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.