they can negotiate with an uninsured patient, too.

Hope she can find a good solution and get the care she needs. I wish I knew more about resources for uninsured patients but most of what we work with is just trying to get insurance carriers to pay.

[sundial]

I'm a social worker and used to work in the hospital setting. I would contact Department of Human Services in her county and make an appointment with a caseworker. Together they can determine what state benefits she may be eligible for based on income and need.

Your friend can also contact the hospital social services and see if she can qualify for medical assistance. Some hospitals have special funds set aside for patients who have particular needs and who offer services at no cost to indigent patients.

[Running Mommy]

Thanks SO MUCH!!! Such helpful info! I knew I could count on you ladies. Just another reason why I love this forum so much!!
TE LADIES ROCK!!!
I have passed this on, and he was amazed at how many good ideas everyone had. He said he will look into all of the programs. He had no idea they existed.
Thanks again!!
denise

[michelem]

I am pretty sure she would qualify for AHCCS, with those numbers.

Here is the link to AHCCS. http://www.ahcccs.state.az.us/Site/ Unfortunately, it looks like her income is WAY to high to qualify (as of 01/01/09, an individual living with spouse qualifies with income 1/2 of 1,167/month after deductions, which comes out to a little over $7,000 a year). Sigh . . .

BUT, good news is that they now have something called BCCTP (Breast and Cervical Cancer Treatment Program), with a much higher limit (looks like close to $35,000 a year).

Oddly enough, there is conflicting income info on the spreadsheet here http://www.ahcccs.state.az.us/Services/CoverageGroups/AdultNoChildren.asp and this page here: http://www.ahcccs.state.az.us/Services/CoverageGroups/AdultNoChildren.asp#BCCTP

So, best to call and find out the real scoop. Hopefully your friend's mom qualifies for something here!

[Possegal]

I have a friend who lost his job just as he was diagnosed with lymphoma. The social worker at the hospital has found him aid through several sources, she has been a godsend. Your friends have lots of options out there, just sadly they have to seek them out. But once they hit on the right people to help them, I think they will find a lot of sources of aid, especially in the cancer field. Definitely look into the breast cancer charities, I do think the Lance Armstrong Foundation has some aid for people in this situation, possibly the American Cancer Society as well.

Working in the field of cancer research, I will echo the idea that clinical trials may not be the best option. There are long lists of qualifications for a trial to ensure that it answers the questions it needs to answer. Your friend would need to have had a lot of tests before they would even consider her, and getting those tests done and paid for is part of the problem right now.

Once they have figured out how to get the tests done and found a dr that will treat her, the dr would be a great source of help as to what funds may be out there for the medications. Older meds are cheaper and the newer meds have programs to defray the costs. My sister's drug for her lung cancer is $4000 a month (it is a pill). Her copay is reasonable but if she wasn't insured, that is a lot of money. However, Genetech/OSI pharm who make the drug, have a program to help people in need. This is true of other expensive new drugs and companies. I think there are a number of programs out there for medication costs help.

Also, here is an organization that I think does a great job of educating and empowering the patient - www.cancercare.org. They may have some information of some help as well. (ha, and when I went there, on the front page is a link about financial assistance, so I definitely recommend they check them out). A lot of these charities/organizations have social workers on staff that can be a great resource.

[OakLeaf]

Unfortunately, it looks like her income is WAY to high to qualify...

Way too high for cash benefits, but if she can prove a qualifying disability or if there's a state medically indigent waiver program, she may qualify for spend-down Medicaid (essentially a monthly deductible). Hospital social worker may be easier to deal with initially than the state welfare agency - although she'd have to deal with the welfare agency eventually, she should be able to get a pretty good idea of whether she might qualify for assistance before she goes there.