Finding resources for living expenses are linked the needs of the person as well as demographics, household size, income and assets. There are ongoing programs such as LIHEAP ( www.liheap.com) that offers qualified individuls support toward heating and energy bills; LifeLine (www.lifeline.gov) for telephone; SNAP (http://www.snap-step1.usda.gov/fns) or SHARE food program (enter your state in google to find location) for food assistance; HUD.gov provides leads to reduced rentals, section 8 and other housing support. For one time support sometimes community action agencies, social services, local and/or national non-profits, disease specific organizations as well as churchs may be of support. I encourge you to utilize a Resource Directory athttp://www.patientadvocate.org/resources.php for a individualized list of resources based on your individual neeeds.

As you outlined, most alternative treatment is not covered by insurance, however be sure to consult with your plan and/or review your plan language before paying out of pocket. If your plan does not cover these services there are few resources to help financially. I would suggest finding a resource that will help offset the cost that you are already paying to help balance the added cost. Below are a few resources depending on your location and need may be of help.

The National Center for Complementary and Alternative Medicine has fact sheet provides a general overview of related topic and suggests sources for additional inforation athttp://nccam.nih.gov/health/financial.

The Annie Appleseed Project ( www.annieappleseedproject.org)provides information, education, advocacy, and awareness for people with cancer, their family and friends.

There are very little resources for alternative care, below are some resources that offer free or reduced services.

The Charlotte Maxwell Complementary Clinic (www.charlottemaxwell.org)is located in Oakland, CA and offers free complementary alternative medical treatments to low-income women with cancer.

The Melonhead Foundation, Inc (www.melonhead.org) supports the needs of children and their families who are seeking alternative methods of healing.

Pacific College Acupuncture and Massage Clinic (www.pacificcollege.edu) offers low-cost treatment for a wide range of ailments using acupunture and other healing modalities of Traditional Oriental Medicine. Locations are in San Diego, New York and Chicago.

Wheither you have outstanding debt or have not yet started treatment, call
the billing office of the hospital and ask if they have a hardship, charity or an indigent program. You will find that most public hospitals and faith-based facilities have a program. Be prepared to offer the facility details about your health and financial status.

There are many programs available to assist you with getting your medications. Many medications are available through patient assistance programs offered by the pharmaceutical companies. Each company has their own eligibility requirements and applications. You can visit www.needymeds.com or www.pparx.org for a complete listings of
all drugs available through these programs.

The Food and Drug Administration (FDA) considers generic drugs to be equally effective as brand names. It's imperative to be aware of what your doctor is prescribing for you and to, whenever possible, choose medications that are covered on the formulary. Medications classified as non-formulary are typically brand-name medications that have no available generic equivalent. They are usually in the third tier of prescription benefits and require the highest out-of-pocket expense. In some cases the medications may require prior approval by your insurance company. Typically the health care provider obtains this approval.

The formulary medication lists are regularly reviewed by a peer review panel of physicians and pharmacists appointed by the insurance company, and medications are added or deleted as deemed appropriate by this peer review process. Patients can reduce their costs by consulting the formulary, because covered medications require less out-of-pocket cost to the insured.

Some medications are selected for the formulary because they are the only available drug to treat a disease and are a substantial therapeutic advance. When there are multiple drugs available to treat a single condition, the insurance companies review the various options for optimal cost-effectiveness. Drugs may be excluded from the formulary if it is deemed ineffective or its safety is called into question in comparison to similar drugs.

If the medication being ordered is the only medication that your health care provider believes will be effective for you, you can request an exception to the formulary. In order to do this your health care provider can contact the Pharmacy Benefit Manager (PBM) for your insurance provider, or write a letter of medical necessity to request approval for you to obtain the requested medication.

Read more: Formulary Vs. Non-Formulary | eHow.comhttp://www.ehow.com/info_7753756_formulary-vs-nonformulary.html#ixzz2IALCyFpE

Formularies are preferred drug lists, and the list should be readily available in your benefit information. Generally, this list of prescriptions extends to specific generic and brand-name medications that have already been approved by the FDA and are considered to be safe. The drugs on your formulary list are usually negotiated between the manufacturer and insurance company for special volume discounts. Some drugs on the formulary may require pre-authorization, be sure to refer back to your specific benefits.

The goal of the a drug formulary is to give physicians more information about alternative therapy, enhancing cost effectiveness and giving patients more access to information. Most formularies are chosen after being thoroughly reviewed by the insurance carrier and are placed on the preferred drug list because they are important therapeutically and/or are less expensive than other drugs with the same effect. Medicare introduced Specialty Tiers with Medicare Part D in an attempt to control the cost of drugs. Many insurance plans have adopted this model making less expensive drugs more accessible, and as the complexity and cost of the medications increase so may your co-payment.

Medicaid is a federally mandated but state run program. Eligibility for Medicaid is determined by each state and takes several factors into consideration. There are many categories of eligibility and several different Medicaid programs. Please review all of the eligibility information and if you think you may be eligible, the best thing to do is apply. While different Medicaid programs have different eligibility criteria, in general four main criteria are used to determine eligibility.

• Income/Family Size: Both earned (wages from a job) and unearned income (Social Security Disability payments). Income limits are adjusted to account for the number of people in your family.
• Age: Eligibility criteria can be based on age. Certain programs are designed for people in specific age groups.
• Resources/Assets: Certain things you have are taken into consideration when determining eligibility. Different programs count different resources/assets.
• Medical Needs: Specific medical needs may determine your eligibility and they may also determine which program can best serve your needs. Some programs are designed to meet the medical needs of a targeted group such as the disabled or aged population.

To learn more about your state Medicaid program and other options available to you, visit www.Medicaid.gov

According to the Federal Trade Commission (FTC), the nation's consumer protection agency, family members typically are not obligated to pay the debts of a deceased relative from their own assets. What's more, family members – and all consumers – are protected by the federal Fair Debt Collection Practices Act (FDCPA), which prohibits debt collectors from using abusive, unfair, or deceptive practices to try to collect a debt.

Does a debt go away when the debtor dies?

No. The estate of the deceased person owes the debt. If there isn't enough money in the estate to cover the debt, it typically goes unpaid. But there are exceptions to this rule. You may be responsible for the debt if you:
• co-signed the obligation;
• live in a community property state, such as California;
• are the deceased person's spouse and state law requires you to pay a particular type of debt, like some health care expenses; or
• were legally responsible for resolving the estate and didn't comply with certain state probate laws.

If you have questions about whether you are legally obligated to pay a deceased person's debts from your own assets, talk to a lawyer.

Who has the authority to pay the deceased person's debt out of his or her assets?

The person named in a will who is responsible for settling a deceased person's affairs is called the executor. If there is no will, the court may appoint an administrator, personal representative, or universal successor, and give them the authority to settle the affairs. In some states, others (or other people) may have that authority, even if they haven't been formally appointed by the court.

http://www.consumer.ftc.gov/articles/0081-debts-and-deceased-relatives

Your ability to qualify for a loan is based on many factors, such as your credit score, income, debts, assets, etc. One thing we would recommend you watch for would be possible discrimination based on your diagnosis. You should not see any different attitude than you would expect in general from a lender. Interest rates, processing fees, processing time, etc. should all be in line with any loan that is being offered to a person submitting an application to the specific lending institution.

