Living Paycheck to Paycheck and then . . . Cancer!

Paycheck to PaycheckAt the beginning of 2016, headlines all over the country read something like “63% Of Americans Don’t Have Enough Savings to Cover A $500 Emergency.”  This alarming statistic was according to a 2015 study by Bankrate.com.  What it really meant is that nearly two-thirds of us are living paycheck to paycheck.  What does a $500 emergency look like– your car needs new breaks, your dog has to go to the vet, or your refrigerator breaks down. These are not uncommon expenses, and they shouldn’t be unexpected expenses.  Nevertheless, 63% of us are not ready to face these everyday emergencies.

What happens when someone in that 63% of Americans is diagnosed with cancer? It can lead to a financial catastrophe. Thanks to the Affordable Care Act (ACA), more Americans have health insurance than ever. But for many people, including those with health insurance coverage through their employers, that insurance doesn’t kick in until they meet their high deductible. If they don’t have $500 in savings, they certainly don’t have the money for their deductible, which often ranges from $1,000 – $10,000. For those without health insurance, they have to pay the entire cost of their cancer treatment. For those with insurance, patients often report being left with out-of-pocket costs ranging from $25,000 to $40,000, beyond what their insurance covered.

Cancer is expensive.  Patients face a myriad of expensive diagnostic tests and therapies including CT scans, MRIs, surgery, chemotherapy and/or radiation, hospital stays, anesthesiologist fees, on-going multiple doctor visits, lab testing, and more. According to the Kaiser Family Foundation, the cost of chemotherapy is going up 10% per year!  And all of this doesn’t take into account lost wages, travel expenses, child care expenses, and other unexpected expenses that may come along with a cancer diagnosis.

If you find yourself or a loved one in this situation, there is help.  Triage Cancer has many financial tools and resources available to you:

Talk with your health care team, as they may know of local resources, as well. The key is not to assume that you don’t qualify. If you don’t ask, you will never know. Remember, you aren’t the only one possibly living paycheck to paycheck.

ADA and FMLA: How Laws Work Together

Regardless of the type of job you have, if you need to take time off work because of ADA and FMLAyour cancer diagnosis and treatment, you should learn about your employment rights. More people are familiar with the Family and Medical Leave Act (FMLA), which is the federal law that allows eligible employees to take time off work because of their own serious medical condition or to care for a spouse, child, or parent. The FMLA provides 12 weeks of unpaid leave, per year.

Most people don’t think about the Americans with Disabilities Act (ADA) as a way to take time off work. But they should. The ADA requires employers to provide eligible employees with reasonable accommodations in the workplace. A reasonable accommodation can include changes to work schedules, telecommuting, or even extended leave from work.

Now the FMLA and the ADA can actually work together.

For example, meet Jane. Jane has been undergoing cancer treatment. She has taken time off from work under the FMLA.  She has almost used all 12 weeks of her FMLA leave and her doctor has not yet released her to return to work. She is concerned that she will lose her job if she tells her employer she will not be able to return to work when her 12 weeks of FMLA leave are up.  It is possible that if Jane is also eligible for protection under the ADA, that she could ask for additional time off as a reasonable accommodation under the ADA, if it does not pose an undue hardship on the employer.

However, ADA case law has suggested that additional time off from work will only be considered a reasonable accommodation if the length of additional leave is for a definite period of time. Some recent cases have also shown that employers shouldn’t have rigid leave rules, but be more flexible with leave decisions on a case-by-case basis.

So, if Jane gets to the end of her FMLA leave and she calls her employer and says, “I would like more time off from work as a reasonable accommodation, but I don’t know when I will be able to return”- that is unlikely to be seen as a reasonable accommodation.  But, if Jane calls her employer and says, “I would like three more weeks off work as a reasonable accommodation, because my doctor has released me to come back to work in 3 weeks” – that is more likely to be seen as a reasonable accommodation.

