The Crucial Role of Financial Navigators in Oncology

Jason Zimmerman, RN, OCN

Clara Lambert, CPH, BBA, OPN-CG

Treating cancer is not cheap, and navigating the complex world of health insurance and financial assistance can be incredibly daunting for patients facing cancer diagnoses. By assisting patients in optimizing their insurance coverage and finding external assistance programs, financial navigators can help to alleviate the financial burden of treatment; as a result, they have undoubtedly become a central component to the delivery of quality cancer care. At the 2023 AONN+ Midyear Conference in Orlando, Clara Lambert, CPH, BBA, OPN-CG, and Jason Zimmerman, RN, OCN, discussed some of the many hats worn by these crucial members of the care team.

The Financial Navigator’s Role

The financial navigator’s role is multifaceted and requires a comprehensive knowledge of all things financial assistance, including a broad spectrum of health insurance policies, government safety net plans, and external assistance programs that cover things like co-pays, medications, and funds for utilities, rent, or mortgage. According to Ms Lambert, director of financial navigation at TailorMed, insurance optimization should always be explored first, followed by external assistance programs (ie, manufacturer patient assistance, co-pay assistance, premium assistance, and patient financial support programs).

“A financial navigator needs to know everything they can about the different types of health insurance policies, whether it’s a government or commercial plan, as well as the different rules surrounding them,” she said.

But it does not stop there; beyond financial assistance and insurance optimization, financial navigators should also be well-versed on disease processes and cancer treatment options for a variety of malignancies. For example, financial assistance for a patient with stage IV disease will differ from that of an earlier-stage patient, not only when it comes to paying for treatment but also considering other factors like how long that person might be out of work. According to Ms Lambert, knowing how a disease might progress enables navigators to anticipate the patient’s needs and proactively offer assistance.

The Trust Factor

Patients often face challenges in understanding complex insurance policies and programs, leading to feelings of helplessness. By acting as patient advocates and offering personalized assistance, financial navigators help patients feel supported and better equipped to make informed decisions about their healthcare.

Mr Zimmerman emphasized the importance of financial navigators being proactive about assisting their patients with the financial burdens of cancer rather than directing them to outside resources. Too often, patients are told to simply call their insurance companies if they have questions about how they’ll pay for treatment.

“If you asked your oncologist to explain your disease to you and they told you to go to the National Institutes of Health website to learn about it, would you trust them? Or would you be out the door for a second opinion?” he asked. “The same applies to financial navigation; experts are needed to help explain and guide patients through this process.”

According to Mr Zimmerman, the statistics prove this. For example, about 30% of Medicare beneficiaries qualify for a low-income subsidy to help with prescription drug costs, but half of all beneficiaries who qualify are not enrolled. “That’s simply because they’re not being navigated through it,” he said.

Ms Lambert added that oftentimes, Medicare Supplement plans can reduce outpatient out-of-pocket costs to almost zero. But unfortunately, some patients are simply unaware of programs like these that can significantly reduce their medical expenses.

Advocacy, Policy, and Education

Advocacy and policy changes play a crucial role in making healthcare more accessible and affordable, and staying abreast of these changes is another vital component of the financial navigator’s role. The Inflation Reduction Act of January 2022, for instance, brought about several changes, including reduced insulin prices (effective January 1, 2023), improved low-income subsidies and caps on oral medication costs for Medicare Part D enrollees (effective January 1, 2024), and structural changes to Medicare Part D, with a $2000 maximum out-of-pocket cost (effective January 1, 2025).

Ms Lambert emphasized the importance of continued education and training in the field of financial navigation and recommends that navigators explore the recently revamped Financial Advocacy Guidelines from the Association of Community Cancer Centers, as well as the NaVectis Financial Navigation training program. By investing in resources like these, navigators can provide their patients with financial navigation expertise, offering them improved peace of mind during challenging times.