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== Managing Costs and Medical Information == <!--T:1-->
 
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People with cancer and their families may face major financial challenges. Cancer treatment can be very expensive, even when you have insurance. And keeping track of tests and treatments, paperwork, bills, and other records can seem overwhelming.

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For information about the risk of having financial problems during cancer treatment, see the PDQ summary, Financial Toxicity (Financial Distress) and Cancer Treatment.

=== Understand Your Costs === <!--T:4-->

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Whether you are someone who feels financially healthy or a person who is worried you can’t afford treatment, it’s important to understand the costs of your cancer care. Because of the many specialists involved and different tests and treatments you may have, knowing what costs to expect is key. Some tips to be sure you understand your costs are:

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'''Be aware of your costs from the beginning.'''

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Costs vary greatly depending on where you live, what insurance you have, and what each hospital charges. As much as possible, know what to expect about costs from the start.

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'''Know the costs of clinical trials.'''

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If you are taking part in a clinical trial, there will be two types of costs: patient care costs and research costs. For more details about both, see Paying for Clinical Trials.

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'''Learn about payment options if necessary.'''

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Talk with the billing office or a financial counselor at the hospital. If you’re worried about paying medical bills, ask them about options to make payment more manageable, such as:

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*Payment plans

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*Reduced rates

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*Patient assistance

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*Help from charities

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'''Talk to your doctors.''' 

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Tell your health care team if you think the costs of care could be a burden for you. Talking with them about these issues may make you feel uncomfortable, but they are there to help you. Your doctors need and want to know how costs are affecting you. Some patients say it makes them feel better to share their concerns with their doctor. Then decisions about what treatments to use and what medicines to prescribe can be made with those concerns in mind.

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The more your doctors know about your circumstances, the more they can be partners in your care. They can also point you to resources that may help you.

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'''Ask the hospital social workers for help in learning about programs beyond insurance.'''
 
They might be able to suggest organizations or other programs that could help you pay for cancer treatment.

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'''Contact your human resources department at work.''' 

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Your employer may have a specific person who can answer questions about your insurance plan or provide a contact name for more detailed information.

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'''Get help understanding your bills.''' 

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It’s normal to be confused about your bills, so don’t feel shy about asking questions. You can ask:

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*Someone in the billing office

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*A social worker at the hospital

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*A trusted friend or family member. See if they can help make insurance-related calls or help organize and track bills and reports.

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*Professionals who offer services to help with bills and insurance. These can include patient advocates and medical billing advocates. Although they charge a fee, in the long run they may save you money by helping you manage the costs of your care.

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'''Look into payment options for other bills.''' 

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If you are having a hard time paying your usual bills (such as mortgage, rent, or utilities) during your cancer treatment, talk to the bank or the companies that you owe. They may be able to set up a payment schedule to keep you from falling behind. It’s important to reach out to creditors as soon as you think you could have financial problems.

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'''Learn where to find organizations and resources that offer financial assistance.''' 

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One resource is NCI's list of Organizations That Offer Support Services. You can also call NCI’s Contact Center at 1-800-4-CANCER (1-800-422-6237) to ask for help finding referrals and resources.

=== Understand Your Health Insurance === <!--T:32-->

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It’s normal to feel confused about what your health insurance covers and the details of your plan. But it’s important to understand your policy and to create an organized way to pay and follow up on health care bills. Dealing with insurance often takes time and effort and can be a large burden when going through cancer care. Ways to manage this include:

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'''Call your insurance company and talk with a benefits coordinator.'''
 
Have your policy in hand. Review which tests, treatments, and drugs are covered and which are not. Ask if your plan will cover any specialists your doctor might refer you to.

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'''Ask about your co-pays, deductibles, and any other costs.'''
 
It’s important to know these costs when your care begins so you’re not surprised. You may also want to ask if co-pays are due up front and how much they cost.

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'''Ask how and when to make payments.''' 

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Find out how you should pay your balance. For example, do you file a claim? Does the insurance company pay first? Or do you pay the bill and then get reimbursed?

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'''Understand your Explanation of Benefits (EOB) forms.'''
 
Your EOBs are the forms you get from your insurance company that list the cost of services and treatments you had and how much of the fee was paid for under your policy. EOBs are not bills.

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'''Know the steps to take to get uncovered treatment approved.'''
 
