BACK TO WORK AFTER CANCER, WHAT DO YOU NEED TO KNOW?
June 24, 2008
BACK TO WORK AFTER CANCER, WHAT DO YOU NEED TO KNOW?
Once your cancer treatment is complete or nearing completion and you’ve been cleared to return to work, at least part-time, more challenges await. Here, what you need to know about how your cancer history may affect you on the job and how to take full advantage of the protections afforded you under the law. Our panel of experts: Page Tolbert, a social worker at the Memorial Sloan Kettering Cancer Center’s Post-Treatment Resource Program, New York; Randye Retkin, an attorney and the director of LegalHealth, part of New York’s Legal Assistance Group; Kimberly Calder, manager of Health Insurance Initiatives for the National Multiple Sclerosis Society; Barbara Hoffman, an attorney and the founding chair of the National Coalition for Cancer Survivorship.
Easing back into the routine
After you return to work, you will probably need to take time off for follow-up visits and checkups, or maybe for remaining chemotherapy sessions. Be aware that you’re entitled to the benefits of the Family and Medical Leave Act (FMLA) if you work for a company with 50 or more employers. Under that law, you can take the leave in small increments, even as little as one-hour blocks of time. It’s explained in more detail at http://www.dol.gov/esa/whd/fmla. If you work for a company with fewer than 50 employees, you might still be covered for medical leave under a state law. Check with your HR department, or your state labor department.
Your cancer history and your insurance
If you were employed and had health insurance before the diagnosis of cancer, took approved time off, and are back to work, there will be no effect on your group health insurance at all, experts say. If you are covered by a group plan, you can’t be singled out for your cancer history. Your premiums can’t go up higher than others’ premiums, and you can’t be dropped from the group plan due to the cancer. The federal law known as HIPAA (Health Insurance Portability and Accountability Act of 1996) protects the rights of people in group health plans. See the details at the government website, http://www.hhs.gov/ocr/hipaa/
Are you being treated fairly?
Legally, your cancer history can’t be used against you in the workplace. But it can be difficult to determine if your cancer history is being used unfairly, because discrimination can be subtle. Some hints: If someone clearly less qualified is promoted, you should suspect the cancer history. If you hear disparaging comments, you are being treated unfairly. One woman (who filed a lawsuit) told of the day the office staff had to exit the building during a blackout and her boss said others should just follow her, since her radiation therapy made her glow. If tasks you used to do competently are being given to someone else, that might be a clue your supervisor thinks you’re not as capable. If your assignments or projects are not as challenging or time consuming as they were before your cancer treatment, that might be a clue. But the evidence is very “fact-specific” for each workplace situation. Fortunately, most employers are savvy enough to know they have to watch their step when dealing with employees or potential employees with health problems. And as more employers experience cancer and other serious health problems in loved ones, many are growing more compassionate towards employees with a cancer history. Conditions may be improving, in a study published in 2004 in the Journal of the National Cancer Institute, researchers surveyed more than 1500 women, including 646 breast cancer survivors, and found “little evidence” that survivors faced discrimination at work due to their cancer history.
What to do if you suspect discrimination
First, discuss the situation with your boss, if you can. He or she might be trying to lighten your load and have the best of intentions. Decide first if that is the case. You might simply ask, in a cordial tone: “Are you trying to make it easier on me? I appreciate that, but I’d welcome the challenge of travel to meetings again.” If your talk with your supervisor doesn’t solve the problem, go next to your HR department and discuss the situation. If you can negotiate and solve the situation informally, that’s better and cheaper than getting a lawyer. Your HR person may have a talk with your boss and resolve the situation quickly. If you do need to take legal action, first sit down and focus on what your goals are–Back pay? To get back your former assignments or clients? Promotion? To stay at the company or not? With those in mind, you can proceed with a clearer head. And your efforts will be more focused.
