How Volunteer Attorneys Are Helping Patients Overcome the “Financial Toxicity” of a Cancer Diagnosis
Recently, we spoke with Senior Staff Attorney Erin Hartung about her work with Cancer Legal Care in Minnesota. Established in 2007, Cancer Legal Care staff, along with a network of volunteer attorneys, have helped over 12,000 Minnesotans with legal issues stemming from their cancer diagnosis and treatment. As the manager of the ICARE Program (Insurance Claim Advocacy and Resolution) at Cancer Legal Care, Erin is all too familiar with the challenges that cancer patients encounter from prior authorization delays and claim denials. ICARE focuses on helping with:
- Health insurance plan and coverage questions, claim denial appeals, and claim management
- Short-term and long-term disability coverage questions and claim denial appeals
- Life insurance coverage questions
Read on for details from our interview with Erin.
Q: Before you joined Cancer Legal Care, you were with a firm that focused on healthcare provider revenue cycle. How did that prepare you for what you’re doing today?
First, it gave me a perspective on what healthcare providers are thinking about, particularly with the focus on the revenue cycle and how it influences operations and financial sustainability. I also gained insight into the processes used in making decisions about their revenue cycle and different aspects of reimbursement–from facilities management contracts to preparing and managing appeals on behalf of providers with contracted health insurance companies.
Q: Can you share how Cancer Legal Care got started and what it does now?
It began as a one woman show. Our executive director, Lindy Yokanovich, had first-hand experience with the difficulties that cancer patients and their families go through on the legal side of things and how the stress trickles into their health and well being. Lindy shared her idea of providing free legal services to cancer patients with Lindsay Flint. The two began meeting at coffee shops around the Twin Cities to bring the idea to life.
Our clients are all Minnesota residents. Some are dealing with cancer directly or within their family. Some are caregivers for a cancer patient. We help those in all different cancer stages, whether in current treatment or in remission. We also help families who have lost a loved one to cancer.
While legal planning and helping patients access public benefits represent more than half of the organization’s efforts, we also provide assistance with housing and financial issues, insurance coverage, employment and disability concerns and more.
Many of our clients are referred through social workers within the provider networks because we’ve established good connections, offering educational sessions or meet and greets to familiarize the social workers with how we can help patients navigate their cancer care journey.
Q: Are there organizations like yours in other states?
I do know that there are cancer-focused attorneys in other states who we connect with here and there. But as far as a total organization providing direct services, I’m not aware of any exactly like us.
Q: Do you collaborate with other cancer-focused attorneys or other organizations to lobby for legislative solutions?
We’re limited in the lobbying activities that we can do, but we participate in committees collaborating on ways to advocate publicly for cancer patients in a lot of different arenas. For example, sometimes a focus on lung cancer is tied to radon bills. We do a lot of brainstorming of ideas and sharing the different avenues we’re pursuing to create systemic changes.
Q: What are the most common problems you help address?
It kind of ebbs and flows. At the very beginning of the pandemic, for example, we fielded a lot of questions about unemployment benefits related to COVID and a cancer diagnosis. Because cancer patients are typically immunocompromised, they had special considerations that needed to be addressed. Estate planning also makes up a pretty large portion–questions about how to make a will, set up power of attorney, etc. And we answer questions about social security disability and help clients with the application process.
Q: You wrote a blog about the need for prior authorization reform. Can you share some of what you have encountered working with clients?
We’ve dealt with a variety of issues related to prior authorizations. We’ve had cases where a client’s provider has submitted a prior authorization request, and it wasn’t being processed quickly enough. It hadn’t been denied OR approved; it was stuck in limbo while patients are waiting on the recommended procedure or course of treatment. We help to push through authorizations on an expedited basis. A lot of other times, we get involved after a prior authorization is denied. And we also get involved after a service is provided and the claim is denied because prior authorization wasn’t requested.
What we’re finding is that there are so many treatments that are emerging now, and a lot of cancer patients have really individualized treatments. If you fall outside insurance companies’ medical policies and qualifying criteria, the prior authorization or claim is going to get denied. We help patients show why they qualify for an exception, and for one case, we actually got the insurer to update its medical policy. We work hand-in-hand with a patient’s physician to identify studies and other supporting reasons for justifying a particular treatment for a patient’s condition.
Q: Do you see any trends related to certain payers?
We don’t see a lot of claims with Medicare and Medicaid, mainly because they are so regulated. And once a provider signs on to participating with those programs, they’re pretty bound by certain rules. One thing that we do encounter are complicated processes with out-of-state networks. With people working for companies that operate in multiple different states, the insurance plan might be based in California, for example, but the patient in another state needs to submit a claim to the satellite in Minnesota before it gets routed back to California. It leads to contracts that don’t match up exactly and that can cause claim processing errors or confusion that ultimately ends up in the patient’s lap.
Q: What is the hardest part of your work?
The hardest part involve cases where an administrative delay occurred from the insurance appeal process or a breakdown in the claims between provider and insurance company. It’s difficult to see a client’s health be put in jeopardy over red tape. It’s a human created problem, right? There are solutions if we could get them in place. It just is tragic to me to see somebody’s life be affected negatively because of paperwork.
Q: Finally, what do you find most rewarding about what you’re doing now?
I think the most rewarding thing is when we win an appeal and patients feel empowered. They’re going through difficult experiences where they have no power to change what’s going on. It really weighs on a patient when the ability to make decisions is restricted. When we can put power back in their hands and let their medical determinations be made solely between them and their provider, it’s very fulfilling.
Want to help Cancer Legal Care empower more patients? Learn how you can get involved.
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