Study: Asking About Insurance Coverage May Lead to Delays in Cancer Care

“Administrative tasks” for cancer patients are linked to delayed or missed doctor visits, lab tests, prescriptions, and other services. 

Attempts by cancer patients to get more information about costs and health insurance coverage may lead to delays in getting medical care, according to a study published in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research (AACR). 

Tasks such as getting estimates of out-of-pocket costs before getting a lab test or scan, before agreeing to treatment, or before filling a prescription; asking the insurance company for help understanding coverage; or appealing a denial of benefits from the insurance company, were associated with delays in treatment, or lack of treatment, the study suggested. 

“It’s fairly unique to our for-profit U.S. health care system for the consumer to be responsible for acquiring the knowledge and skills needed to effectively use those goods or services and to ensure they’re of high quality,” said Meredith Doherty, PhD, LCSW, an assistant professor at the University of Pennsylvania School of Social Policy & Practice (SP2) and senior author of the study. “In the United States, health care is largely treated as a consumer product, so the onus is on the consumer.”

Participants who sought information were 18 percent more likely to experience delays or to miss appointments or treatments than participants who didn’t engage in such tasks, the study said. Gaps in care included doctor’s appointments, follow-up testing, or blood work that were postponed or skipped; prescriptions that were filled late or unfilled; and doses of prescribed drugs that were skipped. 

The survey showed that 55 percent of participants ”never” or ”rarely”[GU1]  engaged in any administrative tasks. Dr. Doherty and colleagues performed another analysis to better examine the effects of increasing administrative burden on the frequency of missed or delayed care[GU2] .

Each task the consumer had to perform, or each time he or she had to perform it, was associated with a 32 percent higher frequency of missed or delayed care, the study said. 

“For those who do engage, there’s frustration, exhaustion, and I think a sense of alienation,” Dr. Doherty said. “If you send me a bill erroneously and can’t help me correct it, you’re showing me you don’t care about me.”

After years of hearing anecdotal evidence about patients’ frustration with the administrative complexities of the health care system, Dr. Doherty came across a study showing that U.S. health care users felt that administrative burdens significantly affected their care. Dr. Doherty sought to explore this phenomenon among cancer patients and further quantify the relationship between administrative tasks and missed or delayed care.

Dr. Doherty and colleagues used data from a cross-sectional survey performed by the nonprofit CancerCare that polled cancer patients and survivors about their engagement in payment-related administrative tasks and their experience with cost-associated treatment delays or nonadherence. Participants were asked about their experiences in getting administrative information about coverage and costs associated with their cancer care.

The 510 responses included in this study were selected to provide equal representation from major U.S. geographical regions (Northeast, Southeast, West, and Midwest). Half of the participant population was selected from patients or survivors who had breast, colorectal, lung, or prostate cancer; the other half was comprised of patients and survivors who had any other type of cancer.

While age, race/ethnicity, and monthly out-of-pocket costs were more strongly associated with missed or delayed care than administrative burden, Dr. Doherty and colleagues noted that African Americans were more likely to engage in administrative tasks and experience treatment delays or nonadherence than other racial and ethnic groups. These data suggest that administrative burden may exacerbate existing health disparities among marginalized groups, Dr. Doherty said.

She hopes this work may help spur further studies and conversations about how to begin simplifying the system. 

“I think we’re at a place now where we may want to quantify how much improvement in outcomes we might see if we alleviated some of these administrative burdens,” Dr. Doherty said.