Moving to another company
Perhaps you’re unhappy enough to look for another job, you’ve decided to go after your “dream job” or you just have an opportunity for an interview with another company. Going on a job interview is always challenging, but if you have a cancer history it might be more so. If you decide to look around for a new job, experts recommend squashing that natural urge some cancer survivors have to talk about it, at least right away, with a potential new employer. Also, you should know that your potential new employer does not have the right to ask about your medical history. The employer only has a right to know if you are qualified to do the job. Legally, potential employers are not supposed to ask about your health, but if they do, answer as of that day. And if you’re well enough to be at a job interview, your health could definitely be described as good. Further into discussions, you may need to tell a potential new employer that you will need an accommodation, if that is the case. But that discussion can wait even until after you get the job offer Nail the job first, experts suggest. Then, if you will need, say, an afternoon off every three months for follow-up care, mention it then, before you accept the position.
Presenting yourself well
You can put a positive spin on things, as all job hunters try to do. One woman, after her cancer treatment, stayed off the job awhile but helped her church computerize their office. Her counselor asked if someone there might vouch for her work, and say that she had been a consultant for them. And that worked out fine. Keep the focus on your present ability to work. Legally, that is all a potential employer has a right to know. During the job interview, keep the focus on yourself as a job applicant, and the best one they will interview, not on yourself as a cancer survivor. Not telling may be hard for some cancer survivors, who often feel they have a “guilty secret.” Experts advise you to get over that apologetic, confessional feeling. Of course, there are always exceptions to these guidelines. Some bold cancer survivors have gone to a job interview and said, “Hey, I made it through cancer.” Their upbeat attitude is, If I can handle cancer, I can handle this job and all its challenges. Experts say it takes a certain type of person to pull this off but that you know who you are.
Handling the paperwork and ticklish questions
While you don’t have to share your cancer history, you can’t lie about a gap on your resume. While potential employers legally can’t ask, “Did you have cancer?” they can ask “What about this gap in your resume?” Still, you can be discrete but truthful. Something like: “I had family issues that are now resolved” Or “I had medical issues that are now resolved” is truthful and provides enough information.
Insurance if you switch jobs
Even if you leave one group health insurance plan, you have protection in transitioning to another group plan. Another law called COBRA (Consolidated Omnibus Budget Reconciliation Act, passed in 1986) provides continuation of group health coverage that might otherwise be terminated. It offers the right to temporary continuation of health coverage under certain conditions. For questions and answers, visit the U.S. Department of Labor page that addresses COBRA at http://www.dol.gov/ebsa/faqs/faq_consumer_cobra.html. If you decide to switch jobs, plan for your health insurance transition. Inquire first about COBRA. Understand when it starts and ends, how much it will cost you (typically expensive since you will be paying both employee and employer portions), and if you have dependents whether they too are covered. Trying to get health insurance on an individual basis can be more difficult if you have a cancer history, especially if your treatment has occurred in the past five years. While it may be tempting to omit the cancer on an application for insurance, do not. That is fraud, not worth the risk, and dishonest. Ask your HR person or insurance representative about preexisting conditions under the group health plan and how they are handled. Under HIPAA, limits have been set for excluding pre-existing conditions, the period during which a specific medical problem may not be covered.
Setting the tone
If you can set the tone as a relaxed, confident cancer survivor, chances are those around you may be less uptight, too. If you can see your return to work as a major step forward in your recovery, that will affect your attitude in the most positive way, too.
This Month’s Topic: Cancer in the Workplace
June 24, 2008
This Month’s Topic: Cancer in the Workplace
Featured Expert: Carolyn Messner, DSW, MSW, LCSW-R, ACSW, BCD
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November 2006 This Month’s Topic: How to Find Reliable Resources Submit Your Questions on this Month’s Topic Featured Expert: Jacqueline Zahora, CancerCare’s Program Director for Online Clinical Resources |
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Q. A number of employees in our workplace have cancer. As the personnel director, I would like to organize educational programs to help all our employees learn more about cancer. How should I go about doing this?
A. Many Human Resource Departments are proactive in helping their employees cope with cancer in the workplace. They demonstrate compassion by developing educational programs to help employees with their concerns and to maintain a productive workplace.
Companies address cancer in the workplace with education and information. Some employers offer annual company-wide health fairs. Smaller companies may not be able to offer a broad-based health fair for their employees, but they might be able to work with their benefits provider to host smaller events and workshops during the year.
Another way to provide low-cost employee education is to partner with community outreach programs, cancer centers and nonprofit organizations that can provide educational materials and lunchtime seminars.