Before making decisions about working through treatment or taking time off work, it is important to get the facts and learn about your options, so that you can make educated decisions about what will work for you.

For more information about your employment rights, visit: http://TriageCancer.org/employment or read our employment-related blogs.

What do you have to disclose to an employer?

disclose to an employerMany individuals decide to work through cancer treatment or return to work, while still managing side effects of cancer treatment with medications.  Trying to figure out what has to be disclosed to employers or potential employers is a common concern for individuals.  For more general information about disclosure and privacy, check out our Quick Guide to Disclosure, Privacy, and Medical Certification Forms.

In this blog we wanted to focus on the issue of disclosing medications to an employer.  As with most situations there has to be a balance between the interests of the employer and those of the employee.  An employee may have a legitimate desire to keep the medications they are taking confidential.  An employer may have a legitimate need to know what medications its employees are taking. For example, a school probably wouldn’t want their school bus drivers taking prescription pain medications that would hinder their ability to drive. So, what does the law allow?

The Americans with Disabilities Act (ADA) protects the privacy of medical information of eligible individuals in the workplace. The ADA includes specific rules about how much information about your medical condition you have to share with an employer or potential employer, and when.

Under the ADA, employers cannot require blanket disclosure of prescription medications being taken by all employees. However, there are some exceptions based on where you are in the hiring process and the particular type of job you do.

Prior to receiving an employment offer, potential employers are not legally allowed to ask any questions about your medical condition or general health. After a job offer has been made, employers are allowed to ask you questions about your health history or to complete a medical exam, but only if they would be required of anyone entering a similar job. Furthermore, employers are not allowed to take back the job offer based on the results of a medical exam, unless the results show that you cannot perform the essential functions of that job, with or without a reasonable accommodation.

Once you are working for an employer, you can only be asked to complete a medical exam or questions about your health history, when it is “job-related and consistent with business necessity” or if there is a “direct threat.”

The Equal Employment and Opportunities Commission (EEOC), the federal agency that enforces the ADA, has issued guidelines providing some additional information on these exceptions. In these guidelines, the EEOC uses the example of a police officer. Because there is a significant safety risk involved with a police officer using certain prescription medications, an employer may be able to demonstrate that asking a police officer about his/her prescription drug use is consistent with business necessity. On the other hand, it probably isn’t reasonable to ask a firefighter, who acts in a purely administrative role, about her medications.

Unfortunately, the EEOC doesn’t provide a list of other occupations that would fall within this exception of being “job-related and consistent with business necessity.” So it is unclear, for example, if a nurse or construction worker who operates heavy machinery would have to disclose his/her use of morphine.

The EEOC does point out that there are other laws that might apply to certain employees, such as interstate bus and truck drivers, airline pilots and flight attendants, and mine workers.

If you have access to an Employee Assistance Program (EAP) at work, and you contact an EAP counselor, the counselor may ask you questions about your medical conditions, but only if the counselor: 1) does not work for or on behalf of the employer; 2) is obligated to shield any information the employee reveals from decision makers; and 3) has no power to affect employment decisions.

Resources:

Choosing to share information about your medical condition and the laws that protect your privacy or require disclosure can seem complicated.

For more information about the ADA, visit www.eeoc.gov or read our Quick Guide to the ADA.

For information about disclosure and privacy, read our Quick Guide to Disclosure, Privacy, and Medical Certification Forms.

Climbing the Winding Staircase: Navigating Complementary Approaches to Cancer Care

by Oncology Social Worker Rita Abdallah, LISW-S, LCSW-C, ACSW

Complementary Approaches to CancerWhen patients enter the cancer center doors for the first time, they see a tall, spiraling staircase. The mystery unfolds as they unwillingly take their first step onto the staircase. With the help of a medical team and loved ones, patients slowly take on this long and challenging climb. Some days, the way up looks clear and easy; other days the staircase seems dusty and difficult.

