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Financial Issues
Insurance
Government health insurance
Other advice
When you're in pain, the last thing you want to think
about is paying for your medicine. Yet money worries
have stopped many people from getting the pain
treatment they need. Talk with your oncology social
worker if you have questions. He or she should be able
to direct you to resources in your area. Here are some general tips:
| "My doctor told me about a pain control technique that he thought would help me. I was a little worried about how I would pay for it. It took one phone call to my insurance company, and my questions were answered." - Terry |  |
Insurance
When dealing with health insurance, you might want to:
- Call your insurance company and find out what treatments are covered.
Sometimes insurance companies pay for only certain types of medicines. If
the medicine you need isn't covered, your doctor may need to write a special
appeal letter. Or your doctor may need to prescribe a different treatment.
- Ask if your insurance company can give you a case manager to help you with
your coverage.
- Check to make sure that your plan will cover any specialists your doctor
refers you to. If it does not, check with your insurance company to see which
doctors are included in your plan. Ask your doctor to refer you to someone
on your plan's list.
- Find out whether you have to pay copayments up front and how much
they cost.
- 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 and get reimbursed?
- Tell the insurance company if you believe you've received an incorrect bill.
You should also tell your doctor or the hospital or clinic that sent the bill.
Don't be afraid to ask questions.
Government health insurance
Medicare
Medicare is health insurance for people age 65 or older. However, people under 65
who are on kidney dialysis or have certain disabilities may also qualify.
Medicare Part B only pays for outpatient medicine given by a pump or by vein.
It doesn't pay for pills, patches, or liquids.
Medicare Part D is a benefit that covers outpatient prescription medicines. It comes
from private insurance plans that have a contract with Medicare. These plans vary in
what they cost and the medicines they cover. Find out which medicines a plan
covers before you join to make sure that it meets your needs. You should also know
how much your copays and deductible will be.
Medicaid
Medicaid gives health benefits to low income people and their families. Some may
have no health insurance or not enough, and therefore need this help.
If you have Medicaid, you should know that it pays for medicine given by mouth
(orally) or by vein (intravenous). Each state has its own rules about who is eligible
for Medicaid.
| To learn more about Medicare and Medicaid talk with your oncology social worker.
You can also go to the Medicare and Medicaid Web site, www.cms.hhs.gov,
or call the helpline at 1-800-MEDICARE (1-800-633-4227). Specialists can
answer your questions or direct you to free counseling in your area. |
Other advice
Don't be embarrassed to tell your health care team if you're having trouble paying
for your medicine. They may be able to prescribe other medicine that better fits
your budget.
If you feel that you're overwhelmed, the stress may seem like too much to handle.
You might try getting help with financial planning. Talk with the business office
where you get treatment. There are many free consumer credit counseling agencies
and groups. Talk with your oncology social worker about your choices.
You can also contact the NCI's Cancer Information Service (CIS) and ask for the
Financial Assistance and Other Resources for People With Cancer fact
sheet. See Resources for ways to contact NCI.
| Tips for saving money on pain medicine |
If the cost of pain medicine is an issue for you, consider the following tips:
- Ask your doctor if there are
generic brands of your
medicine available. These
usually cost less than brandname
medicines.
- 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.
- Ask about drug companies that have special programs to give free drugs to
patients in financial need. Your doctor should know about these programs.
- Remember that pills may cost less than other forms of medicine.
- Use a bulk-order mail 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. Ask your oncology social worker or pharmacist about bulk-order
mail pharmacies.
- Contact NeedyMeds.
They are a nonprofit organization that helps people who cannot afford
medicine or health care costs. Go to www.needymeds.com, or ask someone
to do it for you.
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