New Program for Insured Americans Assists with Co-Pays

March 24, 2005
Web posted by [Anonymous]
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Washington, DC, March 24, 2005 - Serious illness can be a financial catastrophe, even for patients with health insurance. Recognizing this need, the Patient Advocate Foundation has formally launched a program called Co-pay Relief (CPR), A Patient Assistance Program, designed to help insured patients with certain life-threatening or debilitating diseases cope with the significant out-of-pocket costs associated with their treatments.

The CPR program currently assists patients with breast, lung, and prostate cancer, as well as macular degeneration and selected secondary issues associated with cancer treatments. CPR will expand to provide assistance to an additional twenty-three diagnoses as additional funding becomes available. The program has been reviewed and approved by the Office of Inspector General (OIG).

``It's shocking how quickly the costs of treating an illness can push a financially stable person into financial chaos. The challenges of fighting a disease like cancer or macular degeneration can be daunting enough. Being faced with overwhelming co-pays can eliminate many patients from treatment options,'' says Nancy Davenport-Ennis, CEO of the Patient Advocate Foundation.

The program fills a critical gap for many insured patients, especially those who are looking for help from the prescription drug benefit provided by the Medicare Modernization Act passed in 2003. The law creates what many refer to as a coverage gap or a zone of income and expenses where patients are not covered. Patients with qualifying conditions will be able to turn to the Patient Advocate Foundation's CPR program to help them with significant co-pay burdens as they pass through the coverage gap phase of the benefit. In addition, the program will be able to help patients while they wait for the prescription drug benefit to be fully implemented in January 2006.

Financial crisis as a result of illness is not unusual. A recent study conducted by the Harvard Medical School indicated that about half of all personal bankruptcies stem from medical causes among people who had health insurance. ``I have health insurance, so when I was diagnosed with cancer, of course I thought my biggest worry was my illness. But the treatments were so expensive, and I found that I just couldn't manage the co-pays,'' says June Dalton, a lung cancer patient from Santa Maria, California. Ms. Dalton subsequently enrolled in the pilot phase of the CPR program and received direct assistance in paying for her treatment co-pays.

The Patient Advocate Foundation encourages patients diagnosed with one of the illnesses covered by the program to apply for assistance if they are having difficulties paying for their treatment co-pays. Some indications that suggest someone should apply are forgoing treatment because of costs, skipping payments on the mortgage or utility bills, or having difficulty buying groceries because of treatment costs.

Patients receive personalized assistance from the Patient Advocate Foundation CPR Program through a dedicated call counselor who will complete the application process with them. Following the completion of the application process, it generally takes between 5-7 business days to obtain medical and financial documentation of need. When that step is completed, approval is awarded.

Physicians play an important role in helping patients enroll in the program. ``A physician cannot treat their patients in a vacuum. As care providers, we have to recognize that, in order to deliver quality care, we must factor in outside hurdles that insured patients face, including the often substantial co-pays for treatment costs,'' says Dennis Gastineau, M.D., Director, Human Cell Therapy Laboratory, Divisions of Transfusion Medicine and Hematology, Mayo Clinic and Chair of the Patient Advocate Foundation's Scientific Board.

``We have to be vigilant and look for the patients who might be helped by this program. For patients like mine, who suffer from macular degeneration, treatment can mean the difference between sight and blindness, so the stakes are quite high,'' says Alana L. Grajewski, M.D., Director of Pediatric Glaucoma at Bascom Palmer Eye Institute, Clinical Associate Professor of Ophthalmology at the University of Miami Miller School of Medicine.

About the Patient Advocate Foundation

Patient Advocate Foundation is a national non-profit organization that seeks to safeguard patients through effective mediation, assuring access to care, maintenance of employment and preservation of their financial stability. Patient Advocate Foundation serves as an active liaison between the patient and their insurer, employer, and/or creditors to resolve debt crisis matters related to their diagnosis with the help of doctors, healthcare attorneys and a case manager.

Direct services provided to patients at no cost include:

Negotiating pre-authorization approvals

Providing assistance in expediting the appeals process

Negotiating resolutions to coding and billing errors

Resolving debt crisis related to diagnosis

Mediating insurance appeals

Negotiating access to pharmaceutical agents, chemotherapy, medical devices, and surgical procedures

Coordinating benefits

Brokering resources to supplement the limits of insurance and to assure access to care for the uninsured

Resolving insurance issues in the public and private sectors

For more information about Patient Advocate Foundation, please call 1-800-532-5274 or visit our Web site at www.patientadvocate.org or for Co-pay Relief information, call 1-866-512-3861 or e-mail [email protected].