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FINANCIAL ADVOCATE SPOTLIGHT

The ACCC Financial Advocacy Network is the leader in providing professional development training, tools, and resources that will empower providers to proactively integrate financial health into the cancer care continuum and help patients gain access to high-quality care for a better quality of life.

Advocate Spotlight: Arnela Kajdic-Tarantino

“The goal of financial advocacy is to minimize financial burdens and toxicity for patients and be the voice for them when working with multidisciplinary clinical staff, payers, and contractors.”

Upon receiving her bachelor's degree in health science from Boise State University, Arnela Kajdic-Tarantino, CTFC, started her career as a pharmacy technician at Albertson’s Pharmacy in Eagle, Idaho. “That is where I developed my passion for helping patients with their financial issues,” she said. Her transition to oncology happened more than 18 years later, when she started as patient financial advocate at St. Luke's Cancer Institute in Boise, Idaho. A year and half later, Kajdic-Tarantino transitioned into a program coordinator role.”

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Today, Kajdic-Tarantino is the program manager for the Center for Blood Cancer Therapy at St. Luke's Cancer Institute. In this role, she supports patients who are undergoing bone marrow and stem cell transplant and/or who are receiving chimeric antigen receptor (CAR) T-cell therapy. “My team and I obtain predetermination approvals [or prior authorization] for CAR T-cell therapy and bone marrow/stem cell transplants from patients’ payers,” Kajdic-Tarantino said. “We also assist patients with their FMLA [Family and Medical Leave Act] and social security disability lengthy paperwork process.” She is the liaison between patients’ insurance provider and the cancer institute’s internal payer relations, striving to obtain in-network benefits for all patients. Additionally, Kajdic-Tarantino's diverse responsibilities include developing business intelligence dashboards, co-leading revenue cycle working groups, and acting as a key stakeholder in the implementation of CAR T-cell therapy at St. Luke’s Cancer Institute.

While assisting patients with their needs is her number one priority, Kajdic-Tarantino is also passionate about helping her colleagues in similar roles. She supports, develops training materials, and advocates for the cancer institute’s financial advocates. As an advocate for advocates, Kajdic-Tarantino works closely with various departments at St. Luke’s Cancer Institute, including revenue cycle, claims and billing, and blood cancer clinic. “I also volunteer on the Transplant Financial Coordinator Association Financial Coordinator Committee and am a member of the Association of Community Cancer Centers [ACCC] Financial Advocacy Network Education Task Force,” she said. “We also recently started using the ACCC Financial Advocacy Booth Camp for our onboarding because it allows us to give new financial advocates some perspective of what financial advocacy is all about.”

According to Kajdic-Tarantino, financial advocates are crucial to providing high-quality, comprehensive cancer care—particularly for those undergoing stem cell transplant. “Our patient financial advocates work tirelessly behind the scenes to minimize financial burdens and toxicity for patients,” she said. “One of my favorite parts of my current role is being an advocate and the voice for patient financial advocates within my organization.”

Patient Impact

Kajdic-Tarantino met a patient with lymphoma who was covered by Medicare. The patient’s scheduled stem cell transplant did not meet the criteria set by the Centers for Medicare & Medicaid Services, so Kajdic-Tarantino and her team were unsure if the claim would be accepted by Medicare after the procedure was completed. Despite the financial risk to the organization, St. Luke's Cancer Institute proceeded with the transplant because it was a curative treatment available to the patient. “The patient had a claim over $1.4 million that was initially denied by Medicare,” she said. “But that decision was overturned following a successful appeal.”

According to Kajdic-Tarantino, this patient’s story serves as a testament to St. Luke’s Cancer Institute’s commitment to delivering patient-centered care and the role financial advocates have in patients’ treatment journey. “The goal of financial advocacy is to minimize financial burdens and toxicity for patients and be the voice for them when working with multidisciplinary clinical staff, payers, and contractors,” she concluded.

Advocate Spotlight: Kristin D. Sides

“I always say to patients: ‘Your job is to get well and to get the treatment you need. My job is everything else.”

Kristin D. Sides, OPN-CG, has spent the last 15 years working as an oncology patient navigator at Mount Nittany Medical Center. “Oncology has always been my passion, my love. Patient navigation is a nice blend for me because I really enjoy the science of healthcare, and I enjoy helping people,” she said. “Patient navigation is great because there is always a new challenge, a new task, and some situations I have never encountered before, even after this long.”

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Prior to joining Mount Nittany Medical Center, Sides worked at the American Cancer Society, where she helped hospitals establish programs to provide individuals with free mammograms and breast biopsies. She then joined the American Lung Association as the community outreach coordinator and was charged with the organization and supervision of community programs. While with the association, Mount Nittany Medical Center approached Sides to participate in a patient navigation pilot program. “In my previous jobs, I worked primarily with institutions. I knew this role would be more patient focused and that I would get to work with patients every day,” Sides said. “That is really what I wanted to do, that was my goal.”

According to Sides, oncology navigation was a novel concept 15 years ago, and Mount Nittany Medical Center was unsure of their community’s needs for this key service. “Prior to the pilot program, there were really no connections between the patient and the community once they were in the outpatient cancer setting,” she explained, adding, “Patients had to fend for themselves in terms of finding community resources.” Once the pilot program launched, Sides and her colleagues realized that a significant number of patients were missing their treatment appointments due to a lack of transportation, the financial hardships related to the cost of care, and their inability to work due to treatment. These discoveries came to inform the navigation program’s primary objective. “The main goal is how do we reduce patients not showing up for treatment, who are just falling through the cracks otherwise,” she said.

Two additional oncology patient navigators have since joined the team at Mount Nittany Medical Center, who each have different daily responsibilities. Sides and her colleagues are committed to helping oncology patients navigate the healthcare system. “We do a lot of work with outside agencies to reduce barriers to treatment such as working with pharmaceutical companies to lower drug costs, as well as local and national charitable organizations,” Sides said. “The other major part of our job is care coordination. It is helping patients and families navigate through all the different parts of the healthcare system they have to interact with, and to make sure all the puzzle pieces are working together for the patient.”

According to Sides, the fluctuating price of gas over the last year has been a huge barrier for patients to navigate. “We are in a rural area, so we have patients traveling 50 miles, sometimes 80 miles, a day to their radiation appointments—back and forth—because there is just nowhere else.” Due to this patient need, Mount Nittany Medical Center has immediate plans to hire a financial counselor, who will be tasked with providing insurance optimization services to patients. “Unfortunately, right now, we do not have the ability to do that for our patients on a regular basis,” she said. “It is going to require another person, which is great because that is what patients need and is something they ask for.”

Sides believes that the impact financial resources can have on the quality of care a patient receives makes patient navigation a key component of healthcare delivery. “We have patients every day, whose coverage—based on what they can afford and what resources we can find for them—can change the care that they get and limit their financial burden,” Sides said. Further, she argues that the unique challenges a patient faces following a cancer diagnosis requires a strong support system. “Cancer is an island unto itself when you are talking about anxiety, depression, fear, and overwhelming stress,” Sides explained. “Any opportunity we have to reduce any of that is also part of our job. I always say to patients: ‘Your job is to get well and to get the treatment you need. My job is everything else.’”

Patient Impact

While many patients’ stories stand out to Sides, she considers one case to be more peculiar. Sides was helping a patient who was diagnosed with cancer a few months after obtaining insurance coverage through the Marketplace. The patient’s coverage was then terminated by the company because it argued that the patient was aware of their cancer diagnosis prior to obtaining the healthcare coverage. “How that is legal, I have no idea,” Sides said. “Not only is it bad for the patient, but it also takes away resources from our physicians to appeal those decisions. It affects everyone in the healthcare continuum, not just the patient.”

Through collaboration with multiple pharmaceutical companies in addition to helping this patient apply for Mount Nittany Medical Center’s free care program, Sides was able to reduce this patient’s out- of-pocket costs by over $125,000—thereby ensuring this patient received the necessary treatment.