Examples of “lunch and learn” workshop topics include Cancer Treatment Updates, Early Detection of Cancer, Communicating with Your Doctor, Coping with a Co-worker’s Cancer, and Review of Employer Sponsored Health Plans, just to name a few.
CancerCare offers many resources that can assist Human Resource Departments to develop educational programs and services for their employees, including:
- A directory of resources for a comprehensive overview of all the services that CancerCare offers.
- Our Inform® fact sheets on prevention and early detection to distribute at workplace seminars and health fairs.
- CancerCare’s staff of oncology social workers, who are available to assist you and your employees with cancer-related concerns.
Contact us at 1-800-813-HOPE (4673) to learn more about how we can help.
Q. My co-worker has told me she has cancer. We used to have lunch together and she would always listen to my problems. Now I don’t know what to talk about.
A. Many people are not sure what to say when their co-worker is diagnosed and treated for cancer. Our work relationships and friendships are an integral part of the fabric of our work lives. Many of us spend more waking hours at work than at home. Many families are scattered geographically and so for some people, the workplace is “family.” The extent of your involvement depends upon the nature of your relationship prior to the cancer diagnosis. Here are some suggestions that may help you communicate with your co-worker:
- Ask your co-worker with cancer if she wants to talk about her cancer diagnosis and treatment
- Be willing to listen
- Ask how you can help
- Tell her that you care about how she is feeling
- Keep your conversations confidential
- Try to maintain a normal office relationship with her
- Send a card, telephone her outside of work or pay a visit if she is in the hospital
- Offer to help her find resources
CancerCare also has a number of publications you may find helpful that can be ordered online or downloaded directly from our website:
- Coping with Cancer: Tools to Help You Live
- What Can I Say to a Newly Diagnosed Loved One
- Caring Advice for Caregivers
- Finding Resources in Your Community
You may also want to speak with a CancerCare oncology social worker to discuss your concerns. CancerCare’s free counseling services are available to co-workers of people with cancer.
Q. I am an employer and one of my employees has just been diagnosed with cancer. I want to be helpful but am not sure what I should say or do.
A. The most important things you can do are to listen to the employee who discloses his or her cancer diagnosis and to offer workplace support. It is critical to let the employee who is living with cancer know about the ability of your workplace to make accommodations for their needs. The key message you as an employer can offer an employee is your willingness to work with them, if at all possible, to help them continue working as long as their doctor supports their decision to work and they are able to do the job.
The following are some tips that many employers find useful:
- Know the provisions of the Americans with Disabilities Act and Family and Medical Leave Act and make that information available to supervisors and employees.
- Create a workplace culture that allows flextime or other accommodations for cancer patients who can and want to continue working.
- Educate managers to deal sensitively with employees who have cancer so that they do not make assumptions about their ability to perform job duties.
- Teach managers to maintain a dialogue with employees being treated for cancer so that adjustments in workload or work schedules can be anticipated.
- Allow employees to decide if or how they would like coworkers to be informed of their illness and honor requests for confidentiality.
- Work closely with your Human Resource Department regarding employee benefits and resources.
For additional information, listen to CancerCare’s podcast, Creating a Supportive Work Environment.
CancerCare’s Helping Hand Resource Guide is one of many CancerCare publications that can help managers and employees find useful resources. You may also find other CancerCare publications, covering a broad range of cancer-related topics, to be helpful.
CancerCare’s oncology social workers can also assist employees with cancer, their coworkers and managers. Visit CancerCare’s Consult Our Staff to learn more about our free counseling and consultation services available to employers and their employees.
Q. I was just diagnosed with cancer and plan to continue working. Do I have to tell my employer that I have cancer?
A. We see many people who continue to work productively despite their cancer diagnosis. Continuing to work can be vital to your sense of well being. Work is a source of income and, often, health insurance. Each workplace has its own unique culture. Whether or not to tell your employer about your cancer is both a personal and practical decision.
Many myths about cancer exist in our society, including in the workplace. For instance, employers and coworkers may assume that a person with cancer or their caregivers are not able to perform job responsibilities as well as before cancer. Sometimes, these misconceptions can lead to subtle or blatant discrimination.
It is important for you to become familiar with the laws protecting you before you decide whether or not to disclose your cancer diagnosis.
