Reducing the Financial Burden of Advanced Prostate Cancer Treatment

Talk to Your Insurance Company

Much of what you’ll pay depends on your specific plan. You may be able to lower your costs by learning some key details about your coverage. You should ask about the following: 

In-network services. These are health care providers that agree to take your health insurance. Ask your insurance company for a list of hospitals and doctors on your plan.

Sometimes, health plans cover part of the costs of out-of-network care. But you should talk to your insurance provider before you go that route. Explain why you need to go to a certain doctor or hospital. They might agree that this is what’s best for your cancer care and lower the costs.

Preapproval or prior authorization. Health insurance companies often need to sign off on a medical procedure before you get it done. The same goes for some tests and prescription drugs. This is something your doctor or hospital should take care of for you, especially for big things like surgery. But you should always double-check so you’re not on the hook for big out-of-pocket costs.

Negotiate With Your Hospital

First, check your bill for mistakes. Are there any double charges? Did you actually get the services you’re being charged for? Did the hospital or doctor’s office apply your health insurance and wait long enough for payment?

Next, make sure your medical bill matches your explanation of benefits (EOB). That’s a statement from your insurance provider that shows what it has covered and what you’ll need to pay. Call your insurer if you have a hard time with the details of your EOB.

If everything checks out, and you still have trouble paying your bill, many hospitals or clinics will work with you on the issue. Ask if there’s a financial counselor who can help. Here are other steps you can take.

If you have health insurance, you can:

• Call someone in the billing department and explain your problem.
• Ask if you can delay payment or pay a little each month.
• See if the hospital offers a low-income discount. 

If you don’t have health insurance, you can:

• Call or set up an in-person visit with someone at the hospital or doctor’s office.
• See if you can get a discount for self-pay.
• Ask about a payment plan or extra time to pay the bill.

Know Your Legal Rights

Hospitals, doctors, and health insurance companies have to tell you how much something will cost before you get a service. This is called a “good faith estimate.” It’s a new rule that started in 2022 under the Affordable Care Act. The goal is to protect you from unexpected, or “surprise,” medical bills.

Talk to Your Employer

It can be helpful to let your boss or human resources (HR) department know what to expect. Do this as early as you feel comfortable. That way, you and your employer can prepare for when you’ll need to miss work. 

You may worry about bringing up your illness on the job. But there are laws that protect you from work problems related to your cancer. This is something your HR department should know about. Ask it to go over the kind of help you can get.

When it comes to prostate cancer and your job, here are some things to ask: 

• What kind of changes can you make to help me keep working?
• How can I keep my job if I need time off because I’m sick?
• Can I still get short- or long-term disability insurance?
• How much notice do I need to give for family and medical leave (FMLA)?
• What else can I do to protect my job?

Questions for Your Doctor

Prostate cancer treatment costs can add up. For example, you may need to pay a copay every time you go to a doctor visit. Lab tests or scans may cost extra. You may need radiation therapy several times a week or a one-time surgery.

Keep in mind it’s not a good idea to skip recommended treatments based solely on the price tag. But it’s OK to ask your doctor if there’s a way to lower your costs. They can help you weigh the pros and cons of all your choices.

Here are some questions to get you started:

• This hormonal treatment costs me a lot. Why do I need it?
• Is there an older or cheaper treatment I can try first?
• Is active surveillance (watchful waiting) an option for me?
• Do I really need surgery or radiation therapy right now?

You may also want to ask:

• Can I opt for telehealth instead of in-person doctor visits?
• Can you waive the cost of some of my copays?
• Can we combine visits, so I have fewer copays?

What’s most important is that you don’t let high costs get in the way of treatment. And know your medical team is there to help.