About financial toxicity

Who is at risk?

Because cancer treatment is very expensive, people with cancer are more likely to suffer from financial toxicity than those who do not. The National Cancer Institute reports that some cancer survivors spend more than 20% of their annual income on medical care.

Several factors can cause financial distress for people who are receiving cancer treatment:

Type of cancer

• Certain types of cancer can be more costly than others in terms of the drugs that are used during treatment.

Stage of cancer

• Advanced-stage cancer often requires more extensive treatment, which can lead to higher medical bills.

Type of treatment

• Treatment may vary from an affordable daily medication to high-cost surgery and hospitalization.

Health insurance coverage

• Coverage type determines how much a person will pay out-of-pocket.

Financial status

• How much money you have available (your assets)
• How much you owe on your home, car, and other loans
• Whether you are the main income earner in your household
• Whether you are able to continue to work during treatment

The emotional and physical effects of financial toxicity

The stress of financial difficulties can affect not only your ability to pay your bills, but also your emotional and mental health. The National Cancer Institute reports that people who have financial toxicity while battling cancer have a lower quality of life, more symptoms, and more pain. One study showed that some people felt that financial toxicity was more difficult to handle than the physical, emotional, social, or family distress of a cancer diagnosis.

So what can you do to manage these very destructive effects?

Know the essentials of your health insurance

There are important terms you need to know in order to understand how your insurance company bills you. Some of the most common terms you will hear are:

• Copay: The amount you pay for a health care service such as a doctor’s visit or a prescription
• Deductible: The total amount you have to pay before your health insurance company begins to pay
• Coinsurance: The percentage of the costs you pay for a service that your health insurance plan covers. For example, you pay 20% and your insurance pays 80% of the bill.
• EOB: Explanation of benefits. This is a document your insurance company will send with a breakdown of the coverage for each service you have. The EOB will let you know how much that has been covered and how much you will have to pay.

Speak with a benefits coordinator

Call your insurance company and ask to speak with a benefits coordinator. This is someone who can look at your plan and explain the details of your copays, deductible, and coinsurance. You should also discuss the coverage for:

• Treatment
• Tests
• Prescriptions
• Doctor’s visits

Ask about uncovered treatment

Your insurance company likely has a procedure to gain approval for uncovered treatment. If your doctor orders something that is not covered by your insurance, you may need to submit a letter from your doctor stating why it is necessary. Ask if you can appeal if this is not approved after the letter is submitted.

Be your own best advocate

Advocate for yourself by learning about costs before your treatment. Having this information ahead of time will help you plan your budget and prevent unexpected billing statements.

Other costs you may need to think about include:

• Prescriptions
• Transportation costs like gas, parking, and tolls
• Hotel stays
• Childcare
• Pet care

Reach out for more information

You can ask your healthcare team about a financial counselor who can teach you cost-saving methods for treatment.

Talk to your doctor’s office billing department about payment options for your medical bills. You may be eligible for reduced rates, payment plans, or patient assistance.

If you are having trouble understanding your medical bills, don’t be afraid to ask. There are people who you can turn to, such as:

• A patient navigator at your cancer center or hospital
• A social worker at your cancer center or hospital
• A friend or family member you trust to look at your bills
• The Alliance's patient and family support team 

Talk with you doctor

If you are worried about paying for your cancer treatment, be sure to tell your doctor. While you may feel uncomfortable discussing your financial situation, it’s important that your healthcare team knows about any obstacles you are facing in your treatment.

Your team can recommend resources that fit your specific situation. They may also help you with:

• Different treatment options
• Generic drugs
• Parking vouchers
• Transportation assistance
• Combining your appointments to cut down on multiple costs

Keep your bills in one place

If you get your bills in the mail, put them into a specific folder when they arrive. Likewise, if you receive your bills online, create a file folder on your computer and store them there.

Do the same for your EOB’s, receipts, and other paperwork you receive. It’s much easier to find them later if each type of document or record has its own folder.

Don’t let the mail pile up

Open and read any bill or statement sent to you. When you receive a bill, look at it carefully and compare it to the EOB from the insurance company. This is an important step to find any errors and possibly reduce your costs. Contact your insurance company if you find any discrepancies.

Keep a notebook

Log your telephone and in-person conversations. Any time you talk to someone from a billing or insurance office, be sure to write down their name, the date, and the issue you discussed so you can refer back to this later if needed. Be sure to keep your insurance policy number in your notebook so that you have it handy for calls.