Advocate Spotlight: Jared Kast

“We should be helping these patients get past any barrier to care that there is.”

Jared Kast, MHA, started in oncology in 2007 at Gundersen Health System in La Crosse, Wisc., where he was a radiation therapist. “From there, I heard of the struggles that patients had with not only getting through therapy but traveling to therapy, having meals during therapy, and accessing resources outside the cancer center,” Kast said. Costs of care was an issue that stood out to Kast as he grew within the institution, and he discovered the financial barriers that patients undergoing radiation therapy experienced.

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According to Kast, irrespective of the standard of the care or the evaluation of what treatment regimen would produce the best outcome, insurance companies were unwilling to cover the total cost of care for patients at Gundersen Health System. “We had this individual who would do the billing, and she would fight with insurance companies back and forth,” he recalled. “That is when I got to see the behind the scenes of healthcare. Payers are denying things that are questionable.”

Upon his transition to medical oncology as a manager, Kast began to understand more about the potential resources from which patients could benefit and the harmful effects of financial toxicity. “If patients cannot afford their oral chemotherapy, it affects their outcomes. It changes the speed and timing in which they get their therapy,” Kast explained. “I would hear these horror stories from managers, and I realized we needed to do something and tackle this in a different way.” Eager to provide a solution for patients in need of financial assistance, Kast and his team began implementing financial advocacy services at Gundersen Health System. “We owe it to our patients and providers to meet the clinical needs and therapy plans to get the best outcomes,” Kast said. “That was really our goal.”

Kast is currently the executive director at Hall-Perrine Cancer Center at Mercy Medical Center in Cedar Rapids, Iowa. where he joined the staff just three years ago. While the cancer center had a strong financial advocacy program when Kast was hired, the focus of this program was centered on helping patients access and afford their oral oncolytic(s). With the aid of two dedicated staff from hematology/oncology and radiation oncology, Kast implemented an electronic program that was designed to source financial assistance options for all patients presenting to the cancer center. “We meet with every patient and enter their information into this system, and it streamlines our ability to obtain funding for our patients,” Kast said.

“There are studies that indicate that anywhere from a quarter to 30 percent of our patients go through bankruptcy during their course of cancer care,” Kast said. “Nobody got into cancer care to put a patient through that. It should be part of our job and part of the care that we give to keep patients out of that situation.” These statistics highlight the need for financial advocacy services within every cancer program or practice. “If our goal is to have great outcomes for these patients, then we need to support all their needs,” Kast said.

Patient Impact

Following treatment completion, a patient who was diagnosed with lung cancer pledged to donate his entire estate to Hall-Perrine Cancer Center. “He said he wanted to give back to patients and help future patients just like we helped him,” Kast said. “Our financial advocacy team met with the patient, went over his financial barriers with foundation funding, co-pay cards and on occasion supply him with a healthy meal provided by the Mercy foundation.”

Patients receiving the best possible treatment regardless of cost is the driving motivator for Kast. “We should be taking care of every patient that walks through our doors, regardless of what their background is or what their payment status is,” he said. “The reason everyone got into healthcare was to take care of patients who need our help.”

Advocate Spotlight: Christina White

“It was the first time I really got it; I really saw the struggle from people.”

Christina White, MBA, GRMS, has been in healthcare for approximately twelve years; ten of which have been dedicated to oncology. She got her start in the specialty at Summa Screens, a cancer screening program at Summa Health System in Akron, Ohio. White served as the program’s coordinator—a position that provided a renewed perspective. “It was the first time I really got it, I really saw the struggle from people,” she said. With experience working in the emergency room, White was not oblivious to the financial hardship associated with unaffordable healthcare. “There were so many people that came in with tooth pain because they’ve never been to the dentist,” she recalled. "Their only access is the emergency department when they need a dentist. But they couldn’t afford to go to a dentist.” Similarly, patients accessing Summa Screens were uninsured or underinsured and would delay their appointments because they could not afford it.

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White’s work at Summa Screens inspired her to create and implement a financial navigation program within the health system for patients struggling to afford their mammogram appointment costs. She started by helping patients access co-pay assistance, Ohio’s Hospital Care Assurance Program, and other charity programs. Her services have since grown to include accessing foundation-based assistance, in addition to helping patients afford their everyday needs like gas and groceries. White is now the director of Supportive and Integrative Programs at Summa Health System, and she oversees its financial navigation program. Though this program White spearheads is multilateral, there is one consistent goal: zero out-of-pocket costs for patients.

White has four financial advocates on staff—three financial navigators and one manager. These “unicorns,” as White describes them, given the altruistic nature of their motivation, are required to complete ACCC's Financial Advocacy Boot Camp as part of their onboarding and training. These staff work closely with Summa Health’s billing team to facilitate greater collaboration between the departments and rotate between three Summa Health System locations in Akron, Barberton, and Medina, Ohio. Additionally, White’s financial navigators participate in chemotherapy teach appointments with patients and their cancer care teams, regardless of patients’ interest in accessing financial assistance. “Sometimes you don’t know what you need until someone says it,” White said. The goal of joining these appointments is to help people understand their options and the services the team provides, that patients may not know they need. Following a conversation with a financial navigator, patients can choose to move forward with their treatment that they might have initially considered canceling due to costs. It is for this reason, among many more, that White believes a financial advocate “is a worthwhile position to have at your cancer center.”

Patient Impact

Four years ago, at the onset of an insurance optimization initiative at Summa Health System, a mother of two little children was diagnosed with late-stage breast cancer. She was the insurance provider for her family. Her insurance coverage had a $15,000 deductible, and she paid between $600 and $700 a month for “inadequate coverage,” White described. Additionally, the patient could not see a doctor or dentist for preventative care without paying out-of-pocket costs.

After the patient’s household income significantly decreased, due to her illness preventing her from regularly working, she met with White. And with help surveying the Marketplace, the patient was able to apply for new coverage that cost her $1.30 each month. White also found the patient a grant that would cover this new insurance plan’s $7,000 deductible. Thus, $1.30 was the only out-of-pocket cost this mother was required to pay to receive her anti-cancer treatment. More importantly, the new insurance plan allowed the patient to take her children to the doctor for a physical before the school year when they felt sick.

A mother of two herself, White describes Summa Screens’ implementation of financial advocacy services as her first baby. It set her on a path that has allowed her to help other mothers like this patient. “I just remember her sobbing and saying that this help meant so much more for her as a mom, who was struggling with breast cancer,” White said. “That’s why we do what we do.”

Advocate Spotlight: Lyndsey Griffin

“How do I avoid bankruptcy? How do I get through treatment?”

Lyndsey Griffin, MSW, LCSW-C, OSW-C, took a social work class in her last semester in undergrad, knowing she needed one more elective and wanted to help people. It was ultimately a decision that inspired her interest in social work. Griffin then continued her education, achieving a master's degree in clinical social work and aging. Following the completion of her graduate degree, Griffin earned employment at an outpatient dialysis facility in Baltimore, MD. While in this role, Griffin gained experience in case management and developed an understanding of the psychological and financial impacts of treatment. “People didn’t really have the time to talk about their mental health or their feelings surrounding their chronic illness,” she said. “It was more so, how do I avoid bankruptcy? How do I get through treatment? How do I get transportation?” Her experiences with these patients created a curiosity for the financial element of healthcare, so she began learning about government programs and insurance policies—knowledge that served her well moving forward.

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Griffin proceeded to work in hospitals and nursing homes, positions she held while harboring a desire to engage in ambulatory care. In 2016, she started in oncology as an oncology patient financial navigator. Now, she is a social worker at the University of Maryland Capital Health and primarily assists patients with breast cancer. Griffin is currently working as the sole financial advocate. She is in the clinic twice a week, seeing about 10 patients a day. Griffin’s social work background allows her to advocate for patients in a unique way. “I see myself as the middle person between the billing office, financial advocacy, providers, and patients. I am working with the care team to help patients navigate the system,” she said. “I think social workers are really important for this kind of work, because we look at the big, systemic picture.” Griffin helps patients access medical assistance, understand employer insurance, and navigate the health exchange. In addition, Griffin offers patients insurance optimization services, works with hospital charitable programs to reduce, if not eliminate, patients' costs, and aids in acquiring co-pay assistance. Her role is set to expand in 2024 to oversee psychosocial and financial advocacy services across University of Maryland Capital Region Health’s oncology service lines. Upon expanding, her service line will incorporate care for patients with lung, colorectal, and prostate cancer.

