Diane Cole

As many patients and their families discover, fighting cancer is hard enough  without the added worry of potentially fighting bill collectors as well, but a  medical crisis doesn’t need to turn into a financial crisis. A level head and  some financial savvy can go a long way toward allaying a patient’s worst fears,  including the suggestions below from cancer patients and financial experts.

Good financial decisions are seldom made under  intense emotion, says Peg Downey, a certified financial planner in Silver  Spring, Maryland. In the same way that it’s best to research and weigh your  medical options, pocketbook issues also need to be evaluated. When medical  crisis hits, "cash is king," says Downey, because it provides more options for  treatment and more freedom in general. But that doesn’t mean you should  immediately tap into savings, sell your house or take out a loan. You may  eventually decide to do so—but don’t assume you’ll need to do it. Before taking  action, take stock of where you are financially.

First, review your insurance policies. Contrary to  conventional wisdom, you can buy health insurance even with pre-existing  conditions like cancer, Downey points out.

When Carole O'Toole discovered her HMO would not  cover a stem cell transplant to treat her breast cancer at a particular hospital  she and her doctors believed would provide the best treatment for her, she  researched her options to find a better insurance plan. Fortunately, Maryland  had just passed a state law requiring open enrollment periods for health  insurance, regardless of pre-existing conditions. O’Toole was thus able to  switch to a more comprehensive policy that covered the $75,000 procedure.

"The insurance premium was hefty (about $1,000 a  month) but I got the treatment where I wanted, and it was successful," says  O’Toole. Even though O'Toole’s new insurance policy was more expensive, the  pay-off, including the budgeting required, was well worth it.

Many states have similar open-enrollment laws.  Professional associations often offer group coverage as well. Patients should  also tap into job-related benefits, such as short-term disability.

Find out what you can anticipate—and estimate how  that translates into costs, says David Landay, a New York-based lawyer.  Questions to ask your medical team include: What will you need in the way of  such out-of-pocket items as prescriptions, nursing or prosthetic devices? Will  treatment side effects be likely to sidetrack you from work&mdash;and if so, for how  long? How soon after surgery will you be able to return to work&mdash;part-time,  full-time or at all?

"Always keep in mind that what you learn is not  predictive of what’s going to happen to you," Landay says. The idea is to be  aware of and prepared to fund all possibilities.

Prepare a balance sheet that includes assets (such  as property, stocks, bonds, retirement funds) and debts (loans, unpaid bills,  back taxes); income from all sources (salary, interest, dividends, social  security benefits) and your expenses, and not just big-ticket items like  housing, clothing, groceries, transportation, and insurance; but less obvious  ones, like holiday gifts. At the same time, sort your bills and identify a  monthly "must pay" list, in order not to fall behind on such essentials as your  mortgage payment, rent and health insurance.When you total the figures, is there  a shortfall? How much? The next steps will help you bridge the gap.

The financial picture that emerges will give  immediate clues as to where to cut spending. "Look at what you don’t need," advises Cindee Taradash, a financial planner based in Whitefield, New Hampshire.  After her husband Matthew was diagnosed with osteosarcoma, they found they could  dispose of one of the two cars they owned; they further saved by having only to  pay for insurance and maintenance on one car.

At the same time, the wake-up call of illness may  make you realize there are certain things you can’t afford not to do. Before her  diagnosis, Katie Gibson and her husband Scott Bischke had saved as much as they  could in order to fund time off to pursue their passion for hiking and camping.  For them, money in the bank meant “time and freedom to do what we wanted.”

Through Gibson’s illness, they lived even more  simply—at one point, Bischke conserved transportation costs by bicycling instead  of driving as he went about his daily errands&mdash;to allow Bischke to take unpaid  leave from his job, also at Hewlett-Packard, and care for Gibson. Eventually,  Gibson did return to work, as did Bischke&mdash;both of them part-time, taking a cut  in income in order to continue to have more time together.

