The Cancer Patient's Guide to Navigating the Healthcare System

A breast cancer diagnosis comes with one guarantee: a lot of red tape. We asked insiders for their best advice on simplifying the process.

By Cheryl Platzman Weinstock

Don’t rush home. Depending how things go, you may need extra time in the hospital. "Ask your surgeon how long you can expect to stay," Attai says. "Most women will be comfortable going home 24 to 48 hours after a mastectomy. But if your surgeon says you’re only going to stay 24 hours, ask if you’ll be able to get more time if it’s medically necessary," she says. "You shouldn’t feel that you’re getting pushed out."
To Make Things Easier At Work
Know your rights. Many cancer patients keep their jobs through treatment. "Before you negotiate with human resources about time off, find out your rights under the Americans with Disabilities Act," Spicer says. Read your employee handbook to find out what your benefits are during treatment. If your boss gives you a hard time, click on the link below for help finding legal resources. The National Coalition for Cancer Survivorship offers a booklet on employment rights. Go to the publications section and click on "Your Employment Rights as a Cancer Survivor" to get a PDF.

Know when you need a note from your doctor. "If you’re having a problem getting time off, ask your doctor to send a letter to your boss stating your need for treatment," says Ann Marie Rappa, RN, case manager of the Columbia University Cancer Screening Program in New York City. Most employers are more sympathetic when they see the situation validated.

Ask your employee assistance program for help. Most employee programs offer resources to help people cope with a diagnosis and the emotional, legal, and financial concerns that come with it. For information, talk to your HR department and/or your spouse’s HR department.
To Make Things Easier on Your Wallet
Don’t get in deeper than your pockets. "Understand what your insurance covers and what is your financial responsibility," says Jeralyn Cortez, outreach coordinator for the Memorial Sloan-Kettering Cancer Center-City College of New York Partnership Community Outreach Program. Call the customer service number on the back of your card before a treatment or procedure takes place and ask if it’s covered.

Pay in cash, says Michelle Katz, author of Healthcare for Less. "You’ll have more negotiating power. If a procedure is not covered by your insurer, you may be able to negotiate 50 percent off the full amount. If it is, you may be able to negotiate the amount not covered by about 50 percent, or even work out a payment plan for the rest." Here are other tips she offers for people with limited or no insurance or prescription drug coverage:

    * Know that outpatient facilities cost less than a hospital stay. They have less overhead and fewer operating costs.
    * Look for state government programs that can save you hundreds of dollars. Do an Internet search with your state name (for instance, "New Jersey" and "Department of Health") to find out about money allocated for breast cancer treatment.
    * Look for discounted drugs if you don’t have prescription coverage. Almost all drug companies offer compassionate drug use programs.

Laura Weil adds: “Often, Hospitals’ Financial Assistance Offices (once called "charity care") can negotiate bills down from the self-pay rate (what the uninsured get socked with and the most expensive rate) to something more like the Medicaid rate, which is much less expensive—or even nothing.  You don’t have to be paying cash to do this; you just have to prove that you can’t afford to pay.  Of course, this will only affect hospital charges. You need to negotiate with individual doctor’s offices separately.”

Take down names when talking to your insurance provider. "Always write down the name of the representative and take detailed notes," Shaffer says. You’ll want to know who provided coverage information in case a claim is denied. "If the person can’t give you a clear answer, ask for a supervisor," she says. Also, ask to be assigned to a case manager. She can explain protocols and help expedite authorizations for treatments.

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