Another option you may want to consider is getting a viatical settlement. A viatical settlement is when a terminally ill person sells his or her life insurance policy to a third party for a lump-sum payment. In return, the third party, who may be an individual investor or a special firm, takes over the premium payments on the policy. This would allow you to enjoy your money or pay down your debt with the cash. Viatical settlements vary greatly depending on whom you are settling with, your state (or the policy’s state), and the terms of your individual policy.

The viatical industry is regulated on the state level but there is no federal regulation that governs these settlements. If you are interested in being party to a viatical settlement, you can start with the state insurance commissioner’s office or check with your State Health Insurance Assistance Program (SHIP) office. If you are considering this option, the person who is buying your life insurance policy, known as the viator, becomes the new owner of the policy and is the beneficiary upon your death.
You will want to consult with a tax professional or attorney before making a final decision. There is a provision in the Health Insurance Portability and Accountability Act of 1996 (HIPAA), terminal patients are sometimes not even required to pay federal taxes on the proceeds from a viatical settlement.

Some other options you may want to consider:
• Check to see if your life insurance policy has an accelerated death benefit This is generally only a partial benefit, but would give you cash relief and would not be hard on your beneficiaries.
• Take out a loan against the equity in your house or against the cash value of your retirement funds or other assets that you may have. This will provide you with some funds, and it will not totally penalize your heirs.
• For medical treatment debt, think about going on a payment plan using Visa or MasterCard. Most people are very responsible about their charge cards. But you need to pay only the minimum and your doctors get paid. While this will penalize your heirs eventually, it will relieve your worrying and keep you from feeling guilty every time you see your doctors.

https://www.caring4cancer.com/go/cancer/financial/help-with-costs/viatical-settlements.htm

This is a situation we get asked on a daily basis. If your medical debt is through a hospital, you will need to contact the financial counselor or a social worker at the facility and find out if they offer any financial assistance. Most hospitals, especially non-profits, have assistance programs in place for low-income, uninsured, and under-insured patients. Some facilities call the program by different names, charity care or financial hardship programs, but you want to ask if they offer any financial assistance, do not worry about the name. There will be an application process where you will need to provide personal information such as household income in order to be screened for eligibility.

If you are approved for financial assistance, the hospital will notify the applicant of the discount or write-off amount they are able to provide. We suggest notifying other healthcare providers where you still have a balance due, that you were approved for financial assistance through the hospital and inquire if they would consider providing that same discount on your outstanding balance. Often times they will consider this discounted amount. After the providers have adjusted the accounts, if a balance remains, arrange a payment plan that is reasonable for your budget.

We recognize that making a decision on the best insurance coverage for you and your family is a challenging task. The National Association of Insurance Commissioners (NAIC) provides these tips to help you make the best choice of the options available for you and your family.

Whether you are part of the 153 million Americans who receive health insurance coverage from an employer, the more than nine million self-employed, or the almost 14 million unemployed, tough economic times, rising medical costs and new laws related to healthcare reform make now a great time to reeducate yourself about health insurance.

If you receive health insurance through an employer, consider the following before selecting a coverage plan this year:
• Look closely for changes: Don’t automatically renew the option you had before; many employers are making changes due to rising costs.
• Take advantage of wellness incentives: Find out if your employer offers a wellness program that includes money-saving incentives for healthy behaviors such as exercising regularly or not smoking.
• Check out tax-free savings: In addition to your health insurance coverage, you may be eligible to open a Flexible Spending Account (FSA) or a health savings account (HSA). And don’t forget about dependent care savings accounts.

If you are self-employed or if your employer doesn’t offer coverage, you face unique challenges in finding and keeping health insurance, but you still have choices.
• Spouse plan: Check about being added to your spouse’s or domestic partner’s employer plan.
• Individual insurance: Consider shopping for private insurance. This option allows you to customize care to your lifestyle, health and budget. New Pre-Existing Condition Insurance Plans (PCIP) could help if you have had trouble qualifying for coverage in the past. Plus, recent tax law changes make it possible to deduct the cost of premiums from your taxable income.

If you are unemployed, within the past year you were likely forced to determine how, or if, to continue your health insurance. Now is a good time to review your decision. If you’ve been out of work for some time and your income has taken a significant hit, you or your family members might be eligible for Medicaid or the Children’s Health Insurance Program.
Health Insurance for Your Life Stage

In addition to your work situation, your family structure and lifestyle also have an impact on your health insurance needs. Find the right fit for you.
• Young Singles: If you’re a recent college graduate and just entering the workforce, this is likely the first time you’re making your own health insurance decisions. Of course you have questions. What’s the difference between an HMO and a PPO? How long can you continue coverage on your parents’ health insurance policy? NAIC has answers.
• Young Families: A new spouse or baby can significantly change your health insurance needs and costs. In short, it’s not just about you anymore. Consider these tips to ensure you and your growing family are covered.
• Established Families: As your family matures, so do your health insurance needs. From maintenance drugs and braces to insurance for your college student, it’s important to know the facts.
• Seniors: Now that your children are grown, it’s more important that you focus on your own health. Make sure you have the right coverage before and during retirement.

Many other special health insurance considerations come into play for domestic partners, single parents, military, and seniors who are raising grandchildren. Knowing your options helps you save time, money and frustration.

What is Open Enrollment?
Open enrollment refers to the period of time during which all members of your group health insurance plan have the opportunity to enroll in certain benefit programs. During an open enrollment period, insurance carriers are required to accept all applicants of the group without underwriting or evidence of insurability. Open enrollment is generally only held once a year. If you miss your company’s annual open enrollment, you likely will not be able to enroll in your employer-sponsored health insurance program until next year. Certain exceptions apply for new employees or employees with life changing events.

Make sure to check with your human resources department to see when your company’s open enrollment period begins and ends, and when your policy goes into effect, and can discuss your concerns with the selected insurance plan.

Read and Understand the Materials
There are many different types of major medical plans typically offered by employers. For help understanding the fundamental differences between preferred provider organizations (PPO), health maintenance organizations (HMO), point of service plans (POS) or indemnity plans, go to the NAIC insurance education Web site, www.InsureUonline.org and click on the life situation that most closely matches your own. The health section includes basic information about each type of program. Plan materials will detail which medical providers (physicians, hospitals, labs, pharmacies, etc.) are considered in-network and out-of-network. They will also detail how much the insurance carrier will pay under each type of plan.
Before making a choice:
• Check to see if your current physicians and area hospitals are in the plan’s network. Using network providers generally will save money on your health care.
• Check to see if spouses or dependents are covered. Some plans will cover spouses and other dependents, while other plans will not.
• Read all of the plan materials thoroughly. Doing so will tell you what your rights and responsibilities are under each plan.
• Review any pre-existing condition exclusions and prior authorization requirements in the plan materials.
• If you take prescription medications, check them against the list of approved drugs in each plan booklet.
• If any part of a plan is unclear to you, ask for help from your human resources department or the insurance carrier.
• If you are not satisfied with the answers to your questions, contact your state insurance department. Go to www.naic.org/state_web_map.htm for a link to your state insurance department’s Web site.