Patient Assistance

In 2018, when Griffin was affiliated with a different organization, an older patient came in for an appointment with surgical and medical oncology. She was also a widow in need of a hearing aid. Following her consultation, the patient was referred to Griffin, who helped her obtain the hearing aid she needed. As Griffin later reviewed the paperwork, she realized that the patient had a low income and was providing for herself. Upon this discovery, Griffin helped the patient secure Qualified Medicare Beneficiary coverage—a Medicare Savings Plan that also qualified the patient for Extra Help—a program to help people with limited income and resources pay Medicare prescription drug program costs for prescription assistance. Additionally, Griffin obtained transportation assistance for the patient through Maryland’s Department of Aging. This was particularly important because the patient was missing appointments due to a lack of transportation. Finally, Griffin assisted in gathering and submitting the patient’s paperwork needed to secure her senior housing. “It was a never-ending rabbit hole,” Griffin said as she described their journey together. “I just put on my advocacy hat and found one organization that led to the next and the next.” Today, the patient speaks to Griffin on occasion, surely curious to know how the financial advocate who changed her life is doing. And to Griffin, it was just another day, as she was just doing her job. “It is patients like this who make me want to continue the work that I do,” said Griffin. “It is very rewarding to know that what I do, what might not seem huge to me, could mean everything to people going through cancer treatment.”

Advocate Spotlight: Tamika Chambers

Tamika Chambers is a financial advocate at Cancer Care Services—a community-based nonprofit dedicated to providing necessary support to patients with cancer in Fort Worth, Texas. Chambers has worked in the medical field for about 20 years, from starting out as a medical assistant to going back to school for coding and eventually working in pathology. It was not until she joined a nonprofit in Pennsylvania that she gained experience in assisting with insurance verifications for her clients. After moving to Texas, Chambers joined Cancer Care Services in 2020 as a financial advocate, a role she did not previously seek out but that paired together her diverse skill set. Since starting at Cancer Care Services and heading its financial advocacy program, Chambers has navigated about 125 patients in total.

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Chambers’ role is different than most financial advocates because she is not located within a cancer program or practice. Therefore, patients are referred to her via Cancer Care Services’ partner hospitals (e.g., Texas Oncology and John Peter Smith Hospital). “Instead of working for the hospital, I get a chance to really be able to help our clients with education,” says Chambers. “My biggest role is to educate them on everything insurance.” Chambers prioritizes patients’ financial health literacy by teaching them what insurance is, what their options may be, how they can pick a plan, and how to apply for insurance. She will also serve as patients’ authorized representative for those who need additional support in accessing insurance coverage. In 2021, Cancer Care Services’ financial advocates reviewed 723 bills to identify errors and cleared or adjusted $57,000 in medical bills.

After providing insurance optimization services, Chambers will help patients with their bills and with accessing available financial assistance. “Instead of just giving them resources, a lot of our clients come to me with bags and bags of bills that they can't open because it's very overwhelming for them,” she explains. “So I’ve become that person that can stand in for the caretaker or the client.” Chambers organizes patients’ bills within folders and educates them on each and whether it needs to be paid. She will also look over patients’ medical claims line by line to ensure they are billed correctly, and if something looks incorrect, she will help with the appeals process. “I’m just really teaching patients to advocate for themselves during our process as well as educating them,” says Chambers.

In addition to assisting clients with financial concerns, Chambers works within her community to teach about financial advocacy and the importance of insurance through Cancer Care Service’s Wellness Wisdom program. She also dedicates time to specifically educate the adolescents and young adults in Fort Worth to ensure they understand what insurance is and how to handle medical bills as preparation for their transition from their parent’s health plan.

Because Chambers works on-site at her nonprofit, patients can call, email, or visit her in person to access financial advocacy services. This structure is unique in that patients can communicate with Chambers in the way that is most comfortable to them, especially if they are in active treatment. “If our clients are too sick from radiation or their treatments and they can't come in, we'll do everything through email…Or we do it through the phone,” Chambers explains. “Some clients come in and we do a face-to-face, especially those that have lots of bills. They want to come in and drop them all off. I try to make it as easy as possible for them.”

Patient Impact

In 2021, Chambers had a referred patient with Stage IV colon cancer bring her a pile of his bills. “He had no idea what he was supposed to do with any of those bills,” she recalls. She established a relationship with the patient, addressed each bill one by one, and showed the patient how to write financial hardship letters. But because the patient did not have time to write his own letters, Chambers assisted in typing up nine financial hardship letters to send to the patient’s various healthcare providers. She also began searching for resources to assist the patient with his finances, including with his household and utility bills. “By the end, I believe that we got him over $4,000 worth of bills written off, forgiven, or adjusted,” says Chambers. “He always says...‘I had a whole lot of bills. I was overwhelmed. But I knew when I called Tamika that she would help me get it together, and she really helped me through the process to relieve some stress.’ So he's one of my dear, dear clients.”

Advocate Spotlight: Amanda Borges-McCay

Amanda Borges-McCay is a financial navigator at Sutter Health Memorial Medical Center in Modesto, Calif. Her story for entering the field of financial advocacy is unique because it was driven by her daughter. Borges-McCay was born with an autoimmune disease that was also diagnosed in her daughter when she was born. “I was a single mom, and I went to get her medication that would be life changing for her,” recalls Borges-McCay. “It had all the promises of being life changing and when I went to pick it up from the infusion center pharmacy it was $600 for each of us.” She then began looking for financial assistance, including co-pay assistance, to help her acquire the medication for herself and her daughter at a much lower cost. Her daughter is now being treated with the medication at Sutter Health Memorial’s infusion center, as Borges-McCay was able to get their medication costs lowered to $50 total.

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“I just fell in love with the infusion center,” she says. Borges-McCay began working at her current hospital in 2017. As an infusion center scheduler, she was provided with rich experiences to better understand the infusion and oncology patient experience. In 2020, her hospital decided to implement a pilot financial navigation program to reduce the incidence of financial toxicity experienced by patients with cancer because of their treatments. Borges-McCay was a natural candidate for this position and began fastidiously working to build this vital program. She now assists patients with financial concerns who are receiving infusion treatments (oncology and non-oncology) and radiation therapy.

Borges-McCay is also a certified patient navigator, which allows her to treat the whole person. “I feel like being a navigator and seeing patients as a whole, rather than just their financials, has really helped me focus on when to step back and when to kind of push a little bit further and ask questions,” she says. “When you get into talking to patients about their finances, some other things do come out. Maybe they haven't shared with a doctor that they're not eating or that they're not keeping food down.” And because of her patient navigator training, Borges-McCay can help with more than their financial needs by educating on and referring to the appropriate supportive care service(s).

In 2021, Borges-McCay navigated and assisted about 300 patients and is currently pioneering the financial navigation program at her hospital. She identifies patients via their insurance and will look at their expected out-of-pocket costs, if they are uninsured or over insured, and if insurance optimization would be of benefit. Borges-McCay also helps with identifying co-pay and free-medication program assistance and will seek out other avenues if patients need more. “Sutter has shown the need for financial navigation,” says Borges-McCay. “We are looking at spreading the financial navigation program throughout the network, which is an exciting thing for the future for our patients.” She is even featured in a video created by her network on the importance of financial navigation in cancer care.

Patient Impact

When Borges-McCay first became a patient navigator and financial navigator at Sutter Health Memorial, she played a key role in a patient’s course of treatment that continues to spark her passion today. A patient with breast cancer was told that she had no insurance and was going to be financially responsible for the cost of her treatments. The stress from this expense caused this patient to shut the care team out. “She was just going to give up on treatment and not proceed on,” Borges-McCay recalls.

