The financial cost of breast cancer

For many people with breast cancer, the financial costs associated with treatment and care can be substantial. General day-to-day expenses continue, while you may also have to pay for specialist appointments, tests and scans, medicines and other treatments, counselling, travel and so on.

If you're unable to continue in paid work, the loss of income can also contribute to financial pressure on you and your family. Even when treatment is finished, you may still struggle financially, or you may face the longer-term impacts of ongoing care after breast cancer.

For some people, getting by financially is no easy task, even at the best of times. Although finances may seem trivial in comparison to your breast cancer diagnosis, money worries can have a big impact on how you and your family cope.

Cost of treatment

Treatment in a public hospital through the public health system is free to Australian citizens and most permanent residents.

If you have private health insurance, you can be treated in a public hospital as a public patient or as a private patient, or you can be treated in a private hospital.

Treatment in the private health system

Your health care costs can add up considerably if you are having your treatment in the private health system.
Asking your doctors up front about the likely costs of surgery, tests, treatment and support services (including follow-up tests and appointments) will give you a clearer idea of what to expect.

You can ask your private health fund what rebates they will provide so you can plan for your 'gap' expenses (i.e. the amount that you will have to pay after rebates from Medicare and your private health insurance fund).

It is important to understand that your private health insurance will likely cover only some of your costs, and you might be left with substantial out-of-pocket costs. Many people think that after years of paying for private health insurance, it will completely cover them for their cancer care. This is not usually the case.

For more information about choosing between the  private and public health systems, read: Choosing public or private health systems for treatment.

If you don't feel comfortable talking about money, it can be helpful to think of health care as a service like any other you use. Mostly, we would ask for a quote. Getting a quote from your doctors will mean that you know what your out-of-pocket costs will be. It can stop you having to worry about unexpected bills.

Out of pocket costs

Your out-of-pocket costs will depend on whether:

• you have your treatment in the public or private health system
• you are working and need to reduce your work hours or stop working altogether for a period
• whether you have sick leave to cover you for time off
• you live in a rural area and need to travel for treatment
• you have a Centrelink Health Care Card or receive a Centrelink payment - read more about federal government assistance
• you have insurance such as disability, income protection or trauma insurance - read more about superannuation and insurance when diagnosed with breast cancer.

Informed financial consent

Informed financial consent requires people to have information about costs and support to make informed decisions about their care.

Before starting treatment, your healthcare providers should:

• tell you their fee
• inform you of others involved in delivering care and how to find out their fees
• help you identify any reimbursements or subsidies you may be entitled to
• tell you about any out-of-pocket costs you may be required to pay
• answer any questions you have about costs
• gain your willingness to go ahead based on this information.

You should be made to feel comfortable to have this conversation and to ask questions to make sure you have all the information that you need to make an informed decision.

Breast Cancer Network Australia (BCNA), with Cancer Council, CanTeen and the Prostate Cancer Foundation of Australia developed a Standard for Informed Financial Consent to guide discussions between health professionals and patients to discuss the risks and benefits of treatment to include cost.

Why informed financial consent is important

A breast cancer diagnosis can be an emotional time for you and your family and requires decisions to be made about the type of care you receive and where you receive this care.

There can be many costs during diagnosis and treatment, as well as recovery and ongoing care. They can be for the medical care that you receive or for other things such as hospital car parking and over-the-counter medicines. These costs can add up over time and may cause you to worry and impact your financial stability.

Informed financial consent means you should be aware of the total costs for your care and treatment, other health professionals involved in your care and where the same or similar benefit can be provided at a lower cost.

If you have private health insurance, you should contact your insurer to discuss if your treatment is covered.

Everyone deserves the chance to make the best decisions for their care, so it is important that you feel comfortable to talk to your healthcare professional about any financial concerns relating to the cost of cancer treatment.

Cancer Council has developed an information guide for cancer patients and people caring for someone with cancer to help you understand:

• informed financial consent
• the difference between private and public healthcare
• common out-of-pocket costs
• factors that may influence what you pay
• questions to ask your healthcare provider or private health insurer about costs.

How to be more informed about costs for cancer care and treatment

A list of suggested questions you should ask your healthcare professional and questions you should ask your private health insurer about the cost of treatment and any out-of-pocket costs you may incur has been developed.

Additional financial assistance and information is available to guide you to further resources.

Financial support and assistance

There are a number of financial support schemes available through the federal, state and territory governments to reduce the financial impact of medical treatment.

You can find out more by reading the following articles:

• Pharmaceutical benefits scheme (PBS)
• Centrelink payments
• State government assistance
• GP chronic disease and mental health management plans
• Superannuation and insurance.

A social worker or your GP can also help you to find more information about the financial supports available and what the eligibility criteria are.

Your pharmacist and Medicare can explain the safety nets associated with the cost of PBS medications and medical bills. Once you reach the annual PBS and Medicare safety nets, you will be eligible for cheaper prescription drugs and more money back fromm Medicare for tests and treatments.

If you are being treated in the private health system, it's a good idea to confirm your level of cover with your health fund before you have any treatment so you are sure you are covered. You can also ask what the rebate will be for your proposed treatment and what your out-of-pocket costs will be. To do this you may need to provide a list of Medicare item numbers that your breast cancer specialist is charging you. If you are unsure about these, ask the receptionist or practice nurse for a list of item numbers that will be included in your specialist's fees. You can also ask about fees and item numbers for associated specialists, such as the anaesthetist when you have surgery. If there are any items on the bill that do not have a Medicare item number, ask why you are being charged this fee.

Cancer Council's practical and financial assistance program provides free legal, financial and workplace advice to people affected by cancer who cannot afford to pay for advice. Cancer Council also provides support for people experiencing financial hardship as a result of their cancer diagnosis. You can phone Cancer Council 13 11 20 for advice or more information.

Employment

If you are in paid work, looking for work, volunteering or returning to work after treatment is over, there is a range of information and support available to assist you.

For more information about work and breast cancer visit BCNA's work and breast cancer hub.