Compare the Cost and Coverage of the Plans Offered
In this uncertain market, it’s important to carefully evaluate your healthcare costs when making your annual enrollment decisions. While one option might have high monthly premiums and a low deductible, and another might have a low premium but more out-of-pocket expenses, it could be misleading which plan is best for you until you do the figures.
To pick the best coverage, first calculate your healthcare costs from recent years and try to estimate what your costs might be for the coming year. Don’t forget to include the cost of doctor’s visits, daily medications and any procedures you might be planning.

Next, make a list of the premiums, out-of-pocket expenses and benefits under each plan. Co-payments, deductibles and additional charges for wellness care or specialists (e.g. chiropractic care, cosmetic surgery, etc.) are examples of out-of-pocket expenses that you are responsible to pay. Remember, if you use a medical provider that is out-of-network, you will generally pay more out-of-pocket expenses. Include these fees in your calculations.

Finally, decide how much you can afford to pay. Other things to keep in mind:
• Check for any annual limits and prior authorization requirements.
• Some prescription medications have higher co-payments than others and they might vary from plan to plan. Mail-order options might be available for maintenance drugs at a lower cost to you.
• If your dependents have health insurance coverage through their employer, school or the Veteran’s Administration, compare their costs and benefits to the family plans you are considering to ensure that you choose the best plan for every member of your family. Make the same type of comparisons for any dental or vision care plans that you are offered.

Visit the NAIC's Special Section: PPACA & State Insurance Regulation for the latest news regarding healthcare reform implementation efforts.

Visit HealthCare.gov for information from the U.S. Dept. of Health & Human Services (HHS).

Resource: http://www.insureuonline.org/health_page.htm

Overall many patients diagnosed with cancer find themselves underinsured or even uninsured resulting in large out of pocket medical expenses. It is important to pay bills or make payment arrangments to avoid collections that can damper your credit. However, with that being said there are some opportunities to reduce the debt owed.

If your insured you should always review and understand your plan language. Compare your explantion of benefits to your bills to verify benefits are being processed correctly. Additionally, there are multiple strategies that may be employed to help with unpaid medical bills. You may want to discuss options with your treatment facilities on ways to reduce or eliminate your out of pocket expenses:


•Apply for financial assistance through the billing office at your provider’s office or medical facility.

•You may first need to apply and be denied for Medicaid to qualify for financial assistance from the hospital.

•Co-pay relief programs may be able to cover some of your pharmaceutical co-payments. Check with each program to see what is covered. You can also contact Patient Advocate Foundation’s Co-Pay Relief Program at 1-866-512-3861 to see if you qualify for assistance with your co-payments.

•Negotiate discounts with the hospital or medical provider. Some providers will offer a discount for prompt payment of your balance.

•Drug replacement programs may be available to assist you by providing medications to your physician’s office specifically for your use. Discuss these programs with your physician.

•Contact a disease specific organization to see if there are any financial grants available to assist you. These programs vary widely and may pay for transportation or other related expenses

Communication is the key, you may find that they will honor a small payment plan if you express your needs as well.

If you are requesting a medication that is off your prescription drug plan’s formulary, you will want to check with your insurance provider to determine what the process is to request an individual exception. Many health plans will give you the opportunity to request an exception based on medical necessity. For example, the medical necessity of you requesting Emend is that the alternative therapies, Zofran and Compazine, either did not work for you or that you experienced adverse reactions to them. You may want to ask your doctor to write a short letter to support your request.

At Patient Advocate Foundation, our experience with integrative and non-traditional therapies is restricted to helping patients with life-threatening diseases who have limited insurance coverage for recommended treatments or insurance does not cover them at all and thus looking for solutions to manage the debt.

However, here are be some interesting things we’ve found on this topic that might help point you in the right direction for a more complete answer.

http://nccam.nih.gov/ The National Center for Complementary and Alternative Medicine would be more aware of any national initiatives or trends with insurance companies and the adoption of these therapies as it relates to healthcare plans.

http://www.abccodes.com/downloads/AlternativeBillingCodesandYoga.pdf This is an older article but I’m guessing the industry hasn’t changed too much in this regard. This article does a nice job listing the Alternative Billing Codes as they relate to health care services given by providers (including acupuncture, massage therapy, holistic medicine, chiropractic etc).

http://www.cnn.com/2012/02/25/health/medicare-covers-yoga-heart-disease/index.html

http://nccam.nih.gov/health/providers/clinicalpractice.htm This page lists some medical focus areas where these therapies are gaining traction.

http://finder.healthcare.gov -HealthCare.Gov has a wonderful tool to help you identify the insurance policy options available to you in your state and your age group and situation, and the site will also give you a full listing of specific insurance providers that have plans available and their contact numbers. The site will also give a brief summary of the policies so you can easily compare deductibles and plan details.

In general, for individuals no longer eligible to remain on their parent’s coverage, other options to consider include private plans like Individual Plans, Pre-Existing Condition Insurance Plans (a 6-month uninsured requirement is mandatory), Employee-sponsored Plans, adding onto a spouse’s plan if applicable, or public options if you meet the qualifications including Medicaid or a state-sponsored High Risk Pool Plan.

This is best addressed with a medical professional however you might also reach out to any one of as number of cancer patient support discussion groups (like CancerConnect, CancerCompass) to gather the advice and experiences of other patients who have similar situations. It appears that this is a potential complication of the procedure and a quick search within these forums found a number of patient discussions revolving around the topic.

In addition, below are some articles written by one of our partners, LIVESTRONG on your question that might point you in a better direction.

http://www.livestrong.com/article/76270-mastectomy-complications/
http://www.theacpa.org/conditiondetail.aspx?id=66
http://pain.about.com/od/typesofchronicpain/a/post_op_pain.htm

Often medical treatment and care can be very expensive and put strain on a patient’s budget. Here are a few strategies patients can use to manage their medical debt:

Look for prompt-pay discounts: Offer the medical facility a reasonable, but specific amount of money upfront as payment in full for services. Some facilities may be willing to accept a smaller amount of money if it means they will collect at the time services are rendered.

Apply for financial assistance: Ask your provider if they have an application you can complete to receive a discount or write-off on your accounts.

Arrange an affordable payment plan: Speak with the facility’s billing department to negotiate a monthly payment plan that is feasible for your budget to prevent accounts from going to a collection agency.

Participate in Screening Programs: Ask your local Health Department about free screening programs such as the Breast and Cervical Cancer Early Detection Program. If diagnosed through these programs, patients will be referred to covered treatment options.