Instead of placing another phone call, Borges-McCay began texting the patient. She did so to communicate to the patient that she was available to discuss how to ensure access to her cancer care. After getting the patient established with Medi-Cal (the Medicaid program for California), Borges-McCay successfully obtained Medi-Cal coverage that would pay for the patient’s full treatment costs, including any retroactive fees. The patient began treatment right away and only missed one appointment before completing her full course of treatment. “Patients [can be] at a point where they're choosing between surviving for their family or paying bills,” Borges-McCay says. “She was really my first true patient that I navigated and was able to get back on treatment. That was a win for me. My goal within our program is to never have a patient stop treatment or choose not to be treated because of their inability to pay.”

Advocate Spotlight: Rudy Garcia

Rudy Garcia III, MPH, is the administrative supervisor at Ascension Dell Children’s Blood and Cancer Center of Central Texas in Austin. Garcia began his career at Dell Children’s in 2015 as a customer service representative. He was promoted six months later to referral coordinator, where he addressed incoming and outgoing referrals and helped patients access financial assistance through the hospital’s charity program. This role introduced Garcia to the need for financial advocacy in oncology. In 2019, Garcia became the cancer center’s first and only reimbursement coordinator and is now, as the administrative supervisor, working with leadership to establish a formal financial navigation program and team. “There was no set of guidelines, as to ‘this’ is what you’re doing,” says Garcia. “I developed the role. And as I became involved with ACCC, I realized that there are so many resources out there and so many things that we could be doing to help patients.”

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In setting up the cancer center’s first financial advocacy-dedicated role, Garcia identified Medicaid as his primary mode of assistance. Because Dell Children’s treats pediatric patients, Garcia explains that he helps patients and their parents/guardians enroll in Medicaid for insurance coverage. If families do not qualify for Medicaid, Garcia helps them identify and enroll in a Marketplace plan that meets their needs. Garcia also obtains financial assistance through drug manufacturers and independent charitable foundations as well as addresses patients’ outstanding balances. “At some point we realized that a lot of patients’ balances were incorrect,” Garcia explains. “I was actually working in the background to make sure that our patients weren’t stuck with a huge bill that actually wasn’t theirs to pay.” Now, as the cancer center’s administrative supervisor with a focus on financial advocacy, Garcia hopes to bring on a team of individuals to ensure all patients have access to and meet with an oncology-dedicated financial advocate. Unique to the pediatric setting, explains Garcia, is that patients don’t usually experience treatment-related delays—once diagnosed, patients are quickly admitted to the hospital to start treatment. Therefore, it is harder for Garcia to take a proactive approach in addressing patients and their families’ financial concerns. Instead, he may have to wait for patients to be moved from inpatient to the outpatient clinic before meeting. To tackle this nuance, Garcia works closely with the cancer center’s social workers to ensure he is kept up to date on new patients and their financial status. He then calls patients’ parents or guardians to introduce himself and offer his services once the initial shock of their child’s diagnosis has calmed. And when patients are transferred to the outpatient clinic where Garcia’s office is, he keeps his door open so anyone with questions or in need of help can drop by and meet with him. “When I’m working with families, the patient is here and they’re playing with a toy or watching a show,” says Garcia. “We develop a very unique relationship. It’s also really nice to be able to alleviate that stress on the family, so they can focus on taking care of their child.”

Patient Impact

Austin sees many immigrants, especially those from Mexico. And Dell Children’s never refuses a patient regardless of their immigration, insurance, or financial status. But helping immigrants can be tougher for financial advocates because there are fewer options available to cover treatment-related costs. Upon immigrating to a new country, Garcia explains that patients and their families often do not speak fluent English, do not understand the American healthcare system, and worry that their child cannot receive treatment because they cannot afford the costs. “This is where we are able to go in and explain to patients and their families that even though they may not have coverage, we’re going to do x, y, and z so that they will be taken care of,” says Garcia. For example, Garcia has seen outstanding balances of over one million dollars for these patients and their families. “Once our ducks are in a row, those things get taken care of,” says Garcia. “The mere appreciation of that is truly rewarding and just goes to show why we do what we do. I have a heart and a passion for this because if there’s no one to advocate for our patients, then where would they go?”

Advocate Spotlight: Heather Simpson

Heather Simpson is the cancer program coordinator and patient accounts, senior, at Allina Health, River Falls Area Hospital in River Falls, Wisc. Before joining the hospital’s oncology team, Simpson got her start in healthcare as an assistant in a nursing home at 16 years old. She fell in love with the field and later decided she would become a nurse. Due to unforeseen family needs, Simpson put nursing school on hold to raise her children at home. She continued working part time at River Falls Area Hospital where she got her start in oncology, eventually becoming full-time to educate patients with cancer about their insurance and out-of-pocket costs and oversee all screening and prevention programs/events. As the need for financial advocacy services grew among patients, Simpson became River Falls’ first financial advocate. In this role, she assists patients with their available options to cover the full cost of their cancer treatment. “I feel with financial navigation and the advocacy role, I can help so many more people in a whole different way than I could as a nurse," says Simpson. “Anytime I start thinking about financial advocacy in that aspect for patients, I get this burning desire and it makes me feel so productive.”

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Simpson built the financial navigation program at River Falls from scratch. And because the hospital is one of four within a health system, Simpson has dedicated her work to ensure financial advocacy services are provided to all oncology patients. “I want financial navigation for all our patients across the whole health system, which is about 6,000 patients a year,” she says. In doing so, Simpson joined a task force that included leadership from Allina Health Cancer Institute, pharmacy, revenue cycle, social work and IT, as the health system implemented two pilot sites to test its formal financial navigation program. The health system hopes to roll out the program to all its cancer centers within the next two years, so patients have access to a financial advocate regardless of their preferred treatment location. This formal financial navigation program will vary in size due to a cancer center’s patient population and size. For example, River Falls is a regional hospital within the health system, so Simpson works on-site with one other individual to cover all patients with cancer and their financial needs. They complete prior authorizations and help educate patients on their insurance and available financial assistance options. Furthermore, the health system will be implementing Vivor so its financial advocates have the necessary resources in place to best help patients access financial assistance.

As services (e.g., billing and prior authorizations) become more centralized within the health system and move out of the individual hospitals, Simpson is grateful that her leadership values the importance of the financial navigation program. The program will remain within each cancer center with at least one financial advocate on-site every day. “This formal program will be housed at all sites because the face-to-face contact with our patients is really going to determine the trust that patients have in us,” says Simpson. "We'll build those relationships to be able to help patients even as they transition into survivorship.”

Patient Impact

Since starting the financial navigation program at River Falls Area Hospital, Simpson is working toward completing her bachelor’s degree in organizational leadership with an emphasis on healthcare management and becoming board-certified in patient advocacy. She splits her day-to-day between two roles: 1) financial advocacy and 2) coordinating the health system’s cancer screening and prevention activities and programs, including assisting with the Commission on Cancer accreditation. In 2019 River Falls started a lung cancer screening program to address the community’s high smoking rate and high incidence of late-stage lung cancer. When a patient was due for her one-year lung screening follow-up and declined because of the costs associated with her first screening, Simpson thought, “No, this shouldn’t have costed her any money.” Upon hearing of the patient’s cost concerns, the doctor sent the patient to Simpson and asked her to investigate the issue.

Simpson discovered that an error had been made the previous year. The patient paid $571 out of pocket toward her deductible and coinsurance for her first screening, which was supposed to be covered by insurance. Because there was an error, Simpson spent about four months working with the insurance company and her revenue cycle team to get a reimbursement check to the patient for the total amount paid. "I felt so good, and she felt so good," says Simpson. “Patients have so many other things to be concerned about and worrying about. If we can do anything, whether it's big or small, putting money back into their pockets while they're going through cancer treatment—then we've done our job.”