Swimming has been a lifelong passion for Cathy, a middle-aged woman with breast cancer. Cathy’s treatment plan included surgery, chemotherapy and radiation. At her initial oncology visit, Cathy and her doctor openly discussed when she could return to the pool. At first, Cathy adjusted her swimming routine to shorter distances. She updated the oncologist on her progress and/or setbacks. Cathy listened carefully to her oncologist for guidance. In time, she went back to swimming at her own pace. Cathy was so happy to reconnect with her body and find her old self again.

Patients soon realize that cancer is a series of steps involving physical, emotional, mental and spiritual effort. Regardless of how fast or how hard the stairs are climbed, patients desire options that minimize suffering and maximize quality of life. Outside of conventional medicine, they may discover less invasive ways of caring for themselves. Complementary Alternative Medicine, or CAM, offers cancer patients chances to feel better and reclaim some of their health choices. When it comes to using CAM and complementary approaches to cancer care, patients need to talk to their healthcare providers, ask questions and carefully evaluate the risks and benefits of each therapy.

What is CAM?

According to the National Center for Complementary and Integrative Health, CAM is defined as:

  • If a non-mainstream practice is used together with conventional medicine, it’s considered “complementary.”
  • If a non-mainstream practice is used in place of conventional medicine, it’s considered “alternative.”

Other useful terms are “Integrative Medicine” which coordinates conventional and complementary approaches within care settings. The National Center for Complementary and Integrative Health officially uses “Complementary Health Approaches” to cover categories ranging from natural products to mind and body practices.

Talking to your healthcare team about CAM

When it comes to talking to healthcare providers about complementary health approaches, patients are hesitant to take that first step. AARP and The National Center for Complementary and Alternative Medicine asked 1,559 people age 50 and older about their use of CAM and why they don’t talk about it at the clinic. Respondents reported that doctors don’t ask about their CAM approaches and patients don’t know they should disclose this information. Some patients believe doctors don’t have time to talk, lack knowledge about CAM and/or discourage patients from using it.

In the cancer setting, it is crucial for patients and the healthcare team to talk about complementary approaches. When chemotherapy, immunotherapy, surgery, transplants and radiation may be a part of the treatment plan, the healthcare team appreciates a full picture of all healthcare choices made by patients. Open and ongoing communication is essential for reducing and avoiding contraindications, undue harm or unknown reactions.  An excellent resource, full of tips, worksheets and resources is a downloadable workbook published by the National Cancer Institute called “Talking about Complementary and Alternative Medicine.” It also includes a great list of questions for patients to take with them to their medical appointment. If patients don’t have the energy or want help with this conversation, they should bring a trusted family member or friend for support.

Risks and benefits of CAM

Doctors and patients share similar challenges with it comes to determine which complementary approaches are proven, safe and effective. Some therapies are not regulated while others are not standardized. The body of knowledge is fast growing but limited depending on use of complementary therapies for specific cancer stages and disease types. Studies may involve animal subjects but not human testing because of unfamiliar side effects. The American Cancer Society has more detailed information on this subject.

Climbing CAM stairs

Once patients get closer to selecting a doctor-approved complementary therapy, they begin the search of a professional to get help. Use these tips to ensure the experience is a positive and favorable one.

  • Check out the latest research on a specific CAM approach
  • Ask your health insurance provider if coverage available
  • Get referrals from friends/family/healthcare provider
  • Find out the practitioner’s education, training, licensing and certifications
  • Call local cancer organization
  • Carefully search online and check sources
  • Try your chosen CAM approach a few times. If it isn’t working out, try something else or take a break. Don’t buy pricy packages or invest lots of time until this option meets your wellness objectives.

To learn more about CAM and Cancer, register for our free live webinar on February 22, 2017. Oncology Social Worker Rita Abdallah will present Complementary Alternative Medicine (CAM) and Cancer: Show Me the Proof! Register today! 

