5 ways to reduce your out-of-pocket medical costs
Being diagnosed with metastatic breast cancer is often only the beginning of a long, painful, expensive journey. Along with the physical and emotional toll, the financial burden can be overwhelming. Even with health insurance, the associated metastatic breast cancer treatment costs can strain finances and deplete personal savings.
Medical expenses may include direct medical costs (e.g., co-pays, balance billing, deductibles), as well as indirect costs (e.g., child care, transportation, personal care).
Here are some ways to potentially decrease your out-of-pocket expenses.
1. Ask for help
Yelling at your insurance company may be satisfying, but it rarely makes a dent in your medical costs.
Hospitals, treatment centers, and doctor’s offices may offer financial resources for people living with metastatic breast cancer.
Financial counselors: Many hospitals and treatment centers have financial counselors on staff. Their job is to advise patients on medical costs, help with insurance paperwork, and work with patients to manage bills. If your hospital or treatment center doesn’t have a financial counselor, you might get assistance from the billing department.
Your oncologist’s office: This office usually has a billing department, or an individual who serves as the liaison with an outside billing service. They can help you review medical bills, negotiate reduced rates if possible, discuss payment plans, and possibly refer you to other resources.
Social workers or patient navigators: These individuals may work for the hospital or treatment center. A social worker or patient navigator may help you plan your metastatic breast cancer treatment to reduce costs – such as by combining medical visits. They may also know of outside breast cancer financial assistance programs.
From the community: “In October when I retired and went from my work insurance to Medicare, I was no longer eligible for the Pfizer Co-pay card that I had been using to pay for my Ibrance. Pfizer told me that I had to exhaust all the grant monies available before their assistance would kick in. My Medical Center has a Financial Navigator who helped me send in the paperwork. I received $5000 from PAN, which paid for the 2019 deductible and a couple months of co-pays, but now there is only about $1200 left, which won't pay for the 2020 deductible. I will be going back soon to the Financial Navigator who said he would contact Pfizer for me once the grant money is gone. Hope this helps.” - Inspire member
2. Set up a payment plan
Medical bills can increase quickly. Depending on the metastatic breast cancer treatment facility (hospital versus private clinic), the number and frequency of bills, and your financial standing, you may be able to make smaller payments on a monthly schedule, rather than a lump outstanding balance.
Again, ask to speak to a financial counselor, billing office representative, or social worker.
3. Apply for financial aid
There are financial aid resources available to those living with metastatic breast cancer, including loans and grants. Some organizations that offer assistance or help in finding assistance include:
4. Comparison shop
Prices among facilities such as labs aren’t uniform; they can vary greatly, even within the same city. Comparing costs may be time-consuming upfront but can lead to substantial savings.
Frequently, doctors recommend the closest facility or lab for a medical test. The facility may be convenient but potentially out of network, or it’s more expensive than a similar facility a couple of miles away.
Call a lab or other facility prior to scheduling an appointment to find out if it’s in-network and what the services you’re getting will cost (both if in-network and out-of-network). Also, ask your referring doctor to recommend at least one other facility that may be a more affordable option for you.
You can also call your insurance company to find labs and other treatment facilities near you that are in-network.
5. Save on prescription medication
Breast cancer medications can be expensive, and coverage varies greatly among insurance companies. Here are some ways to reduce your prescription medication costs.
Contact pharmaceutical companies about financial assistance programs. Many drug companies offer discount medications or other financial aid.
Shop around. Medication costs vary based on location, type of store, and other factors. Check around at pharmacies, grocery stores, and discount chains to compare prices for your medication.
Ask your doctor for samples. Drug companies often provide samples to doctors. While you usually won’t get a full month’s supply of medication, you may be able to obtain a few days’ worth. This is especially helpful if you’re trying a new medication and don’t yet know its side effects or effectiveness for you.
Check if there is a generic version. Not all breast cancer drugs have generic versions, but it’s worth asking because the savings can be considerable. Also, insurance is more likely to cover generic medications if they are available.
Enroll in a metastatic breast cancer clinical trial. In a clinical trial, the medications being researched are usually covered. And if you’re in the control group and receiving standard treatment, those medication costs are likely to be covered as well.
From the community: “I just found out that there is a Faslodex copay program. $0 copay for commercially insured people. My doctor's office called me and asked if I wanted to sign up for the program. They had to submit the application for me. It was immediately approved. They had been giving me generic fulvestrant injections since last summer (with differing side effects) and I was paying 10% co-insurance. The brand name Faslodex has been keeping me alive (along with Ibrance) for five years and I am so happy that I can now have brand Faslodex again with a $0 copay!” - Inspire member
Sources
Understanding the Costs Related to Cancer Care. Cancer.net. March 2018.
Paying for Your Care. BreastCancer.org. March 2019.
Financial Assistance. Susan G. Komen. July 2020.
Things to Know About the Cost of Your Cancer Treatment. American Cancer Society. May 2019.
Finding Financial Assistance. Metastatic Breast Cancer Network.
Disclaimer
Member comments are lightly edited for length and to remove identifying information but are otherwise reproduced as they appear in the community as part of public posts.
This content is for general informational purposes only and does not necessarily reflect the views and opinions of any organization or individual. The content should not be used as a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider about any questions you may have regarding a medical condition.