The Americans with Disability Act (ADA) requires that organizations with 15 or more employees comply with ADA guidelines. These are the criteria to take advantage of ADA protection: meet the ADA definition of “disabled person,” qualify for the job and be able to perform its essential functions, and not pose a risk to your own or others’ health and safety. The ADA recommends that any accommodation that you need does not cause “undue hardship” to your employer.
Flexible work hours to meet treatment schedules and doctors appointments is the most frequent workplace accommodation required by people living with cancer. If you require flextime, it is important to disclose your cancer diagnosis to your supervisor or Human Resources to be protected under the ADA. If no reason is given for frequent requests of flextime, you could risk jeopardizing your job security. For more information, call 800-514-0301 or visit the ADA website.
The Family and Medical Leave Act (FMLA) enables the person with cancer and family members to take unpaid leave of up to 12 weeks within one calendar year. The FMLA applies to organizations with 50 or more employees. The employee must have worked with his or her employer for at least one year, and employers must continue health benefits during the leave. Leave does not have to be taken all at once, but can be taken in blocks of time. To learn more, visit the FMLA website.
The Equal Employment Opportunity Commission (EEOC) is a federal agency that enforces the provisions of the ADA and FMLA and assists citizens who feel they have been discriminated against in the workplace. If you feel you are being treated unfairly, contact the EEOC at 800-669-4000 or visit www.eeoc.gov
CancerCare’s oncology social workers provide practical resources and help with your workplace concerns. Call 800-813-4673 or visit our website. For further information, participate in our free Telephone Education Workshop, Creating a Plan to Continue Working, on June 20.
Dr. Carolyn Messner, DSW, LCSW-R, is director of education and training at CancerCare. Dr. Messner specializes in the psychosocial impact of cancer on patients, caregivers and families; methods to design educational interventions to ameliorate the distress of cancer; and cancer in the workplace. She pioneered the use of teleconference technology to bring information and support to cancer patients, their families, employers and healthcare professionals.
The questions and answers listed above are from the April 2007 Ask CancerCare feature. New Ask CancerCare topics are introduced every month.
If you have additional questions about cancer in the workplace, please contact CancerCare directly for information and guidance. CancerCare provides free professional support services, including counseling, education, financial assistance and practical help. These services are provided by professional oncology social workers. If you have a specific concern or question and would like to speak with an oncology social worker, please contact us at info@cancercare.org or 1-800-813-HOPE (4673).
For questions about medical issues, please visit Cancer.net, the patient information website of the American Society of Clinical Oncology (ASCO).
Insurance Tips Help Pay for Cancer Care
June 24, 2008
Insurance Tips Help Pay for Cancer Care
Knowing Your Policy is Key to Getting Coverage
When it comes to paying for cancer treatment, the experts agree: it’s not as straightforward as it used to be.
Few patients can afford to fully pay their own way; the majority of patients rely largely on some form of medical insurance. Since policies and coverage vary widely, it pays for insured patients to do their homework, be familiar with the details of their insurance plan, and even to shop around for good coverage.
“Patients really need to become involved by understanding their insurance policy’s provisions and the non-covered charges,” says Jo Ann Flores, Manager of Financial Counseling in M. D. Anderson’s Patient Business Services (PBS) Department. The department handles customer service requests or patient billing issues, and its counselors often walk patients through the payment or insurance process. Although there is no typical cost of cancer care, medical bills can stretch into the hundreds of thousands of dollars, even for short, straightforward treatment.
Between them, Flores and PBS Associate Director Frank Norfleet have more than 25 years of experience helping patients navigate the financial waters of cancer care. They know that insurance coverage terms and related out-of-pocket expenses may affect treatment decisions, and vice versa. They offer the following suggestions for keeping afloat.
Become Intimate with Your Coverage
Whether insurance is through an HMO or some other type of managed care company, Norfleet says the best place to start after diagnosis is often with the patient’s employer or group benefits office. In his experience, patients often enter cancer care with the mistaken notion that their doctors or hospitals will take care of insurance situations, or that they can mediate with the insurer. The truth is, in today’s managed care environment, the onus is on the patient.
“It’s critical that patients understand what their benefits are,” Norfleet advises.
