Obstacles with access to care

Imagine being diagnosed with leukemia, and, in order to keep the disease in check, you need to undergo a certain treatment. The treatment, however, is expensive, so you go through your health insurance to pay for it. But your insurance company takes almost a month to authorize the payment. By that time, the leukemia had spread, and, instead of speaking to your oncologist about a new treatment option that would have kept your leukemia at bay, you are talking about a more toxic treatment option for a more aggressive diagnosis.

“These are the kinds of conversations I must have with patients almost every day,” Dr. George Geils Jr., a hematologist and oncologist with Charleston Oncology, said.

Health insurance is just one of the many challenges people face when talking about access to care, but it’s a big one.

“Treatments are oftentimes delayed because of the restrictions that insurance companies apply to these patients,” he said. “The difficulties getting insurance approval are largely driven by the exorbitant costs of the newer therapies. One year of a new cancer drug can cost $400,000 or more per patient.”

He said that in his 12-physician practice, 30 employees are needed behind the scenes just to follow up on insurance claims for patients.

“It is burdensome on the practices, too, because our hands are tied when treatments that we know will help the patients are delayed or denied,” he explained.

And, unfortunately, medical bankruptcy is all too real.

Dr. Geils said, “The practices have to make ends meet, so what do we do when we find that a patient can’t afford a treatment option? We pursue coverage for the patient through foundations and grants where available, but funding is limited. And that is where the moral dilemma comes into play. How do we take care of these patients that can’t pay for their medical treatments? We are often their only advocate.”

Dr. Jennifer Fiorini, a breast cancer surgeon, said she sees education as hindering access to care as well.

“For my line of work, I see so many patients who do not know the value of an annual mammogram,” she explained.

She said that she hears patients say they thought it would be too painful, so there is fear involved as well. And she said she realizes there are some misconceptions about the screening guidelines.

The American Society of Breast Surgeons recommends annual mammograms for average-risk patients after the age of 40. The society recommends that high-risk patients, meaning that someone in their family either had breast cancer or had a suspicious mammogram, should get annual mammograms before the age of 40.

“As a medical community, we need to all be on the same page,” she said. “We need the doctors on the front lines, our primary care doctors and gynecologists, to be recommending the correct mammogram screening guidelines.”

She said that the good news is that the survival rate for breast cancer patients has dramatically improved in recent years.

“But the success of survival is dependent on early diagnosis,” she urged. “We do have better treatment options now that are more effective rather than more aggressive.”

She also noted that the rise in telehealth and urgent care, where extended hours are offered, has aided in detecting symptoms early on.

“The bottom line is that women need to prioritize their health among all the other responsibilities they have,” Dr. Fiorini said. “A mammogram is preventive care, so it may just be a routine visit, but, if something is wrong, it is vital we catch it early.”

Dr. Geils concluded, “We are at a crossroads. On one hand there are some profoundly exciting cures for cancer coming in the not-so-distant future, but how will people be able to afford these cures?”

By Theresa Stratford

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