Cost of Radiation Treatment
By: Erin Weglage (Patient Advocate)
How much will it cost for my radiation?
This is a question most of our patients ask. Receiving a diagnosis of cancer is scary, and you are likely concerned with not only your physical health but your financial health and how the treatment will affect your family now and in the future. We agree this is an important question for you to ask and have answered before you receive radiation treatment. That said, this is an incredibly complex question to answer. Because several factors influence the cost of radiation, the answer is ultimately different for each patient. This blog post lays out all those variables. Our commitment to you is that we will work with your insurance company to help get your therapy approved and make sure you are aware of the financial obligations you may have prior to your treatment starting. We hope that these conversations will set your mind at ease so that you can focus on your treatments and getting better.
How do we figure out what the treatment costs?
Many factors will be considered when figuring out the cost of your radiation treatment. What kind of cancer do you have and how is it best treated? Do you have insurance? If so, what does your policy cover for radiation therapy? Does your policy have a co-insurance or a daily copay? How much does your insurance allow for radiation costs? In this blog, we strive to explain all these variables and remain available to answer any questions you may have.
Each cancer is evaluated by type, site, and severity to determine the best course of treatment. When it comes to radiation treatments, your radiation oncologist is going to plan the radiation treatment most beneficial for you. Some treatment types cost more than others. The number of treatments also influences the cost of treatment, with the number of treatments required ranging anywhere from a single treatment to 45 treatments. There are also different types of radiation treatments, with varying complexity. These factors affect your cost.
Depending on all the factors just described – the type of cancer, type of treatment, and the number of treatments needed to treat the cancer, the price varies for each patient and situation. Once the physician develops your treatment plan, we work with your insurance to determine what they will cover and whether there will be any out-of-pocket expenses for you.
How We Figure Out What Your Insurance Covers
Two terms we previously mentioned will determine how much you will be responsible for once your primary insurance has paid its portion for your radiation.
Co-insurance: This is a percentage of the total amount you are responsible for paying after you meet your deductible. For example, if your policy has a deductible of $1,000 and pays 80% of the total cost once you meet your deductible. You would be responsible for the first $1,000 and then 20% of the remaining cost. Let’s say your treatment costs $11,000. You pay $1,000 for your deductible, leaving $10,000. Your plan would pay $8,000 (80%), and you would pay $2,000 (20%). You would be responsible for a total of $3,000.
When you start radiation treatment, you may have already met your deductible through surgery, chemotherapy, or other medical services. If this is the case, your insurance would immediately begin covering their portion of treatment costs. Using the same numbers above, if your treatment costs $11,000, your insurance would pay $8,800 (80%), and you would be responsible for a total of $2,200 (20%).
Daily Copay: If you have a daily copay, it means that you will be responsible for a copay each time you come in for treatment. This may be the same amount as your office visit copay, but sometimes it is different depending on the insurance plan.
Out-of-Pocket Maximum: This is the maximum amount you have to pay during your plan year. Take the same example from above. If your Out of Pocket Maximum is $2,500, you would only have to pay $2,500 of the $3,000 you were originally paying. Your insurance would then cover costs beyond the Out of Pocket Maximum.
If you have already had some other medical appointments and diagnostic tests this year, your out-of-pocket maximum may have been reached for the year already. Take the example from above, assuming you already had other medical expenses. For example, if your Out of Pocket Maximum is $2,500, and surgery costs you $2,000 you would be responsible for $500 to meet your Out of Pocket Maximum. Then your insurance would cover the remainder of your treatment costs.
We also see many insurance plans that cover radiation therapy at 100%, so it is worth checking the details of your policy.
Where do we get the amount to charge?
Once your treatment plan is approved by your physician, we submit that plan to your insurance. Each insurance company has a specific amount that they will pay for your type of treatment plan. This is called an allowable.
So what will my treatment cost?
Depending on treatment type and duration, the total price for a course of radiation therapy can range from $4,500 to $50,000. For most patients, much of this cost will be paid by your insurance. The total course of treatment includes:
- All of your treatments
- Imaging used throughout your treatment
- Continuous monitoring by our physicists and physicians
- Weekly visits with your physician
- CT Simulation
- Expertise in planning radiation from our dosimetrists, physicists, and physicians
- Devices or personalized molds to help keep you in the proper position, during treatment
Paying for Treatment
Our primary goal is to make sure you are receiving the best care for your cancer. If you have payment concerns, our office will work with you to design a plan to pay for your portion of the treatment costs. There are several options available.
- Pay as you go. This would be for patients who have a daily copay, not co-insurance.
- Have it billed to you and pay when you receive the bill.
- Have it billed to you and set up a payment plan with our billing company.
- Apply for financial assistance through Alliance Cancer Care, which is based on your income level. This is also an option for patients who do not have insurance.
Our goal is to meet with patients who may have financial responsibility before treatment begins. We will review your benefits and provide you with an estimated total cost and total out-of-pocket cost. If you have questions about your financial responsibility or insurance, please contact our office at 256-319-5400.