Case Study

The Cost of Cancer

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Executive Summary

While bravely battling a rare form of cancer, Gale asked Bedsiide to partner with her during the journey. Bedsiide provided both clinical and financial oversight and steering, which allowed her to find the right providers and treatments. The Bedsiide Team provided personalized health management, daily care coordination, and claims monitoring services. The results: Gale survived a rare cancer, saved her employer $150,000, and saved her family over $35,000 in medical costs.

Client Introduction

In 2015, Gale was diagnosed with Hepatosplenic Peripheral T Cell Lymphoma – a rare form of cancer that attacked her bone marrow, liver and spleen. At the time, Gale was in her mid-40s, living in Florida. After two unsuccessful rounds of chemotherapy, Gale’s health continued to decline, leaving her weak and exhausted. Uncertain about where to go for treatment or what to do next, a mutual friend suggested she contact Bedsiide.

“There is no value that can be placed on the service of Bedsiide, when my insurance was getting in our way, they helped us get it straight, and they have saved me thousands of dollars.”

—Gale, Bedsiide Client

Challenges

Dealing with the shock of a rare cancer diagnosis, Gale and her family had a lot of questions: Who are the best doctors for treating this rare form of cancer? Which hospitals should we consider? What costs are involved and will insurance cover treatment?

Onpulse Plan Of Action & Outcomes

Clinical & Personal Solutions

Bedsiide helped Gale find the answers she needed and our team quickly became the first point of contact for her family and providers.
Gale was considering four leading hospitals, located in Baltimore, Philadelphia, and New York, for her care. Bedsiide initiated conversations with treating providers at those facilities and reviewed Gale’s medical records with them. With guidance from our clinical team, Gale selected two top hospitals in New York – Cornell and Columbia. Bedsiide managed Gale’s care coordination, sourced and involved the right experts, and co-managed treatment between the two hospitals.
Gaining access to these medical experts and facilities is very difficult. And Gale’s type of cancer was so rare, only 100 cases per year are diagnosed in the US, and typically only 1 to 3 cases are treated per year at Columbia. Bedsiide secured an appointment for Gale with Dr. Ahmed Sawas at Columbia for lymphoid malignancies. He presented Gale’s case at a symposium and gathered collective options on treatment. A protocol was established, her test results slightly improved, and the direction of her treatment changed, allowing her entry into two drug trials for blood cancers
After leaving the hospital, Gale began weekly treatment at an outpatient infusion center for 4 weeks. Because her treatments were occurring in New York City, but her home was in Florida, housing for Gale and her family became a concern. Bedsiide was able to secure housing in New York through the Hope Lodge, an American Cancer Society facility for patients who live far from home during their treatments. Her family described this housing arrangement as “blessing” and their “home away from home” for several months until Gale entered remission.

“Bedsiide is an ideal quarterback for my patients. They are a welcomed asset to the care I provide.”

— Ahmed Sawas, MD, Medical Oncology Hematology, New York-Presbyterian (Columbia Hospital)

Financial Solutions

Bedsiide also assisted with the financial aspects of Gale’s care. Our team created an affordable treatment plan and connected her with both hospital and insurance case managers. Bedsiide helped the hospital case managers navigate the insurance pre-authorizations, pre-approvals, and denials processes
Gale has health insurance, but the numerous co-payments for her hospital visits, procedures, and drugs over the course of her year-and-a-half long treatment created a financial burden for her family. “We’re just going to take it a day at a time to pay what we can, when we can,” she said.
Gale’s bills mounted in part because of a $6,000 deductible on one insurance plan. She also had high out-ofnetwork charges for doctors on a new insurance plan she was put on during her treatment. The prep work for a bone marrow transplant at one hospital, for example, resulted in a $30,000 bill for her, even though another hospital ultimately ended up doing the procedure. Throughout her treatment, it wasn’t unusual to receive a $3,000 bill – after insurance – for lab work or a consultation. “You get bills from the cancer center and then you get separate bills for the physicians and then you have a copay every time you go,” Gale said.
Bedsiide spent over 40 hours managing Gale’s medical bills and filing appeals with her insurance. During treatment, Gale experienced a change in insurance companies, which resulted in her claims being denied. Bedsiide identified that the insurance claims weren’t being processed accurately. An Bedsiide Billing Assistant completed a form on Gale’s behalf, asking the insurance company to reprocess all of the claims, which they did. Our team successfully negotiated in-network rates for out-of-network charges, eliminating two out-of-network payments. The result was a savings of $150,000 from her employer’s insurance bill and a savings of $30,000 for Gale’s family.
According to Gale, “There is no value that can be placed on the service of Bedsiide, when my insurance was getting in our way, they helped us get it straight, and they have saved me thousands of dollars.”

Final Thoughts

Bedsiide is honored to have served Gale, her family, and her doctors during this difficult season of her life. We celebrate her remission and wish her many enjoyable years ahead

About Bedsiide

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Case Study: The Cost of Cancer

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