Manage your cost during treatmen: By asking questions and talking to your doctors, you can frequently find quality care at an equal or lower price. Walk-in retail clinics (like Minute Clinic and RediClinic), ambulatory surgery centers, outpatient services, and stand-alone imaging and blood diagnostic facilities, for example, can all be less expensive than the same services at hospitals and the doctor’s office.

Reduce future and current medical costs through a healthy lifestyle: Many patients see a reduction in their need for medications and medical care by improving their health in general through lifestyle and non-medical means. Be sure to maintain healthy habits when it comes to diet, exercise, weight, social behaviors and stress management. These can not only save dollars in terms of necessary treatment, but will also give your body the best internal tools when responding to any needed medication or medical action.

In terms of reducing expenses on pharmaceuticals, speak to your doctor to ask about lower cost and comparable medication alternatives, the use of generic brands, bulk discounts, and access to medication samples to ease the burden of cost. In addition, there may be assistance programs to aid in the cost of your prescriptions.

PHARMACY CHECKER An online resource that helps you identify, locate and compare reputable online pharmacies. www.pharmacychecker.com 718- 554-3067 Also allows patients to compare prices for medications among various pharmacy providers.

RX AID PRESCRIPTION ASSISTANCE Patient assistance programs that aid uninsured patients get their prescriptions at low or no cost. www.rxaid.us 877-610-9360

RX ASSIST A comprehensive directory of patient assistance programs run by pharmaceutical companies to provide free medications to people that cannot afford to buy their medicine. www.rxassist.org

STATE PHARMACEUTICAL ASSISTANCE PROGRAMS (SPAP) Many states have state-sponsored subsidies and discounts for seniors, disabled, uninsured and others. The National Conference of State Legislatures maintains a list of state specific prescription programs with a list of eligibility requirements. 202-624-5400 www.ncsl.org/issues-research/health/statepharmaceutical-assistance-programs-2011.aspx

DRUG ASSISTANCE CARDS /DISCOUNT PHARMACY CARDS These discount cards are offered to patients free of charge and give additional discounts on the out-of-pocket cost of medications. These cards tend to be easy to use and do not require forms to fill out or waiting periods to use. Many are offered by the pharmacy directly, including Kmart, Costco, Walgreens, Rite Aid, etc, or offered as a result of a community partnership. FamilyWize, YourRXCard and NationalDrugCard are examples of discount cards not tied to any specific pharmacy.

Patient Advocate Foundation has written a number of tip sheets and brochures relevant to this topic located. I encourage you to take a look at www.patientadvocate.org/publications, specifically:

National Uninsured Resource Directory – *(the first few chapters discuss low cost options for care and services )

Greater Understanding: Back to Basics: How to Discuss the Cost of Health Care Treatments With Your Provider

Your insurance company will issue what’s called an EOB- Explanation of Benefits for the services in which they have received provider claims submitted for payment relating to your care. The EOB is not a bill, however it will reference a portion of the total amount that the insurance company expects to be responsible for and a portion that you are responsible for based on your plan language. Keep in mind that these may be changed and updated as additional information is received by your insurance company from your providers. Usually, insurance companies will leave a portion of the bill as your responsibility until your full deductible is met, and only then cover in full.

You can expect to receive an actual bill from the provider’s office directly for the portion that remains on your account following the payments made by the insurance company. This is the portion you are responsible for. If you have questions about the EOB or your provider’s individual bills, contact either the customer service number on your insurance card or the billing representative from your provider’s office.

Many insurance companies these days also are offering their clients an online account area that shows updated information on all claims and care items associated with your insurance plan. This area lets you review the summary of your information all in one place and can be quite helpful.

PAF produces a brochure that briefly discusses the EOB, including a visual sample, to help. http://www.patientadvocate.org/requests/publications/GU-Explanation-Of-Benefits.pdf

There are a number of websites and tools out there that will help you get an idea of what a normal charge is for a specific service associated with your healthcare. This might help you get a sense of when a charge on your statement may be the result of a coding and billing error. An example is www.healthcarebluebook.com.

Insurance companies are obligated to pay based on your specific insurance plan and the language associated with it. It is in effect a legal contract between you and the insurance company. If you have questions, concerns, appeals or disputes your contract has to discuss the method and process for which they will address your concerns.

In terms of bills, you might have more luck negotiating remaining balances with each individual medical provider, as they might be able to offer you charity care, reduced rates for prompt, cash, or upfront payments, matching negotiated rates for other insurance types, extended payment plans, etc.

Also, keep in mind that you may be able to take your negotiating skills to some of the other living expenses and items in your family budget, thus allowing you to reallocate money to your medical bills and having the same effect on your wallet.

This is also a great article that references these tips and more.http://money.howstuffworks.com/personal-finance/debt-management/10-ways-to-negotiate-medical-bill10.htm.

Are you disabled enough where you should consider applying for Social Security Disability (www.ssa.gov)? You would then be eligible for a monthly benefit and Medicare after 2 years and/or Medicaid if your income was low enough. This determination would be one you would have to have support from your treating doctors and show your side effects are severe enough and will exceed 12 months or more.

The economy has made finding employment a challenge for most and coupled with your need for stellar medical coverage I am sure is narrowing your search further. Typically speaking, the larger the company you work for the more balanced your medical cost tends to be, however this is not a concrete statement. We have noticed over the past several years that the cost of premiums have shifted to the "employee" themselves and benefits begain to narrow to keep the premiums affordable. We classify this population as underinsured. You may find interest in viewing our publication, The National Underinsured Reource Directory available in print form athttp://www.patientadvocate.org/pdf/1070208NUiRD.PDF. We offer some tips that you may find beneficial.

There are provisions coming with the Affordable Care Act, if you uninsured now you should look at the PCIP plans (www.pcip.gov) for coverage for medical cost. Also your state maybe one that increases their Medicaid up to 133% of Federal Povery Level. Also in 2014 exchanges will enter the market as well as affordability measures that will hopefully provide the support you need. I realize this is not immediate but if you would like to learn more you can visit www.insureUStoday.org or www.healthcare.gov.

If cost is a barrier to your medical care I encourage you to speak to the specialist office directly. They may offer programs internally that could waive, reduce or allow payments to ensure continuation of care while you pay what you can afford, even if just $5 a month.

If they do not offer solutions, you could seek an alternative specialist who may if that is feasible. Seek out resources that help offset the cost you cant afford such as locating a pharmacuetical co-payment program, utility assistance or food assistance for example.

Did you know that HRSA clinic (www.hrsa.gov) offer primary care to patients regardless of their insurance status based on their ability to afford? Maybe you could consider seeking primary care there if they could waive your co-pay for PCP and you could shift that cost to your specialist.

Lastly, depending on your income and asset level, supplemental insurance support could be an option through state programs such as Medicaid. I am going out on a limb but if your current insurance offers a plan with a more affordable co-pay model for a higher premium you may consider that as an option if the math shows savings in the long run.

I recommend looking at the coverage you carry now, determine if that is the best coverage you can gain access to and speak to your provider about your financial barriers.

