Insurance and Breast Cancer Treatment: New Choices

Women are delaying chemotherapy for breast cancer on average by seven months due to high deductibles of more than $1000 according to a new study. Biopsies and imaging studies are also being delayed. Explore this new reality as an RN. Be aware of this new trend which is affecting women.

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Insurance and Breast Cancer Treatment: New Choices

Many RNs work in acute care and do not give insurance a second thought. Most people have Obama Care under the Affordable Care Act, right? As an RN in acute care you may not be aware of this growing trend. A new study in the Journal of Clinical Oncology showed that women with high deductibles put off initiating treatment for breast cancer. Once they found a lump, they did not go for imaging studies or biopsies to confirm the diagnosis right away. This was discovered after a retrospective review was done of claims. In fact, chemotherapy was delayed on average by seven months.

Early Diagnosis and Treatment

Many of us in the healthcare arena have learned through common knowledge and sometimes sad experience that early diagnosis is key with cancer. Oncologists are now sounding the alarm on this timeline. We have all heard anecdotal stories about women who delay treatment for breast cancer for various reasons. Some of this has to do with indecision, as well as denial. Many times, it has to do with family drama as well as lack of money.

High Deductibles vs Lower Monthly Premiums

Research shows that half of all people in this country have deductibles higher than $1000. Eleven percent of those insured have a deductible of at least $3000. This data was uncovered by the Kaiser Family Foundation. This non-profit group is concerned with explaining health policy that concerns all Americans. It also looks at this country's place in world healthcare. Many times, high deductible plans are the only choice in health care insurance options provided by employers. It doesn't end there. Besides a high deductible many times these plans require patients to pay part of their costs of bills before the plan's coverage begins.

Difficult Choices

Employees either pay high monthly premiums and have a lower deductible or the opposite. In the case of breast cancer, the consequences of choosing between high premiums or high deductibles can strike hard and fast. Between 2011 to 2016, research shows that 50 million people chose insurance plans with sky-high deductibles. Twenty-nine percent of those who had employer supplied coverage had these plans. High deductibles occur since insurance companies do not want patients to incur tests that may not be required, in their viewpoint. These are known as unnecessary tests in the lingo of the insurance company.

A Car Wreck

Breast cancer, according to this study is seen as an illness that strikes suddenly, many times without warning. This data is significant in that it examines the behavior of those faced with a life and death scenario. Breast cancer has been compared to a car wreck you didn't expect. How many of us have met breast cancer patients with little or no risk factors and the all too familiar phrase, "No one in my family ever had..."? This is in contrast to diabetes, according to one of the study's authors. This is known as a chronic illness, necessitating ongoing treatment. Breast cancer treatment is deemed "more straightforward". It does not have that many detours to take in the road to remission.

Charity Care

One of the largest breast cancer charity organizations, Susan G. Komen, deals with women who delay treatment frequently. Their staff field questions about the lack of money to treat newly diagnosed breast cancers on a routine basis. In fact, questions dealing with how patients will manage to pay for treatment comprise half of their calls despite Obama Care. They also dispense grants to needy women seeking care. These grants cover shortages when a woman's insurance will not kick in and pay for "unnecessary tests". They will also give women additional avenues to seek funding.

Another charity known as the Samfund, helps younger patients with cancer pay their bills. The charity is named after its founder Samantha Eisenstein.

New Reality in Healthcare

Nurses should be aware of these trends when they see women entering the acute care hospital who may have delayed breast cancer treatment. The model of early diagnosis and treatment many of us learned in nursing school does not apply here. This is important when dealing with this new healthcare reality.

References

Women With Breast Cancer Delay Care When Faced With High Deductibles-The New York Times by Reed Abelson. Published May 4, 2018. Accessed May 4, 2018.

About Us. Henry J. Kaiser Family Foundation website.

About Us | The Henry J. Kaiser Family Foundation. Accessed August 30, 2018.

Is High-Deductible Health Insurance Worth the Risk? -The New York Times by Reed Abelson. Published October 31, 2016. Accessed August 30, 2018.

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Debi Fischer

About Debi Fischer

Debi Fischer RN, BA, BSN, MSW, LSCW is a nurse in a surgical oncology step down unit. Prior to that she worked in orthopedics and neurology. She has earned a master’s degree in social work and is also a Licensed Clinical Social Worker.

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Specializes in Travel, Home Health, Med-Surg.

I think that all cancers/illness' are affected by the fact that people have high deductibles. People who have to pay out of pocket will always think twice before going to the MD. Obamacare did help some people but it also hurt many others. I worked many years in Oncology (before Obamacare) and saw people struggling with Insurance/deductibles and losing everything because of the high cost of cancer treatment and then end up on Medicaid. It would also be helpful to lower the cost of care/medications. No easy answers!

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Specializes in Nephrology, Cardiology, ER, ICU.

Exactly. For those fortunate to have health insurance with low deductible there are more choices. Sometimes, my pts can't even seek a second opinion because of the high deductible.

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Specializes in Case Manager/Administrator.

I think the question to ask is do we continue to treat healthcare as a commodity or as a entitlement? And if we choose entitlement what kind of boundaries do we place on that?

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Specializes in Urgent Care, Oncology.

When I was diagnosed with cancer 10 years ago, I believe my mom paid about $10,000 for the out of pocket maximum for my treatment. I am fortunate that my parents were able to pay that because there is no way I would have been able to.

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Specializes in Flight, ER, Transport, ICU/Critical Care.

I will never forget my patient in her early 50's that did not seek care. This was prior to Obama care. Her hubby had been downsized, recently lost health insurance. The cancer in her breast had eroded and become an open wound. She presented with it packed with a pair of socks (among other absorbent materials) in the wound.

Her sister visited and she smelled it. Smelled it.

Discovered it and hence the ER visit.

The entire visit was excruciating.

It had started as a lump. Grew. And grew. And grew.

No insurance, at first. Denial? Didn't want hubby to know. Money. She told me that her youngest was graduating college and their house was paid off, and she did not want to burden debt. As it advanced, she became insured when hubby found new job. Tho once she had coverage, humiliation kept her from seeking care. She said she was embarrassed.

Yes, it was very advanced on ER presentation.

Lungs, Brain, Bones.

I don't know how she stood the pain.

And the wound was something I will never forget. And. The. Socks. She did say it was a new pair. She said she panicked as there was "so much stuff draining" and "my sister was coming in the bathroom".

Truly heartbreaking.

:angel:

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Specializes in Nephrology, Cardiology, ER, ICU.

Very sad stories

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