Getting Back to Work: Ticket to Work Program

triage-cancer-blog-return-to-workIf you are receiving disability benefits because of a cancer diagnosis, you may be considering going back to work. You may even be eager to get back to the normalcy of working.  As Americans, we get a great sense of worth and identity from our jobs.  Work is also a great social outlet for a lot of people.  After a cancer diagnosis, working can mean more than financial independence.  It can also mean moving beyond your diagnosis.

Well, when you’re ready to return to work, the Social Security Administration is ready to help.  They have a robust program designed to assist you to find work after a disability: the Ticket to Work Program.

Ticket to Work
If you are receiving SSI or SSDI, and are between the ages of 18 and 64, you qualify for a program called Ticket to Work.  This is a free and voluntary service that can help you go to work, get a good job that may lead to a career, and become financially independent.  Essentially, this program matches you with career planners and vocational rehabilitation services that will help you make a plan for getting back to work, and then help you execute that plan.  They will review your resume, set up interviews, conduct job training, and much more.  They will also provide information about your disability benefits and what they will look like when you go back to work.  Here are some things you should understand about the Ticket to Work program:

  • Opening a Ticket to Work does not mean you will automatically lose your SSDI or SSI benefit. If you open a Ticket to Work and make timely progress with either an employment network or a state vocational rehabilitation counselor, your medical condition will not be reviewed and you will continue to receive you normal benefit until you start actually working.
  • Opening a Ticket to Work will not cancel your Medicare benefit. Even if you go back to work and make enough to stop your SSDI benefit, you are still eligible to keep Medicare Part A (hospital insurance) for up to 93 months.
  • Opening a Ticket to Work will not necessarily cancel your Medicaid benefit. If you make enough to stop your SSI benefit, but are still under the earnings threshold set by your state, you could still be eligible for Medicaid.  Even if you make more than your state earnings threshold, you could be eligible for a Medicaid buy-in program.  You need to speak with your state Medicaid office to find out what that threshold is in your state. Click here to find your state Medicaid agency.

Another concern you may have about returning to work too early is sacrificing the SSDI or SSI benefit that took you so long to get in the first place.  Social Security has a work incentive program called Expedited Reinstatement.  Basically this means that if your benefits ended within the last 5 years due to an increase in your earnings, and you still have your original medical condition, you do not have to reapply for benefits.  Instead, you will receive 6 months of temporary benefits while your case goes under medical review.  If you are found not to be eligible for benefits after that review, you don’t have to pay back the temporary benefits you received.

Don’t be afraid to get back out into the workforce if you are able.  Cancer can be very isolating and working can be just the thing you need to feel better and move on from your diagnosis.

Survivorship, Activism, and Cross-Cultural Relationships

By Ruth Ebenstein

I was nursing my baby when I got the bomb-drop.Survivorship, Activism, and Cross-Cultural Relationships

“That lump is cancer. If the pathology report comes back negative, I’m going to think it’s a mistake.”

Breast cancer? Mixed in with mother’s milk? In addition to my baby, I had two others sons under five and two young adult stepdaughters. In an instant, my life plans crashed. Forget a fourth child. Would I even get to rear the ones that I had? I was still mourning a friend I’d lost to breast cancer a few weeks earlier; she was in her 40s, around my age. I despaired, unable to access any hope. Was a good outcome even possible?

Three weeks later, I had a lumpectomy and an axillary dissection, to remove lymph nodes from my armpit. While the doctors tried to decide if I needed chemotherapy, I looked for a support group. I’d heard that women survived better/longer/stronger if they’d had support, and I was keen on that. But most of all, I was looking for a friend.

I’d always been a connector. As a girl, I had embraced babysitters as friends. I connected with everyone: long chats with the bus driver to school, discussions with the librarian over sandwiches at my house (yes, she agreed to come over!), and even my mother’s friends. Friendships were one of my great joys. And now was no different. I wanted women in my life who understood what I was going through. Of course, I did not want my old friends to get breast cancer! But I did hunger to find true companions in breastcancerland. Women with whom I could laugh, complain about hot flashes, share my fears, gather strategies for coping.