Often, patients make the choice to go to providers not participating in their network. If you choose to do this, it is critical to make sure that you have
"Out-of-Network" (OON) benefits under your policy. If you do not have OON benefits and you elect to receive care at an OON facility, you may not receive
ANY insurance reimbursement. If you have OON benefits, your claim will be processed using the prevailing UCR rates for the services provided. In addition, the provider may "Balance Bill" you for the difference between what the physician charges and what the insurance company pays.

When you sign up for health insurance - just like when you sign your auto or homeowner's policies- you are entering into a contract with the insurance carrier. Regardless of whom your insurance carrier is or what type of insurance you have, you are subject to the terms of your policy. It is critical for you as the patient to understand the way your policy works so you can maximize your benefits and your coverage under your plan.

Example:
OON Facility Bills Actual Charge$1 ,000.00
UCR Allowable Charge $ 400.00
60% (OON) Insurance Paid $ 240.00
Your 40% co-insurance $ 160.00
Balance Billing Choosing OON $ 600.00
Your Total Costs $ 760.00

Even if your policy has an out-of-pocket maximum, it is important to understand that ONLY your portion of the UCR amount allowed is applied towards your
maximum. In the example above, only $160.00 (your portion of the amount the insurance company deemed payable) of the $760.00 you paid is counted toward
your yearly out-of-pocket maximum. For this reason, many patients have much larger than anticipated medical bills when seeking services at an OON provider.

PAF has written a very quick read on this topic accessible at the following link:http://www.patientadvocate.org/requests/publications/GU-Understanding-Insurance-Plan.pdf

If you do not have in-network providers or facilities that are necessary to address your health condition, your referring physician should contact the insurer for an exception to seeking an out-of-network provider. This may require an appeal if a verbal request is not accepted. Evidence supporting the request will be necessary to reverse the insurers decision. In certain circumstances the insurer will pay an in-network rate however you will still be subject to the UCR amount and will have a larger out-of-pocket expense. Talk to the OON provider/facility and learn if they are willing to accept charges as full or work out a payment plan with you if it remains a concern.

PAF suggest that if you enjoy the flexibility of going to those you deem best for your illness and your current plan is limiting to seek other insurance options. It is possible you have more then on option at work for example. You should consider enrolling into the most appropriate plan that fits your medical needs during your open enrollment period (of if you have a qualifying event such a birth, divorce, marriage or loss of employment (spouse or self).

PAF cannot express the importance of understanding the current plan you carry to avoid unnecessary denial of claim and/or financial hardship due to large medical bills.

Family Medical Leave Act of 1993 is enforced through the Department of Labor and is a federal law that protects certain employees who have employers with 50 or more employees within a 75 mile radius of the corporate office. You as the employee must have maintained employment for 12 consecutive months, working at least 1,250 hours and carry a FMLA defined serious health condition that would warrant this leave.

A covered employer must grant eligible employee up to a total of 12 workweeks (consecutive or intermittently whenever medically necessary) of unpaid leave during any 12-month period for one or more of the following reasons :

• For the birth and care of a newborn child of the employee
• For the placement with the employee of a son or daughter for adoption or foster care;
• To care for an immediate family member (spouse, child or parent) with a serious health condition; or
• To take medical leave when an employee is unable to work because of a serious health condition

You as the employee must alert your Employer of the need for FMLA and have your provider complete necessary paperwork to verify eligibility. Once your FMLA is exhausted it is up to your employer if they maintain your job and benefits, however you no longer carry any further protection of your employment.

The law contains provisions on the employer coverage; employee eligibility for law’s benefits; leave entitlements, maintaining health benefits during leave, and job restoration after leave; notice and certification of the need for FMLA; and, protection for employees who request or take FMLA leave. The law also requires employers to keep records.

PAF has written a publication called First My Illness, Now Job Discrimination which outlines FMLA as well as ADA in depth at
http://www.patientadvocate.org/requests/publications/First-My-Illness-Job-Discrimination.pdf. You may also visit the Department of Labor’s website at http://www.dol.gov/dol/topic/benefits-leave/fmla.htm to learn more or for contact information to speak to a representative if you have in-depth questions.

Locating solutions to medical needs should start at the prescribing facility/provider first to determine if they offer any support you need. If additional solutions are needed I do hope you find the below resources helpful.

There are many organizations that vary their assistance based on their mission. You can find help by geographic region, disease, age, gender, or a variation of these. PAF has three interactive tools that will help you navigate resources based on your specific needs. You can access them at www.patientadvocate.org/resources and select financial resource guide, underinsured resource directory (if insured) or uninsured resource directory (uninsured) depending on what best suits you. Your local www.2-1-1.org is sponsored by the United Way and will link you to all know local resources based on your zip code.

Typically assistance around medication is limited by non-profits so if you need is more sustained help I suggest you research the drug manufacturer for resources linked to that particular drug. Often their websites carry referrals especially if they offer insurance denial support, discount card, co-pay card or free drug program. There are two excellent websites that will link you to the programs offered by drug name. www.needymeds.org and www.pparx.org . There are also several national co-pay relief programs that offer pharmaceutical co-pay help and some offer premium assistance. I’ve listed them below:

• Patient Advocate Foundation’s CoPay Relief (CPR) www.copays.org 1-866-512-3861

• HealthWell Foundation www.healthwellfoundation.org 1-800-675-8416

• Patient Access Network www.patientaccessnetwork.org 1-866-316-7263

• Heart Support of America www.heartsupportofamerica.org

• Caring Voice Coalition www.caringvoice.org 1-888-267-1440

• Chronic Disease Fund www.cdfund.org 1-877-968-7233

• Patient Services Incorporated www.uneedpsi.org 1-800-366-7741

• Leukemia and Lymphoma Society www.LLS.org/copay 1-877-COPAY

• National Organization for Rare Disorders (NORD) www.rarediseases.org or 1-800-999-6673

If you insured, Managed Rx Plans Inc (1-800-799-8765) maybe a option for you. They provide cost free prescriptions to individuals with long term recurring medication needs, accepting most major medical as payment in full, for all diagnoses. No income limitations. They do not accept Medicare or Medicaid and most HMO’s. Your insurance must cover 70% or better of the medication and results vary and depends on the insurance company and if the insurance company will allow the patient to use Managed Rx as their mail order pharmacy

Assistance provided through hospitals/facilities/doctors/labs, etc are based on their own internal policies. Always inquire about charity care, self-pay discounts, lump sum payment discounts, negotiated payment plans, prompt pay discounts etc. Be sure to follow you policy and elect in-network care to avoid unnecessary financial responsibility if warranted.

If you seeking DME such as a wig or prosthetic there are groups like ACS through their Look Good Feel Better Program (800-227-1213), Cancer Care (800-813-4673), Breast Cancer Network of Strength, formerly Y-ME (800-221-2141), and Crickett’s Answer for Cancer (301-935-4411). Wheelchairs, walkers and other similar items maybe available through donation closets at local charity groups or hospitals.

