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10/19/2017
The Financial Cost of Breast Cancer
The American Cancer Society reports that over a quarter million American women and 2,470 men will be diagnosed with invasive breast cancer this year. In addition to the medical and emotional challenges of a cancer diagnosis, these men and women often face major financial challenges. Even for those who have health insurance, the cost of deductibles, copays, out-of-network charges and other fees can add up quickly during cancer treatment. To top it off, cancer patients' income may suffer due to missed work days.
In honor of Breast Cancer Awareness Month, U.S. News talked to three survivors about how they handled out-of-pocket costs and other medical expenses.
Melissa Thompson, Stamford, Connecticut
In 2015, Melissa Thompson, then age 32, received her stage 3 breast cancer diagnosis five weeks after giving birth to her first child. She had to decide the next day if she wanted to freeze her eggs so she could potentially have more children.
Health insurance pre-authorized fertility treatment, so she started 16 days of hormone injections. Then, Thompson's insurance reversed its decision the day before her scheduled egg retrieval. After the fertility clinic threatened her with collections, she put the entire $12,085 bill on her credit card, because she didn't know what else to do. According to Thompson, young cancer patients are often faced with a tough decision: "Do you want to survive or do you want a family?" On top of the cost of freezing her eggs, she also pays a thousand dollars a year for egg storage.
Thompson is now a cancer patient advocate and is still dealing with the credit card bill and the student loan interest that accrued while she was recovering and couldn't work as an independent contractor. Her out-of-pocket costs from last year topped $64,000. She tried to work from her hospital bed but at times, Thompson says, she couldn't move her fingers. "[In your twenties and thirties] you should be at the prime of starting your career," she says. "I was taken out of that." She was able to defer her federal student loans, but the interest continued to accrue, and she now owes over $170,000. "I got to a point where I skipped scans or didn't fill my prescriptions," she admits. "I stretched out the time in between [chemo] infusions."
Frustrated by the fact that women with infertility due to medical intervention often can't get help from their insurance provider, Thompson worked to change state insurance laws. "On June 20, 2017, Connecticut became the first state to require insurance coverage for fertility preservation," she says. Melissa's Law for Fertility Preservation also passed in Rhode Island in July, and Thompson is currently working to get the policy passed in other states.
Maryann Small, Nanuet, New York
In October 2013, Maryann Small, then age 52, had a routine mammogram that would lead to a diagnosis of invasive lobular carcinoma (stage 1 breast cancer). She stayed in the hospital several times to have her chemo port surgically implanted and to receive three lumpectomies. "The problem with cancer is that you're seeing quite often three different specialties at the same time," she says. Even without complications, Small says, it's likely for patients to see a surgeon, an oncologist and radiologist several times a month.
"Everybody has a copay," Small says. "With mammographies, most insurance companies cover them when they're diagnostic, but once you're diagnosed, they're subject to a copay," she adds. "You also have to have an ultrasound pretty much every time."
The family had just switched to health insurance with a higher deductible, so Small had to pay $1,100 for a 90-day refill of a generic aromatase inhibitor, which is used to stop production of estrogen. "They gave me some samples first, and then when I got my prescription filled, I almost fell over," Small says. The family used credit cards when they needed to and cut back their budget to the bare essentials.
Small works hourly for United Way, a nonprofit focused on health, education and financial stability, in Rockland County, New York, and has continued working during her treatment while also serving as caregiver to her mother, who has dementia. "[My boss] let me work from home sometimes when I felt too sick to go in," she says. "I did continue to work as much as I possibly could just for my own sanity," she adds.
A colleague told her about a United Way partnership with prescription drug savings program FamilyWize, which reduced her prescription cost to $400 every 90 days. The free FamilyWize program has no eligibility requirements and consumers can look up FamilyWize prescription prices at local pharmacies, then show their free discount card or app to get the discount. Some drug companies also offer prescription discount programs.
Through a local cancer support group, Small also discovered that local Meals on Wheels offers nutritionally balanced meals for people going through chemotherapy. "I found out [after completing chemo], but that's something that I pass on to other people in groups now," Small says.
Hannah Martine, San Diego, California
In August 2015, Hannah Martine, then age 29, felt a lump in the shower. At first, she thought she might have pulled a chest muscle, but she got it checked out anyway. Turns out, that lump was stage 4 breast cancer. "As a single professional in San Diego with my insurance tied to my work, I had no choice but to continue working during treatment," she says. "I used all my [paid time off] during chemo, as well as many unpaid hours," she explains.
Martine went on short-term disability to have a mastectomy, but her recovery took longer than expected because she got a staph infection, requiring two more surgeries to clean out the infection. She worked during six weeks of radiation because she could not afford to take any more unpaid time off. She's still getting medical bills from 2015 and has continued care since she was diagnosed with stage 4 cancer, so she's not sure of her exact out-of-pocket cost, but says it's upward of $10,000.
Like Thompson, Martine paid out-of-pocket to freeze her eggs before chemo and other treatments that would damage her fertility. "I don't have children, but it was something that I do want for my future," she says. Her insurance paid for one wig, but Martine also paid out-of-pocket for a couple of others, as well as creams to treat her skin during radiation. She also paid a copay for each of her 35 chemotherapy treatments and continues to pay for follow-up appointments.
Fortunately, Martine's hospital had a cancer care coordinator who helped her identify programs that help cancer patients like her. She qualified for a free meal delivery service and received some financial assistance from Hope for Young Adults With Cancer, a nonprofit that helps patients between the ages of 18 and 40, and Jewish Family Services.
Martine recommends tapping into whatever support systems are available. "It's so hard [to think about money] when you're newly diagnosed, and hard during chemo treatments when your energy is depleted," she says. "If you have a good friend or family member that can really help you … have them help you fill out those applications and that paperwork."
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