Advocate Spotlight: Anette Ehry

Anette Ehry is the supervisor of charity specialties program at SCL Health, which includes cancer centers in Colorado and Montana. She joined SCL Health over 20 years ago with no background or previous knowledge in medicine. Ehry was first hired as a unit secretary for the inpatient oncology unit. It was there that she discovered her love for oncology. Upon transitioning to the outpatient infusion center’s front desk, Ehry quickly learned how crucial insurance and proper healthcare coverage is for patients. In 2012 she officially became the first financial counselor at Lutheran Medical Center and began offering dedicated financial advocacy services to all oncology patients. “I had to teach myself,” says Ehry. “Nobody could really guide me in regard to the assistance programs and insurance knowledge needed.”

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Ehry relied on her colleagues on the hospital’s financial counseling team to learn how to help patients enroll into Medicaid and other state- or government-funded programs. A pharmacy colleague also showed her where to find co-pay assistance for patients. Ehry then trained herself using manufacturers and other charitable organization’s websites that had detailed information on how they could help patients access their medication(s) for free. Within the first year, Ehry secured $100,000 in savings from co-pay assistance alone and built the cancer center’s Financial Counseling Program at SCL Health from scratch. “I would answer my own questions. I would call insurance companies. I would figure out from a claims processing perspective how to read an EOB and just kind of teach myself,” says Anette. “It was trial and error.”

The cancer center’s Financial Counseling Program at SCL Health has since expanded to include five financial counselors in Colorado and two in Montana, with one individual available at each cancer center, and Ehry leading the team as the supervisor. The Colorado-based team members have seen a total of 2,555 patients so far in 2021, averaging about 214 a month. The Montana-based team will begin tracking patients in 2022. After taking on a leadership role, Ehry found her passion: training financial advocates. As a member of the ACCC Financial Advocacy Network Workforce Task Force, Ehry helped develop the ACCC Financial Advocacy Playbook and has since implemented it as a go-to resource for her financial counselors. “I took it hot off the press and used it with my new hire,” she explains. “I’m utilizing the Playbook as an intro but also as something to always go back to refresh your memory. We use it as a reassurance that it's okay to be overwhelmed. It's alright to not know the answers. But if you go to this Playbook, you’ll find that it will point you in the right direction.”

Patient Impact

More so, Ehry emphasizes the need for training on state- and county-funded programs that are available to eligible patients. Because SCL Health provides financial advocacy services in Colorado and Montana, Ehry and her team must keep up to date on state and local financial assistance programs. For example, Ehry saw a patient in 2018 who was diagnosed with breast cancer. The patient was working as a waitress and uninsured, but her earnings were well over the income limit to qualify for Medicaid in Colorado. Ehry knew she needed to help the patient find full coverage for her treatment because she was considering forgoing care due to costs.

After searching and exhausting all available resources, Ehry found the Breast and Cervical Cancer Program that is offered through Health First Colorado—the state’s Medicaid program. She discovered that the patient qualified for the program and quickly applied. Upon enrollment, the patient gained full coverage and could begin treatment without worry of how she was going to pay. “For the longest time, I would still get greeting cards from her, and she would stop by to express her gratitude on how much I helped her,” says Ehry. “What made it so special was that I found a program that, back then, was not commonly known and used. I found something: a perfect solution for that patient.”

Advocate Spotlight: Taveon Brown

Taveon Brown is a medication assistance program coordinator at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute at The Ohio State University in Columbus, Ohio. He graduated from The Ohio State University in 2018 with the goal of becoming a physician but changed course when he found the same passion for addressing affordability in healthcare in financial advocacy. While working as a pharmacy technician at CVS, Brown saw patients who could not afford their medications, whether it be lifesaving diabetic products or high-end brand medications that recently hit the market. “Patients were not aware of co-pay assistance programs,” he explains. “So I started simply looking for those types of programs online and would then apply to them for patients.” Shortly thereafter, Brown himself faced large healthcare bills and unaffordable costs for needed medication. He took it upon himself to seek out affordability options available to him, which included the medication assistance program at Ohio State, and applied. “I've grown to become passionate about finding access to these programs that can provide medications free of charge or help with coinsurances and co-pays that patients may get so that they can live,” he says.

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Brown joined the pharmacy department’s medication assistance program at the James in January 2019. The team’s mission is to assist insured, uninsured, and underinsured patients in accessing both oral and infusion medications. Brown’s role is dedicated to hematology and oncology infusions, and he shares responsibilities with a partner to obtain financial assistance for patients directly from pharmaceutical manufacturers. They receive about 50 referrals in a week requesting help, so patients can begin their treatment plan without any treatment cost-related barriers. When a referral is received, Brown begins searching for financial assistance programs for the patient’s prescribed treatment. He will complete and submit the program application(s) on the patient’s behalf, work with the program if any additional patient documentation needs to be submitted, and prove to a program why a specific medication is medically necessary for the eligible patient. During this time, Brown also speaks with patients to help them understand what these programs are and how they work. He also coordinates with pharmacy staff to ensure inventory is correct and patients’ infusions are sent to the appropriate clinic before their scheduled appointment. If Brown cannot find financial assistance for a patient, he will work with the James’ financial counseling team to request hospital charity funding. If charity funds are unavailable, Brown will reach out to his administration staff for help with assistance options (e.g., other hospital funds) or to reach out to the care team to develop a more affordable treatment plan if possible. “We can be the people that can bear good news or bad news to patients,” he says. “And I try very often to give patients good news."

Patient Impact

A few years ago, Brown received a referral for a patient in her 70s who was diagnosed with lung cancer. Her oncologist prescribed pembrolizumab as an off-label treatment. Since the patient had traditional Medicare, Brown sought out a patient assistance program that would provide pembrolizumab to the patient for free. She qualified and could begin treatment. But before her treatment could start, Brown needed the patient to sign an advanced beneficiary notice (ABN) of noncoverage. At this news, the patient became very upset because she felt lost. She did not understand her why her treatment was chosen, how Brown could help, and why she needed to sign an ABN asking her to be responsible for any treatment-related costs.

Brown explained everything in detail to her, including the price of the prescribed medication, why Medicare wouldn’t cover the costs of the treatment, and how he could help her get free treatment. “After about two days of discussing with her and breaking down the prices of the medication, I was able to get her to agree to the ABN with the understanding that we do have financial support for her,” Brown explains. “We would not make her responsible for almost $170,000 in yearly expenses for a drug.” The patient has since been on treatment with pembrolizumab for two years, and Brown continues to call the patient to ensure she is doing okay.

Brown has met many patients who come to him thinking that no one cares about their situation or who think that no one will help them. “To avoid hearing that, I want to really make sure that we can help them in any way possible," he says. Brown goes beyond helping patients with their infusion treatment costs by finding any assistance available to help with costs related to clinic visit. For those financial advocates in similar roles, Brown says it is best to be patient. Financial advocates are required to work with numerous pharmaceutical manufacturers and independent charitable organizations who have their own rules and regulations. With patience and knowledge, you can best help your patients access their oncology treatments. “You really just have to be patient and very headstrong about what it is that you want and need for a patient," Brown says. “Everything works out.”

Advocate Spotlight: Jennifer Hines

Jennifer Hines is a patient financial advocate at St. Luke’s Cancer Institute in Nampa, Idaho. Prior to joining the financial advocacy team, Hines was preparing to become a physician assistant. With experience teaching anatomy and physiology labs to college students and health and nutrition to elementary students, Hines’ interests switched to public health and is currently completing her master’s degree. “In public health, you can have a greater effect, and you can help a lot more people,” she says. “It's definitely my passion now.” Upon applying to a job opening in financial advocacy at St. Luke’s, Hines knew she had a much different background than anyone else and has since fallen in love with her job.