In contacting their benefits representatives, patients should be as specific and detailed as possible, and find out what kinds of treatment, drugs and procedures are covered. Particularly at specialty centers like M. D. Anderson, some of the newest treatment options may be considered experimental and therefore covered at reduced rates, or not at all. Patients also should stay in close contact with their insurance company and benefits office as their treatment plan evolves.
New authorization is often required for every new service or inpatient stay. “It’s a five-minute phone call, but it can mean the difference between you having to deal with a $100,000 payment, or your insurance company taking care of it for you,” Norfleet says.
Insurance Questions to Ask
How do I Deal with Diagnosis and Second Opinions? After being diagnosed, patients with primary care physicians may need a separate referral for treatment. In some cases, they will also need to contact their insurance company separately for authorization of care. Some insurance policies will allow patients to see a specialist without a referral.
Patients should always ask the cancer treatment provider what kind of insurance they accept. If a second or third opinion is sought, patients also should be aware that it’s their responsibility to go back to their insurance company to initiate approval for treatment. “Sometimes patients get lost in the system,” Flores says, because they think that process is automatic. In reality, she says, “it’s a two-step process.”
Which doctors and treatment centers are part of my insurance network? Patients who are part of an HMO must be clear which services and physicians are in their network, because out-of-network services basically revert to self-pay. Patients should not only ask about their oncologist, but also their pathologist, radiologist, anesthesiologist and any other physician who becomes involved in their care. “All of these people need to be in the patient’s health plan,” Norfleet says.
What medical services and locations are covered? At what level are they covered? With insurance plans that offer different levels of coverage, the difference between, say, an 80% coverage and a 60% coverage can add up greatly over the course of long-term treatment. Choosing a different laboratory for test results could make a big difference in the pocketbook. For that reason, Norfleet suggests asking about coverage for pharmacy prescriptions, lab work, chemotherapy, X-rays, radiation, and initial doctor’s and follow-up visits, as well as other specific treatments.
Are there any pre-existing conditions that my insurance plan won’t cover?
Patients also should ask about rules governing “pre-existing conditions.” While Medicare generally covers everything, other insurance plans may not cover treatment for certain conditions such as cancer. This is particularly true of plans that patients purchase individually, Norfleet says. Group or employer insurance plans will vary depending on the employer’s negotiation with the insurance carrier. In some cases, patients are able to get coverage if they have been with an insurance carrier a certain amount of time.Who should I contact, and under what circumstances? Flores notes that some policies require patients to contact both the insurance company and the primary care physician each time a new service is used. If the patient doesn’t comply with this rule, or doesn’t know which services apply, the company can deny coverage or reduce payment – no questions asked. Patients play a vital role by understanding their responsibilities prior to services being rendered.
Shop Around
Once a patient knows what the cancer treatment plan will involve, and the patient understands his or her current medical coverage, it pays to shop around for the best insurance coverage, Norfleet says. He advises Medicare patients to compare the benefits offered in their HMO or other insurance plan versus traditional Medicare. Also, there are other options available, such as drug assistance programs and assistance through the Medicare savings program.
Annual enrollment periods or treatment considerations may preclude patients from switching plans right away, but certain insurance coverages may allow patients to save out-of-pocket expenses by choosing laboratory or pharmacy locations carefully.
Norfleet suggests that patients provide a copy of their treatment plan to both their HMO representative and their primary care physician. Then, they should go over the plan, item by item, and find out which services are covered where. A primary care physician may be able to provide chemotherapy in his office with less out-of-pocket expense, freeing patients to pay for specialty services only provided elsewhere.
Health Maintenance Organizations (HMOs)
HMOs are probably the most complicated insurance companies to deal with, Flores says, especially if patients want care outside of their managed care network. In rare circumstances, primary care physicians can advocate for a patient to receive out-of-network care. Often, however, some plans deny out-of-network care because they have the ability to render care within their own network.
Another option that many patients don’t know about, Norfleet says, is that people over age 65 always can drop their HMO coverage and opt for Medicare instead. The federal program pays less than most private insurance companies, but Norfleet says the price difference is worth it for some patients.
“The majority of patients are willing to accept that to get the care they want,” Norfleet says. Federal rules also allow patients to switch back to a regular HMO from Medicare with 30 days’ written notice.