In 1998, with Gibson in remission, they also used  their savings to fund a three-month hike across Montana’s Continental Divide.  Admits Bischke: "We picked the cheapest form of entertainment you can think of  because when you backpack and camp out, the lodging is free, the food is what  you carry on your back, and your feet provide the transportation.” But the  trip’s symbolism was priceless: "We saw the trip as a celebration of a return to  life and living, because we were able to do something that we could have done  before cancer," says Bischke.

Or the personal goal may simply to feel more secure  financially. To that end, as part of their budget plan, O’Toole and her family  set up what she dubs a "slush fund" of several thousand dollars as an emergency  home repair fund. It was one less worry to distract her from getting well.

Although most complementary therapies are not  reimbursable through insurance, many practitioners will be open to negotiation.  Similarly, even if insurance appeals are unsuccessful, physicians may prove open  to discounting their fees or setting up a payment plan and working with you on  the cost of treatment. Ditto with other services. For example, when Taradash’s  husband required a prosthetic leg, insurance covered only part of the cost, she  says, but "the man who constructed it was kind enough not to bill us any  additional fees." If treatment takes you to a hospital out of town, check if  they provide discounted rental or hotel rates.

If you still need cash, you now have a solid base on  which to choose the option that fits your particular medical, financial and  family situation. Before proceeding, though, be sure you understand, and can  accept, the possible risks and tax bills each could incur:

Selling stocks, bonds, or mutual funds, for  instance, can provide cash—as well as commissions and a sizable tax bill. That’s  why the rule of thumb is to sell low-earning assets, or those that will yield a  tax loss, first.

If you’re severely ill—or if your nerves are made of  steel&mdash;instead of selling, borrowing on margin (taking out a loan against your  brokerage account holdings) may make more sense. In the case of one of Downey’s  clients, for instance, paying interest on the margin loan came to less than  paying capital gains taxes on stocks whose value had risen considerably over the  several decades she had owned them. The risk here: if the stock against which  you borrow declines significantly, you’ll receive a "margin call"&mdash;that is,  you’ll have to pay back the loan, in part or in full, perhaps losing the stock  altogether.

Retirement accounts may provide another source of  quick cash—if (for those under the minimum age of withdrawal of 59 and a half)  you’re willing to pay the 10 percent penalty for withdrawal. Even so, check with  your employer or accountant to see if you can avoid the penalty by qualifying  under its hardship provision.

If you’re a homeowner, you might look into a home  equity loan, mortgage refinancing or reverse mortgage. The plus is immediate  cash, but the caveat is that you might lose your home if you aren’t able to make  the payments.  “If you can’t afford the payments, you will lose your home, and  you do not want to be sick and homeless,” cautions financial planner Ginita  Wall. But if you have a second home or property consider selling—or renting it  out.

Then there are credit cards, which offer a  short-term solution—as long as you’re able to pay on time. Just be aware that  interest rates can grow at astronomical rates. And if your bills are headed out  of control, says Wall, call Consumer Credit Counseling Service, a non-profit  organization that can help you negotiate a payment plan you can follow through  on.

Life insurance policies also provide a number of  possibilities for raising cash—but the pros and cons are especially tricky. For  instance, you can borrow against the value of your insurance policy&mdash;but you may  still have to pay premiums on the entire policy, points out David Landay.  Accelerated benefits&mdash;getting an advance on the death benefit while you’re still  alive&mdash;will decrease the amount left to provide for survivors. "It’s a matter of  balancing current need against" the future, says Landay.

Most controversial of all are viatical  settlements,which is selling your life insurance policy, for a percentage of the  full benefit, to another party who, as the new policy owner, continues to pay  all premiums and receives the benefits upon your death. Proceed cautiously,  though and make sure you’re dealing with a reputable broker.

Whether or not you’re  already used to handling finances, calculating the best money moves in a time of  crisis can take time, energy and focus. And for the cancer patient, fighting the  illness and getting well often leaves little strength or patience for other  matters. If you can rely on someone else to take charge of financial and  insurance issues, do so. It can be a relative, close friend or a financial  adviser. "We have some clients who have had or are going through treatment for  cancer, and one of the biggest issues they face is fatigue. As a result, many  times the last thing patients want to deal with is money issues," says Scott A.  Leonard, a financial planner.

