Navigating Uninsured Lung Cancer Patients: One Thoracic Oncology Nurse Navigator’s Experience in Removing Financial Barriers

November 2020 Vol 11, No 11
Kammi Fox-Kay, MSN, RN, AOCNS, ONN-CG(T)
Thoracic Oncology Nurse Navigator
Community Healthcare System
Munster, Indiana

Background: One recent study revealed that lung cancer was the most common cancer among those uninsured. In this author’s service area, it has been reported that 20% of the population is uninsured. Since July 2018, this navigator has had an interest in uninsured newly diagnosed lung cancer patients. This thoracic oncology nurse navigator (ONN) recognized a gap at her institution in lack of assistance or in lack of follow-through for patients obtaining Social Security Income (SSI), Social Security Disability Insurance (SSDI), Medicaid, or assistance obtaining Marketplace insurance.

Objectives: To assist patients in obtaining SSI or SSDI, and Medicaid if qualified, or assist in obtaining Marketplace insurance. The healthcare institution and physicians will realize reimbursement of services when a patient is approved for Medicaid.

Methods: While navigating 4 advanced-stage lung cancer patients in 2018, this ONN identified a gap in assistance available at her institution for uninsured patients obtain to government insurance. All 4 individuals were in their 50s, male, and at one point held good-paying jobs. This navigator became interested in the process that patients go through to obtain government entitlements, what this ONN’s institution did to assist these individuals to obtain assistance, and how this navigator could assist. This ONN did a literature review on government entitlement processes as well as collaborated with additional hospital resource personnel on individual financial methodology opportunities.

Results: In August 2019, this ONN focused assessment on uninsured newly diagnosed lung cancer patients. The ONN teamed with the facilities Patient Benefit Advisors (PBAs) to promote follow-through from initiated SSDI and Medicaid applications while inpatients. To date, 6 of 9 patients have successfully been navigated to receive SSDI and Medicaid, resulting in their ability to have cancer care costs covered. One patient was denied SSI and SSDI, and therefore Medicaid, due to his monetary resources but obtained Marketplace insurance. Of note, 1 additional patient, aged 61 years, for whom his employer was still providing health insurance but no income, was advised by the thoracic ONN to apply for SSDI and received back-dated benefits.

Conclusions: The ONN’s role is to remove barriers to care for patients by ensuring they have the resources to adhere to treatment plans. By assisting patients and their families to obtain government entitlements and medical coverage, the ONN assists in diminishing financial barriers. By collaborating with PBAs, and increasing her knowledge base of government forms for medical coverage, this ONN was able to assist 6 patients in obtaining healthcare coverage. Knowledge of resources to assist uninsured patients obtain disability/Medicaid and Marketplace insurance is invaluable for ONNs.

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Last modified: May 7, 2021

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