Medicare Considerations
Most hospitals accept Medicare assignment, Norfleet says. On the other hand, Medicare doesn’t cover take-home medication. Again, the patient should pursue other drug assistance programs or Medicare supplemental coverage/plans.
Keep Detailed Records
One of the keys to staying above water in financing cancer care is to keep on top of paperwork. Norfleet suggests that the first thing patients do after being diagnosed is get two folders: one for inpatient services and one for outpatient services. “Every time you get a piece of paper, or make an agreement or phone call, put that information into one of those folders.”
The folders should include:
Records of authorization and referrals. Anytime something new happens in a patient’s treatment, he or she should make sure to get proper authorization from the insurance company, primary care physician, or both, prior to treatment. This includes hospital stays. Authorization can be obtained in writing or by phone, but patients should be sure to write down the date, name of the person spoken to, and what was agreed. Always request a copy of the authorization for your records.
Explanation of Benefits (EOB). “Short of an authorization or approval record, the EOB is the most important piece of documentation a patient can have,” Norfleet says. An EOB is issued by the insurance company each time a patient receives service. It outlines what services were received and when, which services the insurance company paid for, which the patient is responsible for, and why certain services may not have been covered fully. Norfleet and Flores urge patients to read their EOBs carefully as soon as they get them, because they often contain requests for information within a certain timeline. Also, if patients wish to dispute a payment, they often have only a certain number of days after receiving an EOB to appeal.
“A lot of patients set the EOBs aside,” Flores says, “and before you know it, their bills become really large. Then they’re harder to deal with.”
Keeping a journal or log also may be useful. “Six months into an extensive chemotherapy treatment, a patient may feel too sick to read the information or keep up with it,” Norfleet says. But if the system is in place, family members or caregivers can more readily take over.
The bottom line, Norfleet and Flores say, is to get organized early. Paying for care isn’t an easy thing to juggle on top of all the other concerns surrounding cancer treatment. But having a plan and being armed with information can help patients and their families stay on solid ground.
Life Insurance After Cancer
June 24, 2008
— Chris Parlove
ANSWER: Assuming that you do indeed start a family in the next three years, you’re right to think that life insurance should be a part of your planning. Unfortunately, though, given your recent health history, you probably won’t have many coverage choices — at least for the next few years. That’s because life-insurance companies evaluate you on personal information such as your age, occupation and health to measure your risk as a potential policyholder. And having a pre-existing medical condition like cancer makes it unlikely that you’ll get coverage at all.The goods news, though, is that your ability to purchase life insurance will dramatically improve if you stay healthy for the next several years. Most companies will sell cancer survivors policies at normal rates if they’ve had a clean bill of health for at least five years, says Jack Dolan, a spokesman at the American Council of Life Insurers.
Luckily, in the interim, you already have a policy provided by your employer — even if it’s inadequate for your future needs. (Certainly some is better than none.) And if you should lose your job, you can probably convert the group insurance into an individual policy, says Gary Webb, president of FirstQuote.com, an insurance-provider Web site. Chances are, however, you’re going to pay quite a bit for it, perhaps as much as four times the premium of someone who never had cancer. Nevertheless, it’s probably a smart thing to do, since it won’t require a medical exam. And then, if you start working at another company that also provides a life-insurance benefit, you can hold on to the old policy and have the combined coverage of the two.
If you do decide to seek additional coverage on the open market, your best bet is to look for insurance companies that specialize in providing insurance to people with medical conditions, or even more specifically, cancer. These companies can better evaluate your case on an individual basis. Just be sure that you go with a company that’s rated A or better by A.M. Best or Standard and Poor’s, says Webb. Even with these insurers, however, you might find that you can’t get coverage until you’ve remained cancer-free for two years or more. And if you can get a quote from a specialty insurance company, be sure to compare it against what you might pay for a conversion policy from your employer.
Our life-insurance calculator can help you estimate just how much life insurance you might need in the future. But our advice is to stick with your current policy for the next few years. Given the difficulty you’re likely to have obtaining extra coverage in the meantime, you’re better investing the money you’d have spent on additional insurance premiums. After all, planning for retirement and, eventually, college for those kids you want to have is important, too. And the best part is, you can get started without waiting for some insurance company’s approval.
Originall published on August 20, 2001.