Outside costly COBRA benefits and high premium guarantee issue and conversation plans, currently, the options that will bring the best cost savings tend to be around enrolling in group health insurance. This can be a challenge with an self-employed individual but groups like the National Association for the Self Employed (www.nase.org) offer insurance options for members. I do not know your employment status but wanted to point this out to you or others who may benefit. If you don’t already carry a high risk pool plan you can explore the following list outlining states that have risk pool insurance outside the already offered PCIP plans mentioned in a moment below athttp://www.naschip.org/states_pools.htm. These plans run differently and allow individuals with creditable coverage options to secure insurance when other options are not available due to pre-existing health conditions. These plans will also allow you to enroll if your current premium is higher than their premium.

Until the Affordable Care Act (ACA) enacts affordability across the country, premium rates can remain a challenge for patients such as yourself with a pre-existing health condition. ACA did bring into place Pre-Existing Insurance Plans (PCIP) for those without access to affordable coverage however with your current insurance you wouldn't qualify - you must be uninsured for 6 months or longer (www.pcip.gov). In 2014, we will see exchanges entering the market as well as the lift on pre-existing health clause on adults and affordability as well as other insurance options should improve. With the Supreme Court ruling states are deciding if they will be expanding their Medicaid guidelines to include up to 133% of the federal poverty level- perhaps you fall within that guideline?

There are no known premium assistance programs for breast cancer that I am aware of, however there are two co-pay relief programs that maybe of assistance that could help offset the cost of your premium by bring support to your pharmaceutical out-of-pocket cost.

• Patient Access Network Foundation (PANF)866-316-7263/www.panfoundation.org

• Patient Advocate Foundation Co-Pay Relief Program 866-512-3861/www.copays.org

Additionally, you may find benefit in using our online tool, the National Underinsured Resource Directory is intended to intelligently narrow the vast and overwhelming number of potential local, state and national resources. By sorting based on specific information, this online tool helps to navigate and identify valuable tools as you seek alternative coverage options or methods for better reimbursement. www.patientadvocate.org/underinsured

As long as the claims are not in collections, you should request to speak to the hospital billing office/financial counselor (names can vary depending on facility). Your bills should carry a contact number and account numbers to direct you. If you find no success in speaking to a billing representative ask to speak to a supervisor to discuss your affordability concern.

Your insurance status and income/assets will most likely play a role in any negotiations that are application/paperwork driven. Which would be required in the instance of charity care/financial hardship program. Eligibility varies but these programs have been known to assist those with and without insurance who financially qualify. Be sure to ask the direct question, the information may not be offered otherwise. Charity care can be full or partial in nature.

Any remaining amounts I would suggest you offer to make a payment arrangement that you can afford to pay or if you are fortunate to have a lump sum of money you could afford to settle with offer, say 50% of the original billed amount and work your way up.

If you are uninsured and do not qualify for any of the items pointed out above, ask if they would be willing to reduce the bill to the Medicare allowable amount or their self-pay rate. If any of your outstanding debts are related to a pharmaceutical co-pay you should explore co-pay relief programs like ours, Co-Pay Relief Program 1-866-512-3861 ( www.copays.org will list qualifying diseases).

PAF has written a publication that you may benefit from called A New Approach: A Simple Dialogue Between the Patient and Provider about the Cost of Medical Care available at:http://www.patientadvocate.org/requests/publications/New-Approach-Simple-Dialog.pdf.

It sounds as if your doctor is not a contracted provider under your insurance contract. If that is the case the doctor is not subject to the insurance company, the insurance company's rules, regulations, policies and procedures have no jurisdiction on the non-contracted provider. Therefore, the non-contracted doctor has no legal obligation to send a claim, receive payment from the insurance company, or appeal a denied or partially paid claim. Everything reverts to the contract between the patient and their insurance company. That contract requires the patient to submit their own claim, however they can decide to submit a claim but it is only as a courtesy to the member. If the doctor is contracted with your insurer they must submit your claim for you and this scenerio should be reported to your insurer.

Keep in mind if you are using a non-contracted provider you will be subject to higher out-of-pocket cost since they do not have a pre-negotiated rate with your insurer. PAF has a great publication on Usual, Customary and Reasonable Charges (UCR) a result from using an out-of-network provider/facility.http://www.patientadvocate.org/index.php?p=439

Silver Cross www.silvercross.com helps you find recycled or new accessibility lifts and mobility devices that fit your budget. Depending on your needs they maybe able to help. There are several wheelchair foundations but I am unaware of any free car modification organization. I would also suggest contacting your local community action agency or local church to learn if they offer any grants to fullfil your need. These grants vary. You may find locating funding for readily available programs such as co-pay relief or energy assistance can offset the cost to afford purchasing the necessary modification you need. PAF case managers can explore if there are specific resources based on your particular diagnosis and location as well.

After being diagnosed with any illness, especially a serious one such as cancer, other areas of your life are unfortunately affected as well. When your health does affect your employment, the last thing you expect is to be confronted with harassment or the threat of losing your job, income and health benefits. Despite significant gains in cancer survival rates and the passage of the ADA, people with cancer still experience barriers to equal job opportunities. One reason individuals with cancer face discrimination at work is their supervisors' and co-workers' misperceptions about their ability to work during and after cancer treatment. Even when the prognosis is excellent, some employers expect that a person diagnosed with cancer will have long absences from work or not be able to focus on duties.

Keep a detailed journal of all incidents including the date, time and what was said and by who as well as when you sought assistance from managers to resolve the matter. Ask for a meeting with our manager, human resources or union depending on you company set up. Come to the meeting organized with detailed facts and your concerns. If you have suggestions offer them as well. Under the ADA, it prohibits harassment based on disability just as other federal laws prohibit harassment based on race, sex, color, national origin, religion, or age. Harassment is actionable under the ADA when a person is subjected to offensive conduct that is sufficiently severe or pervasive to create a hostile or abusive work environment. Employees who believe that they have been harassed because of cancer may file a charge with the EEOC if you still find your personalized meetings are not resolved to your satisfaction. Keep in mind that the charge must be filed by mail or in person with the local EEOC office within 180 days from the date of the alleged violation.

Patient Advocate Foundation's publication "First My Illness, Now Job Discrimination" is a good resource as well.

Contact the treating provider/facility billing clerk for clarification of the bill. You may request an itemized statement that breaks down the cost for you to review. If your insured you may also contact the insurer for further clarification on the benefits or lack of. Patient Advocate Foundation has a publication on understanding your explantion of benefits athttp://www.patientadvocate.org/index.php?p=441. Coding and Billing errors do occur so if the bills seems questionable and you feel if incorrect dig deeper you may find a simple phone call to the billing department where the claim may recify the situation. If you find these steps are unsuccessful, PAF can also provide assistance in reviewing the bill in question.

If you have worked at your new employer long enough to accumulate leave time I would utilize vacation, sick or personal days for a scheduled doctor appointment. If you find that you need more then one day or your request are frequent you should discuss with your human resources department your needs to see if accomidations are offered. Maybe you could seek a later afternoon appointment and flex. If you have been employed for at least 12 months and worked enough hours you could be eligible for Family Medical Leave assuming your employer employees the required number of employees (www.dol.gov).