On the other hand, throughout her treatments Katie  Gibson felt that handling the family’s financial affairs was one activity she  could still do, and gave her satisfaction knowing she could. Either way, the  decision is yours.

The most important aspect a patient should be  focused on during treatment is to be well; physically, emotionally—and  financially.

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10 Steps to Financial Peace of Mind During Treatment

A growing number of companies are directly offering to assess a person’s  DNA—testing for everything ranging from risk of hereditary breast and ovarian  cancer to cystic fibrosis to how quickly a person metabolizes caffeine. 

For cancer patients and family members worried about their genetic legacy,  access to these tests is only a mouse click away. But the Food and Drug  Administration is taking steps to regulate the budding industry of what it calls  in vitro diagnostic multivariate index assays.

The FDA already regulates genetic test kits sold to hospitals because they  fall under the realm of medical devices, but genetic tests developed and  performed by a single laboratory were previously considered lab services. The  FDA released draft guidelines in early September that create a new category for  the multivariate index assays, which involve multiple genes and complex data  analysis. The Centers for Medicare and Medicaid Services currently regulate  multigene assays under the Clinical Laboratory Improvement Amendments of  1988.

For consumers worried about confidentiality, these tests can be ordered  online, making “do-it-yourself” part of the appeal. But lack of medical  oversight is part of the problem. Steve Gutman, MD, director of the FDA’s Office  of In Vitro Diagnostic Device Evaluation and Safety, says consumers should be  wary because lab results are not always reliable, many tests lack scientific  data gained only from clinical trials and even reliable test results are  difficult to interpret without the help of a trained medical professional. While  companies like Sciona Inc. or Genelex Corp. offer DNA tests for things like  nutritional predispositions, other companies deal with tests for serious  diseases, including cancer.

“These [cancer gene] tests can be complicated and very nuanced, and do not  lend themselves well to self-testing in the same way as a test for cholesterol  or pregnancy,” Dr. Gutman says. “Tests purchased using the Internet should be  approached with care.” Though insurance often covers most or all of the cost of  genetic testing for appropriate candidates, the at-home tests can set consumers  back anywhere from $100 to thousands of dollars.

San Francisco-based DNA Direct, a company formed in March 2005, offers  direct-to-consumer tests for a variety of illnesses. Its cancer tests look for  23 DNA markers associated with colorectal cancer and precancerous polyps, BRCA1  and BRCA2 for breast and ovarian cancer and the tamoxifen 2D6 gene, which  reveals the effectiveness of tamoxifen in a specific breast cancer patient. DNA  Direct has performed about 1,000 tests since 2005, and about 15 percent of the  patients who contact DNA Direct are referred by a medical practitioner, says DNA  Direct’s clinical director Elissa Levin, who is a genetic counselor.

“Before we engage anyone in the testing process, they go through a  comprehensive genetic counseling session by phone,” usually 45 minutes to an  hour long. For most tests, she says the results are delivered by phone, and a  detailed, secure report is made available online. Subsequent counseling sessions  and the option to send the report to the primary care doctor for follow-up care  are also offered.

Despite the test result—positive or negative&mdash;genes only provide limited  predictability for cancer risk. Many cancers are caused by interactions of more  than one gene, as well as environmental factors, such as diet, smoking and a  variety of cancer-causing exposures. Patients, with the assistance of a medical  professional, must take all factors into consideration to determine and  understand their individual risk.

Before taking any direct-to-consumer test, experts advise making sure the  tests offered by a given company are research-backed, medically accepted  procedures. Patients should confirm that trained, board-certified genetic  counselors work for the company and are available before, during and after the  testing process. And it’s critical to check the bona fides of the lab conducting  the test by seeing if it follows standards set by the CLIA.

In addition to mail-order tests, other tests ordered by physicians, such as  the well-known OncotypeDX™ that measures risk of breast cancer recurrence, also  fall into the category of tests the FDA plans to regulate. 

To find a genetics professional in your area, contact the National Cancer Institute at 800-422-6237 or visit 

This article discusses genetic test kits and the types of cancer they test for. 

Diane Cole

10 Steps to Financial Peace of Mind During Treatment

Home-Brewed Gene Tests

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