Financial & Legal Support

Financial Resources List with Links

We were honored to be joined by Laura Beilke, JD and Staff Attorney at Triage Cancer who shared budgeting tips for AYAs.

• Understanding Health Insurance Terms
  • Health insurance is often the largest factor in an AYA (Adolescent and Young Adult) patient’s financial health. Understanding these five key terms is essential for budgeting:
    • Premium: The fixed monthly cost paid to keep the insurance active, regardless of whether care is received.
    • Deductible: The amount paid out-of-pocket for medical services before the insurance company begins to pay.
    • Copayment (Copay): A fixed “entrance fee” paid at the time of service (e.g., $30 for a doctor’s visit).
    • Coinsurance (Cost Share): The percentage of costs you pay after meeting your deductible (e.g., an 80/20 plan means you pay 20%).
    • Out-of-Pocket (OOP) Maximum: The most important figure for budgeting. This is the absolute limit you will pay for covered services in a year. Once reached, insurance pays 100% of covered costs.
• Strategic Health Insurance Comparison
  • When choosing a plan, do not simply pick the one with the lowest monthly premium. You must “do the math” to find the total annual cost:
    • Multiply the Monthly Premium by 12.
    • Add the Out-of-Pocket Maximum.
    • Result: This is your “worst-case scenario” cost for the year.
  • Example: A “Platinum” plan with a high premium but a very low OOP maximum often ends up being cheaper for cancer patients than a “Bronze” plan with a low premium but a massive OOP maximum.
• Managing Prescription Costs
  • Formularies: Every plan has a list of covered drugs.
  • Payment Tiers: Drugs are grouped into tiers. Tier 1 (generics) is the cheapest. Tier 4 (specialty/new drugs) usually requires coinsurance (a percentage) rather than a flat copay, which can be significantly more expensive.
• The Explanation of Benefits (EOB) is sent by the insurance company. It is not a bill. It shows what the provider charged, what the insurance covered, and what you likely owe.
• Best Practices for Paying Bills
  • Wait for the EOB: Never pay a provider’s bill until you have compared it to the EOB from your insurance. Providers often bill faster than insurance processes claims.
  • Ask for Time: If a bill is due but the EOB hasn’t arrived, call the provider and ask to move the due date back.
  • Check for Errors: Review CPT codes and service descriptions for mistakes.
• Financial Assistance and Charity Care
  • Hospital Charity Care: Nonprofit hospitals are required by law to offer “Charity Care” (financial assistance) to those who meet income requirements or are underinsured.
  • Dollar For: A recommended nonprofit resource that helps patients check eligibility and apply for hospital charity care.
  • Negotiation: Before a bill goes to collections, contact the provider to negotiate a payment plan or a lower lump-sum settlement.
• Fighting Denials (The Appeals Process)
  • If an insurance company denies a claim, you have the right to fight back.
  • Internal Appeal: Asking the insurance company to reconsider.
  • External Review: An independent third party decides if the care was medically necessary.
  • Success Rates: 40–60% of external reviews are decided in favor of the patient. Note: Over 99% of denials are never appealed; those who do appeal have a high chance of winning.
• Paying for Medical Expenses with Tax-free Dollars
  • Health Savings Account (HSA):
    • Requirement: You must have a “High Deductible Health Plan” (HDHP).
    • Benefit: Money goes in pre-tax, grows tax-free, and stays with you forever (it doesn’t expire).
  • Flexible Spending Account (FSA):
    • Requirement: Offered through an employer.
    • Constraint: Usually “use it or lose it” by the end of the year.
• Essential Budgeting Sheets (available on Triage Cancer’s website)
  • The Health Insurance Comparison Worksheet: * Used to calculate the Total Annual Cost (Premium x 12 + OOP Max).
    • Helps you decide which plan is actually the cheapest for someone in active treatment.
  • The Medical Bill Tracker: * A tool to log every bill, EOB, and payment.
    • Key Feature: It automatically calculates how close you are to meeting your Deductible and Out-of-Pocket Maximum, so you know exactly when your medical care will become “free” for the rest of the year.
• Financial Pressure Points and Direct Tips
  • The “Math of 12” Strategy: Budgeting based on the worst-case scenario. If you know your OOP Max is $5,000 and your premiums are $2,400, you know your “Cancer Budget” for the year is $7,400. Dividing this by 12 gives you a monthly “health cost” to save for.
  • Avoid Collections: The biggest tip for protecting your long-term financial health is to contact providers before a bill is overdue. You can negotiate:
    • Extended payment timelines.
    • Lower lump-sum payments.
    • Payment plans that fit your current income.
  • Identify Charity Care: Use the Dollar For’s services to see if you qualify for “Patient Financial Assistance.” This can wipe out hospital bills entirely based on income levels.
• Triage Cancer Legal and Financial Navigation services – connect with a legal and financial navigator for two free sessions and personalized guidance and support.

Triage Cancer’s List of Resources

We were honored to be joined by Laura Beilke, JD and Staff Attorney at Triage Cancer who shared some ways to avoid financial toxicity as a result of cancer treatments, with a focus on health insurance. Here are some key things discussed.

• Terms to know: premium – fixed amount you pay each month just to have insurance; Annual deductible – fixed amount you have to pay each year before insurance kicks in; Co-payment – fixed amount you pay each time you get care (like an entrance fee to see your doctor); Co-Insurance/Cost Share – percentage you pay each time you get care; Out-of-Pocket Maximum – ***possibly the most important thing you should know about your insurance, fixed dollar amount of what you could owe
• Your annual cost will include your premium, co-payments, deductibles, co-insurance, and out-of-pocket maximums
• Make sure to check that your providers and facilities are covered in your network
• To research the insurance marketplace, go to healthcare.gov and start there. You may be directed to a new site depending on your state

If your insurance denies coverage, you can appeal.

• Internal appeal – go back to your insurance and ask them to reconsider
• External appeal – go to an independent third party to determine if the insurance should have covered it, this is a binding decision
• About 40-60% of appeals result in insurance paying; about 99.9% of denied claims never get appealed

Keep these records for a minimum of 3-6 years

• medical bills from all providers
• payments from insurance and EOBs
• any pre-authorizations
• dates, names and outcomes of any correspondence with insurance companies or providers
• non-reimbursed or outstanding medical and related costs
• meals, lodging, and travel expenses as a result of your diagnosis/treatment (including gas, parking, and tolls)
• your medical records

Some helpful links:

Employee Rights and Work Information

Medical Bill Tracker

Financial Support

Pharma Assistance

Help from Triage Cancer

Recursos en español

Resources for Avoiding Financial Toxicity

HealthWell Foundation is a financial resource that helps by assisting with copays, premiums, deductibles, and out-of-pocket expenses for essential treatments and medications.

Some of their funds include:

General Oncology Funds

Cancer-Related Behavioral Health Fund

Oncology Caregiver Behavioral Health Fund

Cancer Home Care Services

HealthWell Patient Brochure