The following are resources that provide free wigs as well as other items you may find of benefit:

Breast Cancer Network of Strength , formally known as Y-ME helps breast cancer patients and survivors regain their sense of well-being and self-confidence by providing bras, wigs, and/or prostheses at no cost to those with limited financial resources. www.y-me.org or 1-800-221-2141

CancerCare under their Women's Cancer Program, offers financial assistance and counseling, support groups, and patient education. They also provide free wigs and breast prostheses to women who have lost their hair or a breast as a result of their cancer treatment. 1-800-813-HOPE (4673)

Crickett's Answer for Cancer 1-301-935-4411 provides free wigs, mastectomy products, mastectomy and lymphedema massage, facials, and other pampering services, as a way to keep a woman feeling feminine and beautiful despite losing her hair and/or breasts.

The following are resources that provide free breast prostheses:

Breast Cancer Network of Strength , formally known as Y-ME helps breast cancer patients and survivors regain their sense of well-being and self-confidence by providing bras, wigs, and/or prostheses at no cost to those with limited financial resources. www.y-me.org or 1-800-221-2141

CancerCare under their Women's Cancer Program, offers financial assistance and counseling, support groups, and patient education. They also provide free wigs and breast prostheses to women who have lost their hair or a breast as a result of their cancer treatment. 1-800-813-HOPE (4673)

Crickett's Answer for Cancer 1-301-935-4411 provides free wigs, mastectomy products, mastectomy and lymphedema massage, facials, and other pampering services, as a way to keep a woman feeling feminine and beautiful despite losing her hair and/or breasts.

The impact on Medicare Part D as a result of healthcare reform provides the following relief, while small a stepping stone to the closure of the gap as anticipated in the year 2020. For this year (2011) manufacturer’s are to offer a 50% discount on brand name prescription drugs and 7% discount on generic prescription drugs. Over the next ten years, Medicare beneficiaries will receive additional savings on brand name and generic drugs until the coverage gap is closed in 2020.

I don’t have concrete evidence based on your message if the medication you have a large out of pocket expense is a result of a grandfathered drug under Part B or more common drug covered under Part D which you must elect to enroll. Either way if you have insurance coverage for the medication I would strongly encourage exploring co-pay relief programs such as our own Co-Pay Relief (www.copays.org) they offer a 12 months look back period if approved, which is especially helpful for money you are out of pocket currently. Other copay programs are Assistance Fund, Cancer Care, Chronic Disease Fund, Inc, Healthwell Foundation, Leukemia and Lymphoma Society, National Organization for Rare Disorders, Patient Access Network Foundation, Patient Advocate Foundation Co-Pay Relief, and Patient Services Incorporated. Qualifiers all vary based on disease, drug, income levels.

Depending on the household income and asset level you should look into programs such as the Medicare Savings Program, there are programs that help millions of people with Medicare save money each year. States have programs for people with limited income and resources that pay some or all of Medicare’s premiums and may pay Medicare deductibles and coinsurance. You can learn more by visiting www.medicare.gov See publication #10126. I have listed below each of the programs. These figures do change each year and can vary per state but the following are for 2011:

QMB- Qualified Medicare Beneficiary - Covers part A and B premiums, and other cost-sharing (like deductibles, coinsurance and co-payments)
• Individual Monthly Income limit $903.50
• Married Couple Monthly Income limit $1215.00
SLMB- Specified Low-Income Medicare Beneficiary -Covers part B premiums only
• Individual Monthly Income limit $1,083.00
• Married Couple Monthly Income limit $1,457.00
QI- Qualifying Individual- Covers part B premiums only
• Individual Monthly Income limit $1219.00
• Married Couple Monthly Income limit $1,640.00
QDWI- Qualified Disabled & Working Individuals-Covers part A premiums only
• Individual Monthly Income limit $1825.00
• Married Couple Monthly Income limit $2448.33

A government program is also available to discount the amount a beneficiary pays for their medications. Eligibility is based on income and assets.
Also referred to as the “Extra Help Program.” The 2011 Guidelines are listed below and help Medicare recipients with premiums, deductibles and co-pays/coinsurance.
• If your yearly earnings and resources are:
• $21,855 married w/resources <$25,010
• $16,245 single w/resources <12,510
• If you qualify, you can enroll into a Medicare part D plan at any time.
o Online at www.socialsecurity.gov
o See publication #11318-AA


Additionally, explore your state to see if they offer a prescription drug program (pays for premiums or discounts.)http://www.rxassist.org/patients/res-state-programs.cfm

You should always review your current Part D or Advantage plan coverage annual during open enrollment to see if you are enrolled in the best cost effective plan as well. PAF case managers are available to provide support as well. I hope this information was helpful.

In our experience medical debt crisis is a large concerns for patients who contact Patient Advocate Foundation. Many cancer patients have inadequate insurance or none at all and due to affordability, pre-existing clauses or a multitude of other reasons find themselves in this situation upon diagnosis. Some of the areas a patient can explore depending on income, asset and qualifiers are to apply for governmental programs such as Medicaid and/or Medicare, obtaining charity care and/or financial assistance through medical facilities, and obtaining necessary medications through prescription assistance programs or other state/national medication assistance programs (www.needymeds.com). Patients can explore clinical trials as a feasible option for access to care as well. It is always important to explore insurance options such as enrolling in plans offered at their own place of employment or their spouses. Children now can remain enrolled or re-enroll in their parents plan up until age 26 under healthcare reform, explore high risk pools or pre-existing health insurance plans (www.pcip.gov) now mandated by healthcare reform in each state, guarantee issues plans, individual/group insurance, and COBRA options. Georgetown University has an excellent website,http://www.healthinsuranceinfo.net that is a state by state consumer guide on how to get and keep health insurance and addresses topics I outlined here.

If the patient is insured is underinsured meaning he/she has health insurance coverage but lacks the financial resources needed to cover out-of-pocket expenses for medical care. Or underinsured when access to medical services is inhibited as the direct result of insurance benefit exclusions the patient can follow the same options as listed above. If they are insured through an employer who offers more than one plan, they should consider switching their benefit plan to a better option come open enrollment or if there has a been a qualifying event. Also there are many co-pay relief programs available such as our own Co-Pay Relief (www.copays.org)that can offer financial relief to qualified patients.

PAF is here to provide support to any patient with cancer who has difficulty accessing care regardless of their insurance status. We can be reached at 800-532-5274.

Without specific information on your current health condition, treatment protocol and review of your disability plan, I am not able to tell you if you would qualify for benefits. Each disability plan have their own contract language that dictates benefits offered, when they start and how long and when they continue. Additionally, often the medical support of your treating physician(s) is necessary to support a disability claim. If your treatment and/or side effects are affecting your ability to work, review your plan and discuss going on disability with your provider. File a claim and await a decision. If you do find yourself denied, review the reason why and file an appeal. Patient Advocate Foundation wrote a publication called Your Guide to the Appeal Process available athttp://www.patientadvocate.org/index.php?p=489.