If your doctor feels that you need a test or procedure that is not covered by your insurance policy, you may want to ask if the doctor will write a letter stating why it is needed. You will then submit this letter to the insurance company. If the company does not agree to cover the treatment or procedure, you can go through its appeals process.

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'''Request to have a case manager at the insurance company assigned to you.''' 

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This way you can talk with the same person each time you have a question or concern.

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'''Contact Medicare.''' 

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For questions about Medicare coverage, go to Medicare.gov or call 1-800-MEDICARE. Medicare is government health insurance for people age 65 and older. Among other things, you can learn how to save on drug costs, what to do if you have other insurance, and the claims and appeals processes. The State Health Insurance Assistance ProgramExit Disclaimer (SHIP) provides state specific information, referrals, and counseling to Medicare recipients and their caregivers.

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'''Contact Medicaid.''' 

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For questions about Medicaid coverage, go to Medicaid.gov or call the Center for Medicare & Medicaid Services at 1-877-267-2323. Medicaid gives health benefits to people with a limited income and their families. The program is run by each state, and therefore states may differ in who is eligible and in what benefits they cover. To learn what your state covers, see Contact Your State with Questions.

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'''Review guides from government agencies.''' 

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Look online for guides that explain how insurance plans work. Some examples are:

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*From Coverage to Care (C2C)

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*Do You Have Health Insurance?

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'''Contact programs that help with insurance coverage.''' 

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Seek help from organizations that help people who are worried about their insurance coverage. For example, the American Cancer Society's Health Insurance Assistance Service offers help to cancer patients and survivors who have lost, or are in danger of losing, their health care coverage (1-800-227-2345).

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If you can’t afford insurance and are ineligible for Medicaid or Medicare, ask about charity care and sliding-scale programs (in which fees are based on your income) at hospitals and clinics. Some hospitals are required to see patients who are uninsured. Contact your local department of public health or social services or the business office of your hospital of choice for more information.

=== Save Money on Pain Medicine === <!--T:53-->

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Cancer pain is a common side effect of cancer and its treatment. If the cost of pain medicine is an issue for you, talk to your doctor. Do not skip doses or save them for later. Doing so will interfere with your pain control. To save money on pain medicine, consider the following tips:

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'''Ask your doctor if there are generic brands of your medicine available.''' 

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These usually cost less than brand-name medicines. You can also ask about the form of the drug. Pills may cost less than other forms of medicine.

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'''Ask your doctor for medicine samples before paying for a prescription.'''
 
You can’t get samples of opioids. But you can ask your doctor to write only part of the prescription. This way you can make sure that the medicine works for you before buying the rest of it. This will only help if you pay by the amount you buy. For some insurance plans, you pay the same amount for part of or the whole prescription. Find out what will work best for you.

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'''Find out about discount drug programs.'''
 
Some organizations and drug companies have special programs that help pay for prescription drugs. Ask your social worker about these programs.

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Ask if you can buy your prescription drugs from a mail-order pharmacy. 
Many insurance companies offer the option of getting prescriptions through mail-order pharmacies. Sometimes mail order is cheaper than buying drugs at a local pharmacy. But first make sure that the medicine works for you. Also, be aware that you can’t order opioids in bulk or through the mail.

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'''Contact NeedyMeds.''' 

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NeedyMedsExit Disclaimer is a non-profit organization that helps people who cannot afford medicine or other health care costs.

=== Track Key Medical Information === <!--T:62-->

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As challenging as it may be, having records of the medicines, tests, and treatments you receive is very important. It may be helpful for you to get systems in place for organizing information about your care from the very beginning of treatment. Here are some ways to keep track of the medical care you receive:

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'''Ask for and keep copies of treatment plans and results.'''
 
Keep these in a file folder, or scan and save them on your computer. Other items to record are:

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*Dates of each medical visit

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*Tests and procedures received, with dates and results

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*Treatments received, with dates

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*Side effects and symptoms you have had, with dates

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*Any medicines prescribed

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*Other supportive or complementary care received

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Here is a sample chart showing the type of information that is helpful to keep handy and up-to-date.

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'''Use the electronic tools provided.''' 