And then this email turned up in my inbox. “Would you like to join an Israeli-Palestinian breast cancer support group?” I wondered if perhaps something good could come out of something bad.

At the first support group meeting, a mother-earth woman with warm brown eyes came over to introduce herself. Although Ibtisam Erekat was a devout Palestinian Muslim woman hailing from the West Bank and I was an American-Israeli Orthodox Jewish woman hailing from Jerusalem, we discovered that we had very similar life narratives. We were both religiously observant and we had both married in our thirties, late in our respective traditional communities. Each of our husbands was a divorcé who was several years our senior and had brought children into the marriage. We both had birthed three children in three years. And we were both diagnosed with breast cancer while nursing our babies, which was rather uncommon.  I had never met anyone who shared so many critical elements of my life story. “Same here,” said Ibtisam at our first meeting, in impressive English she had gleaned off the television. I soon discovered that we were both fearless, outgoing, daring. The conversation flowed and we cracked each other up.

In 2012, we traveled together to Bosnia as part of an Israeli-Palestinian delegation of breast cancer survivors. The mission: to meet and learn from other breast cancer survivors who also cross religious, ethnic and cultural lines to support each other. On that trip, many incredible things happened. I felt a tremendous connection with the Bosnian women, women who remain my friends today, despite the challenges of a language barrier. I also developed beautiful friendships with the Palestinian breast cancer survivors, facilitated by the intimacy of togetherness and being miles away from the bloody headlines and turmoil of our region. In particular, my friendship with Ibtisam blossomed. Over the next months and years, we grew to be kin; our children, spouses, and extended families grew close, too.

I realized that this inspiring friendship story ought to be shared. So I did. I crafted a piece about our trip to Bosnia for Tablet, which won an award. I wrote another essay about our friendship for the Atlantic. Penning a memoir was a natural next step.  I’m working on that manuscript right now, with literary agents waiting to read my book proposal.

In 2014 I started to do public speaking across the US to share the positive things that emerged from my breast cancer experience. The cross-cultural friendships, the growth, the peace and health activism—and the hope. Most remarkably, the incredible sisterhood with Ibtisam Erekat.

Through my public speaking, writing and activism, I’ve made friends with breast cancer survivors who hail from Mexico City to Mostar, Herzegovina, from Abu Dis in the West Bank to an ultra-Orthodox community in Israel. Breast cancer has taught me how to connect in ways that I did not even know were possible. My hope is to spread this message to others: our real enemy is illness, not man-made conflict. And the greatest lesson of all? “Other” is actually just like me.

Gift Ideas for a Cancer Patient

triage-cancer-blog-gift-ideasWhen someone close to you is sick, the instinct is to shower that person with love in the form of chocolate, flowers, and balloons. This is a very kind instinct, but when someone is going through cancer treatment or in the hospital, you may need to rethink these gifts.

Chocolate and flowers each may present a possible problem for a cancer patient.  Depending on the type of cancer they have, they may have dietary restrictions, and sugar can be a forbidden ingredient.  Many hospitals are now banning flowers because of the germs and bugs they may carry. And you may want to stay away from mylar balloons, which pose a risk to power lines and there is a worldwide helium shortage.

So, what should you bring to a cancer patient? Really, anything that will bring comfort to the patient and is allowed in a hospital environment.  Here are a couple of ideas:

  • A cozy set of button-up pajamas, robe or slippers
  • Warm, fuzzy socks
  • A soft blanket
  • A basket of unscented lotions and lip balms
  • A good, funny book
  • A nice journal and pen
  • Magazines
  • Music or relaxation/meditation exercises
  • Movies, a Netflix/Amazon subscription, or an iTunes/Amazon gift card to download their own

 

You can also give the gift of your time. Besides visiting someone, you could offer to help with daily activities. For example, you could babysit young children. If their parent is in the hospital, you could take them for a walk or out to get something to eat. Pick up their mail, feed a pet, or water plants. You could even offer to help them sort their medical bills and other paperwork.