Some areas I would request your review are:
1. Does the policy have a waiting period (period of time) before it will allow you to submit a claim?
2. Are there medical requirements you have to meet, i.e, cannot perform your job or ANY job; must be unable to work for at least 6,12 months etc.
3.Do you have/have you applied for disability through work? or if your disease is suspected to bypass a 12 month timeframe for recovery applied for Social Security Disability (www.ssa.gov)?

On a side note, if you are out of work now. Are you currently on medical leave? If your employer has over 50 employees and you have worked there for at least a year you may be eligible for Family Medical Leave Act, which protects your job up to 12 weeks. It’s important to discuss this with your employer to protect your job, and or apply for benefits that you may be entitled to. Some employers will also allow accommodations to work modified schedule or use their FMAA intermediately if working less hours is what you need as well.

I'd be happy to offer additional support if you are willing to share more information. Or you may contact us at 800-532-5274

A law was passed in 1996 to protect individuals who are seeking new employment opportunities or who simply would like to change group health insurance options. The Health Insurance Portability and Accountability Act also known as HIPAA (http://www.dol.gov/ebsa/newsroom/fshipaa.html) will provide anyone who has health insurance for at least 12 months and has had no break in coverage greater then 63 days an opportunity to pick up their new insurance without a pre-existing clause. Since some employers have a waiting period of 3 months before insurance will be in effect, but sure to elect COBRA benefits in the interim. Also under the Patient Protection and Affordabe Care Act, there are provisions in place to remove pre-existing health conditions starting in 2014 for adults and have already impacted those under age 18. (www.insureUStoday.org or www.healthcare.gov) Additionally, each state is mandated to offer a Pre-Existing Insurance Health Plan (www.pcip.gov) for when you are not eligible for other coverage and have had a lapse of 6 months or more.

Life insurance does not have any laws to offer the same protection. This is not an area of specialty for PAF, I recommend you speak to your employer human resource department about conversion opportunities or open enrollment options without medical disclosure requirement at the new employer or even a life insurance agent.

Telling your boss is your personal choice, however there are protections available to you only if they know about your illness and the modifications you need. Depending on how large your company is, you may only have to tell your Human Resources Department and you can specifically ask that they not to share your diagnosis with other co-workers if that is your preference.

Prior to your conversation, talk to your doctor and determine what accommodations if any you will need and be fully prepared for your conversation with a notebook and any medical documentation you may need.

• Several U.S. laws protect people with disabling chronic illness from workplace discrimination.
• Per the Americans with Disabilities Act (ADA), individuals with cancer account for 2.5% of ADA complaints. ADA protects workers against discrimination in the process of hiring, firing, promotions, training opportunities and many other activities. The law also requires that employers make reasonable accommodations, so that people with a disability or disabling chronic illness are able to function in the workplace. Accommodations can include anything from modifying a work schedule to altering the physical workplace to make it accessible.
• And if more time then you have is needed to complete treatment, the Family Medical Leave Act (FMLA) allows employees to take up to 12 weeks of leave in a 12-month period. During this leave, an employee's job is protected and that person must be considered for any promotions he or she might be eligible for. You can take leave in one 12-week block, or it can be taken in smaller increments, as long as the reason for the leave is the same. A parent, child or spouse can also take FMLA leave. You are only eligible for FMLA leave if you have worked with your employer a year and have put in 1,250 hours throughout the previous 12 months. In some rare cases, employers may not be required to provide leave, such as if the company has fewer than 50 employees, but many may still provide it.
• Additionally, some employers have Employee Assistance Programs (EAPs) that help employees deal with personal problems that might affect work and overall well-being. These are private and confidential services.

Many accommodations such as ADA or FMLA leave require application through the your human resources representative.

After being diagnosed with any illness, especially cancer, other areas of your life are unfortunately affected as well. When your health does affect your employment, the last thing you expect is to be confronted with harassment or the threat of losing your job, income and health benefits. Our publication, First My Illness, Now Job Discrimination (http://www.patientadvocate.org/index.php?p=122) is designed to empower you to fully understand what your rights are, to assist you with direction in filing a claim of discrimination and to help you deal with job discrimination.

I concur with Tanya's recommendations as documentation of the events you feel are discriminatory is important. Discrimination can come in all forms and if you dealing with needing time off from work to undergo treatment, depending on the size of the employer and how long you have been employeed with them you can qualify for up to 12 weeks of Family Medical Leave (FMLA) allowing you protected time away from work.

If you find that your Human Resources is not helpful or your still having challenges you can file a complaint with the US Equal Employment Opportunity Commission (EEOC) at 800-669-4000 or contact Patient Advocate Foundation at 800-532-5274.

SSDI is a federal disability insurance program designed for individuals who have worked enough to earn sufficient "work credits". Under this program monthly payments are based on the individual’s earning record, which is on file with the Social Security Administration.

SSI is a federal financial assistance program which provides monthly payments to individuals who have either never worked or have insufficient credits on their earnings record to qualify for SSDI. SSI recipients are required to have limited financial resources and assets that do not exceed $2,000.00. In 2010, the basic SSI benefit program paid $674.00 per individual or $1,011.00 per couple per month.

There are multiple strategies that may be employed to help with unpaid medical bills. You may want to discuss options with your treatment facilities on ways to reduce or eliminate your out of pocket expenses:

For assistance with Part A or B cost, apply for financial assistance through the billing office at your provider’s office or medical facility.

You may first need to apply and be denied for Medicaid or one its programs, such as Qualified Medicare Beneficiary (QMB) or Specified Low-Income Medicare Beneficiaries (SLMB) Program to qualify for financial assistance from the hospital. To apply contact your State Department of Social Services in the State where you reside.

Co-pay relief programs may be able to cover some of your pharmaceutical co-payments. Check with each program to see what is covered. You can also contact Patient Advocate Foundation’s Co-Pay Relief Program at 1-866-512-3861 to see if you qualify for assistance with your co-payments or explore websites such as www.pparx.org for a list of programs by disease.

Negotiate discounts or payment plans with the hospital or medical provider. Some providers will offer a discount for prompt payment of your balance.

Drug replacement programs may be available to assist you by providing medications to your physician’s office specifically for your use. Discuss these programs with your physician.

Contact a disease specific organization to see if there are any financial grants available to assist you. These programs vary widely and may pay for transportation or other related expenses. Patient Advocate Foundation’s National Underinsured Resource Directory can lead you to the best resources for you needs. Visit http://www.patientadvocate.org/help4u.php

For assistance with Part D cost, apply for Extra Help through www.ssa.gov that offers qualified individuals with extra help to pay for the monthly premiums, annual deductibles, and co-payments related to the Medicare Prescription Drug Program.

Some states offer a State Prescription Assistance Plan. Explore the site http://www.needymeds.org/state_programs.taf to learn more about the your state.

Discuss generic alternatives with your physician if brand named drugs are too costly.

We encourage the review of our publication, A New Approach: A Simple Dialogue between the Patient and Provider about the Cost of Medical Care available at http://www.patientadvocate.org/pdf/pubs/a_new_approach.pdf.