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Ketki Patel, MHA, is a Program Operations Specialist/Post Award Specialist for the University of Washington Thoracic, Head and Neck Oncology Research Program in Seattle, Washington.

Ketki is an experienced Patient Financial Advocate with a demonstrated history of working with clinical trials/research, medical oncology, and holds knowledge in prior authorization of inpatient and outpatient chemotherapy and appealing all types of claim denials. She has experience working with the drug manufacturers for drug assistance and copay assistance in the hospital billing setting.

Covid-19 Financial Impacts and Resources for the Cancer Patient
Tue, 08/04/2020 - 18:47
Author
Ketki Patel, MHA, GRACE Guest Contributor
Covid-19 Financial Impacts and Resources for the Cancer Patient

As many of you know, the costs of treating a new disease or virus are often astronomical, and most insurance companies are in flux as they incorporate these therapies into their step therapies and tier programs, and work to come up with medical necessity criteria to allow coverage for experimental treatments.

There are many potential financial impacts and, as a result, many resources emerge to help mitigate these impacts. Thanks to the wide array of organizations dedicated to helping people dealing with cancer, resources have been extended to assist with some costs associated with Covid-19. The list below is just a few of the many options available; I highly recommend working with a financial advocate to see what may be available specifically in your area as well.

Lymphoma and Leukemia Assistance
Breast Cancer Assistance
Colorectal Cancer Assistance
Lung Cancer Assistance

 

Medicare currently provides coverage for the following Covid-19 related services:

  • Medicare Part B will cover the coronavirus or Covid-19 test done to determine whether or not someone is positive for the virus itself https://www.medicare.gov/coverage/coronavirus-disease-2019-covid-19-tes…
  • Medicare Part B will cover any FDA approved antibody or serology (blood serum) tests
  • Medicare Part A will cover any medically necessary hospital stays for Covid-19, including if someone is diagnosed with Covid-19 and might otherwise have been discharged from the hospital after the hospitalization/inpatient stay, but needs to stay in the hospital under quarantine. A patient would still pay for any hospital deductibles, copays, or coinsurances that apply.

 

One other item that has probably changed drastically is the venue in which you see your doctor. Many providers have switched to telehealth visits, or visits through a video conferencing platform like Zoom or Skype. With that comes a plethora of medical necessity criteria as well that insurance companies need to account for. It looks like Medicare is following suit and has posted on their website that they will cover virtual visits at 80% under Medicare Part B, and the remaining 20% and/or deductible will default to patient responsibility.

Telehealth coverage varies by state, some states are integrating more coverage on their insurance plans as well. For example, Oregon recently announced that their commercial plans should provide expanded access to telehealth visits through the end of the year. It is always important to call your provider’s office to see if they offer the option and to check with your insurance company if they provide telehealth coverage and in what circumstances, a price estimate, and some insurance companies may even offer a free advice line as well. I have provided a link below that may help identify what’s available for telehealth options.

Oregon specific:

 

As policies are being created and insurance companies determine how to pay for these situations, I highly recommend reaching out to the insurance commissioner to ensure insurance companies are handling these claims appropriately. Many insurance commissioners have been pushing for insurer flexibility in light of the recent increase in health emergencies, and I recommend working with a financial advocate to pursue this route.

 

Lastly, there are currently several clinical trials that are monitoring Covid-19 and patients with cancer.  Clinicaltrials.gov is a great resource to see if there are any trials in your area.

 

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