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Some health care providers, insurance companies, and employers give patients access to tools on the computer. For example, you can set up a personal health record (PHR) that allows you to enter, manage, and track important medical information. A PHR is similar to an electronic medical record that your doctor may keep, except that you are the one who keeps the PHR and controls who sees it.

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'''Use a notebook or journal.'''
 
Write down details about side effects or questions to ask the doctor. Bring it with you to medical visits to take notes and to refer back to.

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'''Ask if you can record talks with your doctor.''' 

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Create a voice recording of these conversations with a recorder or mobile device to help you remember and track information. It will also make it easier for you to listen during the conversation itself, knowing you won’t miss anything.

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'''Keep a calendar or daily planner.'''
 
Track daily events, appointments, and important dates to remember.

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'''Use apps on your mobile device or computer.''' 

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There are many apps that can help you remember and organize information. Some organizations that have apps are:

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*American Health Information Management AssociationExit Disclaimer

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*HealthIT.gov

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'''Keep a sheet with the information below handy for yourself and others:'''

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*Names and contact information of the people on your health care team

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*Diagnosis information, such as type and stage of your cancer

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*Your treatment plan from your doctor

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*Possible life-threatening side effects or changes in health to be aware of and for which urgent medical care should be sought

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'''Talk with a social worker at the hospital to learn more about ways to track key medical information.''' 

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It’s not important which system or tool you choose, but that you use something to keep everything organized and easy to find.

=== Organize Medical Bills and Statements === <!--T:90-->

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Develop a system to track your medical bills and the EOB statements from your insurance company. Doing so may allow you to spot billing problems. Some ways to keep your bills and other financial paperwork organized include:

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'''Keep paperwork in one place.''' 

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If you get your medical bills in the mail, put them in a single folder or binder. If you get your bills online, store them in a file folder on your computer. To be safe, print out hard copies to store in a separate folder as well.

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'''Create a special email account.''' 

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Use this account only to communicate with the hospital and the insurance company.

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'''Organize bills and statements.'''

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For example, you could keep a separate folder for each month, or a separate folder for each kind of paperwork.

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'''Always check your bills and statements.''' 

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Match each bill you receive to the EOB statement from your insurance company. Ask about any differences you see between the EOB and the bill. Always speak up if you think your bill is wrong. It’s okay to question your bill with the doctor or the insurance company. You may find it helpful to keep a record of your conversations. Here is a sample chart to note the details of what you are told.

=== More Tips to Manage Costs === <!--T:100-->

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'''Follow your treatment and medicine schedule.''' 

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Extra costs can result from unnecessary trips to the emergency room or hospital. It’s important to take care of yourself and follow the treatment and medicine plan your doctor prescribed for you. Doing so may limit trips to the hospital you don't need.

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'''Know the details of your home care'''. 

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Make sure you know how to care for yourself at home before you leave the hospital. If you don’t fully understand your discharge instructions, ask the staff to explain them to you again. Have someone with you who can also hear the instructions and take notes. The more information you have, the more you can avoid unnecessary visits to the doctor or emergency room.

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'''Ask for help with travel costs.''' 

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Transportation expenses can add up for patients and families. If transportation is an issue for you, talk to your social worker about organizations that provide rides or help with travel costs. Or contact the NCI Contact Center at 1-800-4-CANCER for more information.

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'''Look at online tools that help you with money and budget.'''
 
There are many online tools designed to help you manage your money. For example, the National Council on Aging has a BenefitsCheckUpExit Disclaimer to help you find benefits you may qualify for or programs that can save you money. It also has an EconomicCheckUpExit Disclaimer to help you budget your money and other tips. There are many tools available online, so choose one that feels right to you.

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'''Get emotional support.'''
 
Stress can affect your physical health, which can mean more visits to the doctor and extra costs. If you feel upset and confused about financial issues or with the burden of having cancer in general, seek help early on. It’s important to ask for emotional and social support. Talk to friends and family about your stress. Let them know how you feel. Or ask for help from a social worker or other trained professional. They may be able to help you cope with your feelings.

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'''Look for ways to ease the tasks of daily life.''' 

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If you have to manage financial issues on your own, it can take up a lot of your time. It might help to arrange automatic payments for monthly bills. Or seek help with errands or chores you have to do. For example, ask friends to pick up your kids, bring meals by occasionally, or run errands for you. Or ask if they could help out by making non-medical phone calls or writing notes.
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