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Hines has been working in financial advocacy for two years and is a member of a 17-person team. Because St. Luke’s oncology services are sprawled across Idaho for the purpose of bringing comprehensive care to patients close to their homes, at least one financial advocate is available in person at every location. A St. Luke’s financial advocate can see from three to 40 patients within one week, depending on the clinic’s patient volume. The team provides financial advocacy services to patients who are receiving medical and radiation oncology treatment of varying backgrounds and demographics. Because of this, Hines must be well versed in insurance optimization and financial assistance investigations to find funds and programs that are applicable to patients’ specific needs. Hines herself sees many immigrants and those who are not citizens of the United States. This is because of the agricultural industry in Idaho. To help these patients access much-needed financial assistance, Hines relies on charitable organizations/foundations and the St. Luke’s Financial Care—a charity fund offered by the health system for patients—because these patients do not qualify for state assistance, like Medicaid.

Within her time at St. Luke’s, Hines found her calling: training others new to their role. She has helped the financial advocacy team’s leadership create videos and resources to provide robust training to new financial advocates, showcasing step-by-step the needs and responsibilities of the role. This training also includes education on the cancer institute’s patient demographic and the importance of empathetic listening and relationship building with patients. Due to cultural barriers, Hines has experienced difficulty in discussing patients’ finances and helping them understand the financial assistance options that are available. For example, Hines has noticed that female Latinx patients may not have the same understanding of their family’s finances as their husbands do. More so, older adults who come in for treatment may not willingly share their financials with financial advocates because patients view this as a private matter. In both cases, Hines trains financial advocates on how to have these conversations with patients. “We do a lot of active listening and empathetic listening, so we can hear what they're saying and try to touch on their concerns first,” she says. Hines also has new financial advocates shadow those more experienced in the role, so they can teach how to best build relationships with patients and have those difficult conversations.

A Recent Win

A few months ago, Hines met a gentleman in his early 50s who was diagnosed with prostate cancer that metastasized to the bone. He is a husband and a father of six daughters. Through relationship building, Hines learned that the patient worked full time, while his wife stayed home to care for their children. Upon receiving his diagnosis, the patient was scheduled for radiation treatment and chemotherapy. Shortly thereafter, the patient could no longer work and ultimately lost his healthcare insurance. The family had well over $150,000 in medical debt.

Because the patient could not yet apply for Medicaid, Hines quickly acted to help him apply to St. Luke’s Financial Care. Once he was enrolled, the debt was completely cleared from his account. “When we pulled them into the office and gave him the status of his approval and notified them, I just remember he wept,” Hines says. She then was able to convince the patient to apply for Medicaid once he qualified for state assistance. His application was approved, and the patient had full healthcare coverage once again. “That was a big one for us,” Hines says. “Just seeing a man of that stature weep in front of you...that's why you do this.”

Advocate Spotlight: Magdalena Cervantes

Magdalena Cervantes is a financial advocate for oncology at the Sidney Kimmel Cancer Center at the Thomas Jefferson University Health System in Philadelphia, Penn. She fell in love with the medical field after working at the cancer center’s front desk as a patient registrar in late 2018. While at the front desk, Cervantes enjoyed seeing patients every day and found passion in doing what she could to help, including regularly donating blood. She then transitioned to the hospital’s neurology department for a brief time until an oncology financial advocate job opening became available in May 2019. Upon hearing the news, Cervantes immediately applied. “I really love to work with patients,” she says. “To know that I can at least help patients financially is fulfilling to me.”

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Cervantes is a member of a team of three financial advocates, who provide financial advocacy services to all oncology patients across the health system’s five hospitals in southeastern Pennsylvania and northern New Jersey. When patients start their treatment, Cervantes contacts them via phone or will see them in person at their first appointment. Due to the COVID-19 pandemic, Cervantes and her team have had to rely on phone calls to help patients, but they are beginning to see a few patients a day in the cancer center as in-person services pick back up. Before meeting, Cervantes checks patients’ benefits to see if their insurance is sufficient and can help them apply to Medicare or Medicaid if needed. She also reviews patients’ treatment plans, finds available financial assistance for their disease and/or treatment, and creates an estimate that includes the total expected costs of their treatment (e.g., infusion costs, injections costs, etc.) and out-of-pocket responsibility. “Before I talk to any patient, I like to have all the information up front,” Cervantes explains. “It’s very important because this way they can see the bigger picture.”

After effectively communicating all this information to patients and receiving the necessary signatures, Cervantes applies for financial assistance on patients’ behalf and will follow up with manufacturers and independent foundations to ensure all applicable treatment costs are covered on time. On average, Cervantes sees about four to five patients in person and completes 20 phone calls per day.

Adding Value Through Bilingualism
Cervantes is fluent in Spanish. Therefore, she can explain the financial aspects of cancer care to Spanish speaking patients. “I know how it feels for patients to not be able to communicate with their team,” she says. “Many more of the patients that speak Spanish are starting to come to me, and it's sometimes for things that are not financial advocacy related.” Because these requests are still advocacy related, Cervantes helps in any way she can. In doing so, she can build deeper connections with patients and offer assistance that surpasses her main role in the cancer program.

A patient with lymphoma presented to the cancer center after traveling from New York to receive treatment in Philadelphia. He was enrolled in Medicaid in New York but had yet to apply to Pennsylvania’s Medicaid program. In learning this, Cervantes got into contact with the patient’s dedicated social worker at the hospital to ensure they were helping the patient apply for Medicaid coverage in the state. The patient was then approved for coverage, ending Cervantes’ role in his care. But because of the trust built between Cervantes and the patient, he continues to call Cervantes for help in communicating and understanding his treatment. When the patient calls, Cervantes always asks if he is experiencing any symptoms or needs, triages the call, and gets into contact with the necessary care team member (e.g., social worker, nursing staff, etc.) to ensure the patient is cared for appropriately.

Cervantes also finds value in explaining insurance to Spanish-speaking patients in their native language. Often, these patients do not understand that regardless of their insurance provider and plan type they could be responsible for some costs. “I know how patients feel because they don't understand what insurance does,” she explains. “I try to simplify the language and put myself in their shoes.” After doing her homework, Cervantes can explain in Spanish to patients what a deductible is, what their out-of-pocket may be, and why insurance works the way it does in America. More so, she will write everything down and offer handouts for patients to take home. Cervantes applies this passion and dedication to any patient that comes to her for help, and especially to those who trust her because she can communicate in Spanish. “They feel connected to us,” she says. “If something's happening or their treatment changes, they have the trust to call me. They have that confidence knowing they can ask for help.”

Advocate Spotlight: Karen Carter

Karen Carter is a financial advocate at Carol’s Wish—a community-based financial navigation program of the nonprofit Colorado Ovarian Cancer Alliance located in Denver, Colo. The program began in 2018 in honor of Carol Dauer, who fought a three-year battle with ovarian cancer before passing away. Prior to the start of Carol’s Wish, Carter faced her own battle with cancer after being diagnosed in 2009 with intraperitoneal cancer. She became acquainted with the nonprofit during her treatment and has since become a dedicated volunteer, helping the Colorado Ovarian Cancer Alliance with its annual health fair, fundraiser, and gala. With a background in patient advocacy for AmeriCorps, Carter became one of the first financial advocates of Carol’s Wish. “I was very happy and excited to join Carol’s Wish,” Carter says. “I wanted to jump on board to see what I might be able to do for individuals facing the same journey that I did over a decade ago. It's not a job for me, it's a calling.”

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Carol’s Wish offers financial advocacy services to patients at two cancer clinics located in the Denver metropolitan area. The financial navigation program began with a mission of providing financial advocacy services to patients with ovarian cancer, but due to increases in patient need, Carol’s Wish financial advocates help referred patients with any type of gynecologic cancer. Carol’s Wish receives about 50 patient referrals every month, including those with non-malignant diagnoses, and its team of two financial advocates offer their services at the cancer clinic, in patients’ homes, or over the phone.

