Costs

Who pays for the costs of patient care on clinical trials?

In general, the trial sponsor will pay for anything that isn’t part of “routine patient care.” Any experimental treatment you are taking should be provided by the sponsor. Also, if the study requires any special testing or extra doctor visits, those will also be covered by the sponsor. Procedures that are considered “routine patient care” (i.e. doctors visits, x-rays, laboratory tests, non-experimental medication) will be billed to you.

Usually your health care plan will cover the cost of routine patient care while you are on a trial, but some plans will not. It is important that you talk with your health plan provider to find out if they will cover these costs. Work closely with your doctor and research team to find out what your insurance will cover.

Here are some tips while working with your insurance company (Provided by the National Cancer Institute, www.cancer.gov):

• Find out if there is a social worker or financial counselor that can help you contact your insurance company.

• Keep your own copy of any materials sent to your insurance company.

• Ask your insurance company if they cover the cost of “routine patient care” if you are on a clinical trial.

• If they do cover it, ask if they need to authorize the clinical trial in advance.

• If they need to authorize the trial, be sure to ask them exactly what you need to send them. You should also send them information from your doctor about why this trial is necessary for you. This may include medical journals that show how patients benefit from this trial, a letter of medical necessity from your doctor, or support letters from patient advocacy groups.

• If an authorization is not required, ask your insurance provider to send you a letter confirming this.

• Every time you speak with your insurance company, make a note of who you are speaking with, the date, and the time.

• You can also try working with your employer’s benefits manager. They may be able to help you work with your insurance company.

If you experience an illness or injury while on the trial, any necessary services will be provided to you at the usual charge. There are not funds set aside to compensate you in the event of an injury.