Submitted by the Breast Cancer Care and Research Fund
Over the last year, much has changed in oncology care. Prior to this year, patients would consult with an oncologist, decide on and pursue appropriate care and trust that their insurance would fundamentally support them in the pursuit of this care–paying the contracted amounts to preferred providers to deliver the recommended treatment.
When the prescribed treatment was novel, or “cutting edge,” they had confidence that a knowledgeable oncologist and his or her staff could appeal to their insurance company and, with data and clinical experience to support their recommendation, could achieve the desired authorization for the recommended medical treatment. Oncologists were mindful of the patient’s insurance benefits because these are precious patient resources, to be expended in a conscientious manner by the treating physician.
In the past several months, however, a new day has dawned in the area of insurance reimbursement for recommended cancer treatment. Private insurers, following the precedents set by Medicare, have further reduced reimbursement for cancer drugs and the costs of the delivery of care. Novel treatments that are especially important to patients suffering from recurrent disease have increasingly been denied for insurance coverage of these treatments.
This means that patients in the most need of novel care are no longer able to access that care if they do not have the personal resources to pay for the medicines out of pocket.
Insurance companies have established a policy of providing fewer and fewer mechanisms of physician provider access to enable a physician to “make the case” for his treatment recommendation with another professional in oncology evaluating the data.
Instead, more often than not, a non-medically trained individual–reading from a list of “approved” drugs, simply informs your doctor that the medicine he would like to prescribe is either on their list of approved drugs or it’s not. In the event that it is not, there is frequently no line of access to a medical professional offered.
Patients are powerful consumers of medical services and insurance coverage. And–there is good news–there is much that you can do as a consumer to express your voice and your will for yourself and your loved ones.
Breast Cancer Care & Research Fund’s mission is to provide information and to promote clinical research quality care and advocacy for women with breast cancer and their supporters.
The Breast Cancer Care and Research Fund is sponsoring a community forum entitled “A Public Dialogue Around Cancer Care: Who is Paying the Price?” on July 25, from 6 p.m. to 8:30 p.m. at The Grand, 4101 East Willow Street. RSVP to the BCCRF at (310) 927-7606.
