Surprise Billing, Cancer, and You

One of the most nagging issues patients face in the American healthcare system is the risk of what are called “surprise bills,” billing for procedures or treatments that are provided by out-of-network physicians or facilities. While most of the headlines about surprise billing have focused on emergency treatment, there are also cases where treatment for many things, including cancer, have wound up being a trap door that a patient can find themselves falling through due to health insurance plan fine print.

Worrying about surprise bills while navigating cancer treatment is an additional stress that can impact outcomes – you may even have to delay treatment if you discover that some phase of your chemotherapy treatment is out of network, or requires prior authorization for each treatment. Fail to get prior authorization, get billed for treatment, and you’ll have to negotiate with your insurer to get that treatment covered, with no guarantee you’ll win that argument.

So, what’s the best way to avoid surprise bills while dealing with cancer treatment? Here’s where your clinical team can come in handy with a recommendation for a navigator, someone to help you manage the administration side of treatment – ensuring you’re covered, and that your health plan will pay for the treatment your oncology team orders for you. The American Cancer Society has information on their site specific to what a cancer navigator can do for patients and families, and links to finding local navigators.

Here are some steps you can take to ensure your cancer treatment journey avoids surprise billing trap doors:

  • Ask your primary care team to help you with determining the need for referrals to the specialists who will treat your cancer (oncologists, surgeons, radiation oncologists, complementary therapies like lymphedema service)
  • Make sure the clinicians you’re referred to are in your insurer’s network – call your insurer to check, make sure to get the name and employee ID number for every insurer customer service human you talk to about this, and keep a log of those names and numbers
  • Work closely with your oncology team to ensure that prior authorization for treatment, particularly chemotherapy, is secured for you – here’s a place where a cancer navigator can be a literal life-saver

In addition to the American Cancer Society’s guide on insurance and cancer, there are other resource guides on managing the coverage and cost of your cancer treatment. There are a number of options on the Cancer + Careers website – they’re an organization that helps people stay employed, or find jobs, while navigating cancer.

Despite the American healthcare payment system being a labyrinth leading to a rabbit hole, there are options, and help, available. The key is to start asking questions early in the process, even as you’re pursuing a diagnosis, to ensure your treatment plan doesn’t get any unpleasant surprises in the form of big bills that your insurer is refusing to pay.