 

Use these ideas, or use them to spark your own ideas.  What every cancer patient needs more than anything is love and support, and any gift will be appreciated, because it is the thought that counts!

FICO ® Score – What is it and What Does It Mean for You?

Today we share some expert advice from financial planner Kristi Sullivan about understanding your credit scores and how you might be able to improve your credit if you have dealt with financial challenges.

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So, what is a FICO score? The Fair Isaac Corporation is a software company that has a

super-secret formula using data from the 3 credit bureaus (Transunion, Experian, and Equifax) to create you credit score. That credit score is used on everything from renter applications to car loans, mortgages to insurance rates. Some employers even check your FICO score before making a job offer.

Although the actual formula is a guarded secret, the elements of a FICO score are public knowledge:

From www.myFICO.com

  • 35% Payment History – how many late payments do you have?
  • 30% Amounts Owed
  • 15% – Length of Credit History – how long have you been borrowing money and paying it back?
  • 10% – Types of Credit In Use – secured versus revolving credit
  • 10% – New Credit – do you have a ton of new loans/credit cards opened recently?

What are some things you can do to improve your credit score? According to www.myfico.com (the horse’s mouth), these three things:

  1. Check Your Credit Reports. Make sure there are no incorrect open accounts or late payments. Maybe there are payments you owe that you didn’t even know about. The most common instance of this is unpaid medical bills. By the time the insurance companies and providers go back and forth you may have no idea how much you owe or think you owe nothing at all. This is an honest mistake that costs many consumers in the form of a lower FICO score.
  2. Make your credit card payments on time and for more than the minimum. Credit card companies report to the credit bureaus monthly, so the better your payment history with them, the faster your FICO score improves. Also, the worse your payment history is, the faster your FICO score goes down.
  3. Reduce the amount of debt you owe.   Not so easy, but the first thing to do is stop using your credit cards if you are heavily in debt.

There are many other tips on improving your credit score on www.myfico.com. Also, if you have errors on your credit report that the credit bureaus are not helpful in resolving, you can go to www.ftc.gov to get help.

Stay tuned for more information on changes to FICO scores and how it may help those who are coping with medical debt!

Medicare Open Enrollment

medicareandyoucover2-300x225Medicare is a government sponsored health insurance program for most people who are 65 years old and older, or for individuals with a disability, who have been collecting Social Security Disability Insurance (SSDI) for at least 2 years.

Medicare can be confusing to navigate because its coverage is broken into four parts:

  • Part A covers inpatient hospital stays
  • Part B covers outpatient medical services
  • Part C (also known as Medicare Advantage Plans) allows beneficiaries the option of receiving their Medicare benefits through private health insurance plans and combines the coverage of Part A and Part B (meaning that if you have Part C, you do not also need A, B, and D)
  • Part D covers prescription drugs.  Anyone with Part A or B is eligible for Part D

Parts A and B are typically referred to as Original Medicare.  Everyone who is eligible and has paid into the system gets Part A and is automatically enrolled after age 65.  For most people there is no charge for Part A.  To receive Part A for free you generally have had to pay into Medicare for 10 years (40 quarters).  However, if you would like Part B, Part C (Medicare Advantage) and/or Part D you need to take proactive steps to enroll.  There is a fee for each of these Parts.  The standard 2014 premium for Part B is $104.90.  The premiums for Parts C and D will vary depending on the plans you choose.

Each year, during a period of Open Enrollment, you can sign up for a new plan or make changes to your existing plans.  Open enrollment starts October 15, 2013, and ends December 7, 2013.  While you don’t have to make changes this is your opportunity to review your coverage and change plans if you choose.

To find out more about when you can join or change a plan, click here.

To find out more about your Medicare coverage choices, click here or review this Medicare and You 2014 booklet.

Go to www.Medicare.gov to enroll in Medicare, check your current enrollment and compare your coverage options.