Information about Carol’s Wish is included in both cancer clinics’ new patient packets, and patients are usually referred to a financial advocate by their care team. Once referred, Carter gathers all necessary information on the patient: their diagnosis, their treatment plan, insurance status, and any financial concerns. She is equipped to help patients optimize their insurance, apply to Medicaid, apply to available financial assistance options, and provide support in other areas patients may be concerned about. For example, Carter always asks patients what upcoming bills they have and what they are concerned about. She asks this so patients can feel comfortable sharing anything else that may be unrelated to their medical care. When a patient told Carter that her state property taxes would be due soon and was concerned about the costs, Carter quickly found a program the patient qualified for that would cut the tax bill in half. The team at Carol’s Wish takes pride in their ability to address an array of patients’ needs. “Karen possesses the perfect blend of dogged persistence, creative thinking and compassion for her patients, which is why she has literally saved lives in this role,” says Rachel Dauer, a financial advocate at Carol’s Wish.

A Recent Win

A widow in her early 60s presented to a partner cancer clinic with abdominal pain and a mass in her abdomen. She was immediately scheduled for surgery and referred to Carol’s Wish. After taking a second look at the patient’s insurance status, Carter learned that the patient was underinsured. Her insurance would only cover a small portion of the hospital bill per day (about $750 a day) and would not cover any of the surgeon’s costs. The hospital then told the patient that the cost of her surgery and care would be $30,000 in total and that $7,500 needed to be paid out of pocket on the day of her surgery to begin surgery. With news of the cost, the patient declined treatment, stating: “Oh, the pain is not that bad. I will wait seven months to get another insurance policy during open enrollment.”

Carter knew she couldn’t let the patient wait seven months before receiving treatment. In an effort to help, she first began researching to see if the patient qualified for Medicaid. Because the patient was self-employed and made well over Colorado’s Medicaid income limit, Carter suggested the patient gather all her business-related receipts to see if any business deductions could be made to bring her income amount down. Through dedication and great patient engagement, Carter helped prove the patient’s income was low enough to qualify for Medicaid and got the patient signed up later that afternoon. “As a result, the patient had her surgery completed in 22 days rather than six months later, and she had zero out of pocket costs,” Carter says. “She was so grateful following the surgery after admitting what a stressor this all really was on her.”

Advocate Spotlight: Gretchen Van Dyck

Gretchen Van Dyck is a financial counselor at Green Bay Oncology in Green Bay, Wisc. She also serves on the Wisconsin Association of Hematology and Oncology (WAHO) Policy Engagement Committee. Prior to a career in financial advocacy in oncology, Van Dyck joined Green Bay Oncology in 2011 as a receptionist. In this position she built strong connections with the patients she would regularly see. Her passion for helping patients and grow within her organization led Van Dyck to transition to a financial counselor in 2012. Van Dyck quickly taught herself the basics of financial advocacy when emergency coverage was needed on the financial counseling team. “I honestly think it was the best thing that could have happened because I learned so much from it,” she says. She quickly got up to speed on how to help patients in medical oncology alleviate the financial burden of cancer care, including all options available to them and how to apply for assistance.

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After working with patients in medical oncology for four years, Van Dyck refocused her financial counseling efforts on patients in radiation oncology and patients with gynecologic cancers as her team expanded to encompass more of the hospital’s oncology patients. “I take care of the patients surgical and radiation authorizations, review the patients benefits with them, and assist with any financial concerns they have with their treatment,” Van Dyck says. “I love what I do.” She explains that the hardest part of working with patients in radiation oncology is the lack of available options to help them pay for their treatment. Unlike the abundance of manufacturer and independent foundation assistance commonly available to patients on intravenous or oral chemotherapy, Van Dyck can offer radiation patients the community care program funded by her hospital, payment plans, and minimal foundational assistance from their community. As Van Dyck began to see this need grow, she joined her state’s hematology and oncology association to advocate on behalf of her patients for policy change at the state level.

Van Dyck also participated in the Association of Community Cancer Centers Virtual Hill Day on May 12, 2021 and joined her fellow WAHO members in calls with their Wisconsin state representative and senator as they shared the issues most pertinent to their patients. The focus of the meeting, Van Dyck shares, was to speak on the impact co-pay accumulators have on patients struggling to afford their cancer treatment costs, showing a need for policy intervention. For others looking to advocate for patients in oncology at the state or federal level, Van Dyck shares that “we have to look at it from the patient perspective. Put yourself in their shoes and just fight for them.”

A Recent Win

Van Dyck shared with her state representative and senator about a patient with a GI stromal tumor, who’s treatment is long term. The patient is unable to take the generic version of her prescribed medication due to adverse reactions to the drug. Therefore, the patient must receive and take the costly name brand version of her prescription. She also recently received a letter from her insurance company stating that she could not use the prescribed medication’s manufacturer co-pay card against her out of pocket due to its policy. This means that even with the $30,000 a year assistance the co-pay card would provide, the patient is responsible for her out of pocket costs and must also pay the difference between the costs of the brand name medication and the generic medication.

The team at Green Bay Oncology is currently fighting for the patient to help change the insurance company’s policy. “The amount of money and the stress that would be alleviated from these patients if the insurance companies would just let them use the assistance that is available to them is immeasurable,” Van Dyck says. “If they’re not able to pay these bills off, they just accumulate year after year.”

Advocate Spotlight: Joelle Ferguson

Joelle Ferguson is a financial counselor at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute at The Ohio State University (the James) in Columbus, Ohio. She began her career in healthcare in the billing department for another hospital’s surgical physicians and surgical groups. Ferguson was then hired by The Ohio State University, Wexner Medical Center in 2010 as a pre-certification representative where she completed prior authorizations and checked patients’ insurance. “I enjoyed the job, but I wanted something different,” she explained. "I wanted to be more hands on and feel like I was making a difference by helping patients with insurance or any other issues.” She has been a financial counselor for the James for six years now.

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With her insurance and pre-certification background, Ferguson quickly became a key member of her team. At the James, financial counselors specialize in specific areas of financial advocacy. For example, Ferguson specializes in helping patients with out-of-network insurance coverage and veterans access financial assistance or optimize their insurance to ensure they can receive optimal care at the James without financial stress. She emphasizes that one of the most important roles she plays in patients’ care is providing them with all information needed regarding their insurance coverage and helps direct patients to solutions that best meets patients’ needs. Ferguson helps patients understand their diagnosis and treatment costs and finds solutions for their treatment costs, including waiving deposits. “We never want our patients to walk through the doors and end up bankrupt when they are all done with their care,” she says.

Ferguson was also one of the first on her team tasked with understanding chimeric antigen receptor (CAR) T-cell therapy and helping patients find financial assistance for this costly treatment. She dedicated her own time to educate herself on the novel therapy and will now train others on how to best help these patients. Helping active and retired veterans also comes with its own set of nuances. The James is one of a few cancer centers in the state who sees veterans. In many cases, Ferguson checks patients’ billings prior to meeting with them to ensure it is done correctly and that any prior authorizations are identified and sent to billing management. Sometimes she must take the extra step to get in contact with the local Veterans Affairs hospital to ensure patients’ prior authorizations are correct. “I love this job,” she says. “If you need help, I'm going to help you. And all that matters is that the patient gets the best care and the best answers they need from us.”

A Recent Win

Ohio is home to many Amish and Mennonite communities and treating these patients requires understanding and support from the entire cancer care team, including those in financial counseling. Ferguson helps many Amish patients, who do not have healthcare insurance or access to technology and mail. When these patients do not have enough money to pay for their cancer care, they rely on people like Ferguson and those in their community for help.

Recently, an Amish patient was diagnosed with an orthopedic cancer and had to travel over 2 hours to receive treatment. The patient was billed for over $200,000 as self-pay and could not afford the amount out of pocket. In response, Ferguson quickly called the Amish Church Fund to see if the patient was a member of the organization's community. As a member, Ferguson was able to get the patient’s bill paid by the church community within the week. “These families bond together. If they don't have a church fund to turn over their bills to, their community joins together to pay them," says Ferguson. “And that is just simply overwhelming to me. It's all about providing the patient everything we can and sometimes it takes our whole community to be able to provide patients what they need.”

Advocate Spotlight: Amy Elgin

Amy Elgin is an oncology patient resource coordinator at AnMed Health Cancer Center in Anderson, SC. She is a self-taught financial advocate who provides services to two oncology programs in her hospital: the Anmed Health Cancer Center and a private practice. She started her oncology career in 2015. She was wary of her position at first because she knew what patients’ experiences were like after losing her mom to cancer at 13-years-old, but this experience has since drove her passion to advocate for oncology patients. Upon being hired, Elgin immediately revamped he oncology patient resource program to better meet patients' financial needs and to help her program and health system save money. "I just took things into my own hands,” she says.

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After her program lost their pharmacy assistance staff member during her second year on the job, she started to notice more patients that needed help. So, she started Googling "patient assistance" and "pharmacy assistance" to find any help available. Elgin’s services are in high demand because she is the only financial advocate providing support to four oncologists, one gynecologic oncologist, two radiation oncologists, four nurse practitioners, and one physician assistant. She has since received training from NaVectis and was part of Vivor’s pilot program (a third-party financial assistance platform at a cost). But she considers the ACCC Patient Assistance & Reimbursement Guide and Google to be her best friends. “The ACCC Patient Assistance and Reimbursement Guide is one of my go-tos,” she says. “I have tabbed each company name, so when I hear a drug, I can quickly turn to the page.” As an oncology patient resource coordinator, Elgin helps patients find and access all aspects of financial assistance. She is trained to understand and know how to apply for Medicaid on patients’ behalf and on how to optimize patients’ insurance, and she is self-trained on how to access assistance for patients with disability, track financial assistance received by free drug programs, and even on how to get patients access to free mobile phones and cell phone service (You can read her Oncology Issues article "Helping Patients Access Free Mobile Phones and Cell Service" for more information on helping patients with this need.) Elgin does it all.

Because of her passion and know how, Elgin provides patients security in their financial health so that they can focus on their physical health. “I tell people when they come in here to let me take care of the financial stress, so they can deal with their medical stress,” she says. “Financial stress can impact patient's health just as much as any other stresses. It's a huge part of their treatment plan in my opinion. And I've finally gotten the oncologists on board to understand that." Elgin’s efforts to improve her program’s financial advocacy services has greatly impacted the view all oncology staff have on her support to patients. After doing the necessary research, she hopes to transition her title to oncology financial navigator.

A Recent Win

Elgin helped a patient a few years ago who was in his twenties and diagnosed with glioblastoma multiforme. At the time of diagnosis, the patient was uninsured, unemployed, and was accompanied by his mother in all appointments. At news of this diagnosis and insurance status, Elgin quickly helped the patient enroll in Medicaid and supplemental security income, which helped pay for all of his medical bills. Unfortunately, the patient recently passed, and his mom reached out to Elgin to share their sadness and thank her for all the help she provided. “We get those patients that just grab a hold of our hearts and when they pass you just cry,” Elgin says. “But you also know they're in a better place."

Advocate Spotlight: Mia Nutter, MBA

Mia Nutter, MBA, is a financial navigator at Winship Cancer Institute of Emory University in Atlanta, Ga. She is also a ACCC Financial Advocacy Network Advisory Committee member. She has worked in healthcare for 20 years and has been a patient advocate for the majority of that time. She began her career as a financial counselor in a level 5 trauma center in her organization’s Emergency Room, where she worked with patients to help them access financial assistance.

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She then transitioned into the role of senior financial counselor, supporting the entire hospital system and assisting all patients with accessing financial assistance whose bills would soon be sent to collections and forgotten. Through this experience, Nutter saw many patients who could not afford their payments and who would file for bankruptcy once their accounts were sent to collections. Others would deplete their life savings to continue paying for their treatment. “Listening to patients and hearing story after story about how the cost of healthcare is too expensive and that they are often faced with paying for medications or paying for food, I knew I had to be an advocate and resource for these patients,” says Nutter.

Her passion and drive quickly led her to gain leadership opportunities and ultimately joined the revenue management team where she stayed for over 12 years. “I always felt my real passion was the connection I had with my patients and assisting them during their most challenging times—financially and emotionally—so I decided to focus on being a financial advocate,” says Nutter. “I became a financial navigator to be the voice of the patient because many patients will discuss their struggles and anxiety with financial debt with me more often than they would with their provider or family. By gaining their trust and proving that I am an advocate for them and that I will find a solution to their financial strain through various financial assistance programs, patients can focus on their treatment and healing.” Nutter has found that many patients will cancel their appointments or choose to not receive their oncology treatment because of their felt inability to afford treatment. But through education on the various community and manufacturer resources available that provide financial assistance, Nutter ensures patients’ treatment costs are 100 percent covered.

A Recent Win

A patient was scheduled to receive infusion treatment for lymphoma on a Friday, but her healthcare plan was terminated the prior Monday without the patient’s knowledge. Due to a mix up in the patients’ insurance, a change in her premium cost, and decrease in work, Nutter’s patient was facing a serious question: “Do I continue treatment?”

While Nutter and the patient investigated into why the insurance was terminated and getting it reactivated, Nutter knew the patient couldn’t wait the month it would take get the insurance cleared. She immediately took the patient’s case to her cancer program’s financial assistance program and had the patient apply. She met with the Charity Department’s representatives and pleaded her case. Her patient needed chemotherapy treatment which could not be delayed, so she asked them to process the patient’s application immediately. Nutter gained the department’s approval within 24 hours to cover the costs of the patient’s clinic and chemotherapy treatments (costs up to $16,000). She also gained coverage for the patient if oncology surgery and/or inpatient stay was needed. Nutter also helped the patient re-enroll in the Marketplace to obtain insurance for other services not related to her cancer diagnosis. “She was so relieved that she can receive her treatment without any delay in care that she broke down in tears for me working with her and not giving up,” says Nutter.

Advocate Spotlight: Aimee Hoch, LSW

Aimee Hoch, LSW, is an oncology financial navigator at Grand View Health in Sellersville, Pa. She is also an ACCC Financial Advocacy Network Advisory Committee member and Voice Task Force member. Before becoming a financial navigator, Hoch was a social worker for 14 years at Grand View Health, a small community hospital about 45-minutes outside Philadelphia. While in this role, she noticed an increase in patients seeking help with accessing and affording their cancer treatment.

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Hoch discovered through her own research that establishing a financial navigation program at her cancer program would be key in meeting patients’ long-term needs. But she also knew that advocating for this expansion to her leadership would require diligent work. Hoch shared with her cancer program and leadership patient stories, her day-to-day experiences, and metrics to prove that a dedicated financial navigation program could meet this patient need. In just a year and a half of advocating, Hoch established the financial navigation program at Grand View Health and became its first financial navigator—a part-time role that grew into a full-time position. She is no longer placing a band-aid on patients’ financial needs to ensure treatment for one day. Instead, she helps patients become financially healthy, so they can receive treatment for their entire cancer journey. “Patients are able to participate in their healing and recovery more. And they don’t have to worry about their finances,” she says.

A Recent Win

One of Hoch’s recent patients was receiving treatment for lung cancer when she suddenly lost her job and insurance coverage due to the pandemic. This patient was the sole provider of the family and was facing multiple other stressors in her life. She was concerned that she wouldn’t be able to continue her treatment. Once made aware of the patient’s situation, Hoch acted. She secured a foundation fund to cover the costs of the patient’s premium for COBRA coverage and applied for the manufacturer's free medication program on behalf of the patient. The patient qualified for both programs and could receive treatment without worry of cost. As 2021 approached, the patient’s COBRA premiums would nearly double, and Hoch knew she would have to identify a more sustainable and affordable solution. Hoch helped the patient pick and secured an affordable Marketplace plan. Hoch also noticed the foundation fund previously used was available for 2021 and applied on behalf of the patient. On top of insurance premium assistance, the patient also qualified for the manufacturer’s co-pay card program. For the rest of 2021, the patient will no longer have to worry about her insurance premium or co-pay costs associated with her cancer treatment.