"I never thought I'd see the day that I was in this situation," said Natashia Pierre, 41, of Central Islip, N.Y.
Pierre, who was diagnosed with breast cancer in January 2007, is insured through her husband and pays 20 percent of her medical bills out-of-pocket.
Her monthly co-pay for chemotherapy is $500, and she is still struggling to pay the $1,000 fee from her lumpectomy earlier this year. She says debt collectors call her home every day.
"How do I tell my kids they can't have lunch money because mommy has cancer?" she said. "It's so frustrating. My husband has to work all the time, to keep the health insurance. He can't even take time off when I have surgery."
"We're not middle class and we're not poor — and we get no assistance."
Pierre's situation is not unique. Numerous posts on the ABC OnCall Plus Breast Cancer site testify to the fact that paying for breast cancer screening and treatment is a top concern. These worries affect both those without health insurance as well as those who are underinsured, meaning that they don't have adequate coverage to pay their bills in the event of a major medical problem.
According to a recent survey conducted by USA Today/Kaiser Foundation/Harvard School of Public Health, 33 percent of cancer patients have trouble paying medical bills and 43 percent report skipping treatments or not filling prescriptions because of the cost.
In addition, one in five cancer patients with insurance will use up all or most of their savings during the course of treatment.
"It's very difficult," said Dr. Stephen Edge, medical director of the Breast Center at Roswell Park Cancer Institute in Buffalo, N.Y. "Not only with breast cancer, but with all areas of medical treatment, people in America are commonly forced into desperate financial situations and even bankruptcy by medical bills.
"The overall cost for treating a typical breast cancer will top $50,000 or even $100,000."
Doctors Give Advice on Insurance Companies
Though 15 percent of Americans are uninsured, some doctors say that the real problem is for those who do not qualify for Medicare, like Pierre.
"The working poor that make too much for Medicare are the problem; they sometimes fall through the cracks and struggle to get care," said Dr. Anne Wallace, associate professor of surgery and director of the University of California, San Diego Breast Care Unit, noting that her hospital sees many such patients.
The good news is that in many hospitals, bills and payment can be negotiable. "You can talk to the financial department of the hospital," said Karleen Habin, ABC OnCall Plus nurse consultant. "They can work with you on figuring out a schedule to make payments, or defer payments."
"Also, many people don't know the fine print of their insurance plans," she said. "Get it out and read everything. Try to understand it."
Still, intricacies of the system can make it difficult for many patients to carve out the care they need, despite the fact that many doctors often try to work within the system to give their patients good care.
"I think it stinks that Medicare considers it fraud to undercharge a patient or excuse their co-payments without extensive documentation," said Dr. Anthony Elias, professor of medicine at the University of Colorado. He says that most hospitals will see a small number of uninsured patients, especially if they live in the area and they may be eligible for Medicaid in the future.
"For millions of people with cancer, there is little hope when the costs of treatment are more than they can afford," said Steven Weiss, senior director of communications and media advocacy at the American Cancer Society (ACS).
"Some pharmaceutical companies offer drugs for little or no cost to those in need — called 'charity care,'" he said. "But for those who cannot benefit from these limited offerings, the choice often comes down to paying for treatment or paying for daily needs such as food, electricity or the mortgage."
In light of the problem, ACS recently launched a campaign to bring awareness to the issue of cancer treatment for the uninsured.
Many doctors say that the key to change lies at the federal level, and that the current situation is not sustainable.
It's a conclusion with which cancer patient Pierre agrees. Pierre, who just found out she needs more chemo because the cancer is not gone, said, "I just hope I'll be alive to see the change. It's so frustrating."
Know Your Rights
When it comes to getting screened for breast cancer, most women know what to do to: go to the doctor and get a mammogram.
But what about women who have no insurance, or women who have insurance that doesn't cover all treatment for breast cancer?
There are state and federal programs that can help, including some that are not widely publicized. With National Mammography Day coming up Friday, there is still time to find a free or low-cost medical center.
Here are some organizations that can help:
At the American Cancer Society Web site, you can enter your zip code or call 1-800-ACS-2345 to find out where to get a free mammogram.
The National Cancer Institute can be reached at 1-800-4-CANCER, and the representatives can tell you where to find a center for a free mammogram.
The National Breast and Cervical Cancer Early Detection Program is designed to provide access to mammography and related services, including breast biopsy and treatment, through local providers. The program works differently in each state, so check the specifics for your area.
Breastcancer.org has advice on how to pay medical bills.
The Susan G. Komen Foundation provides a listing of organizations to which they have granted funding, so call to see what services might be available in your area.
YWCA Encore Plus Programs provide services on a sliding scale. Screening mammography is available to women 35 years and older who are medically underserved. Call 1-800-95-EPLUS (1-800-953-7587).
At the American Breast Cancer Foundation you can apply for mammogram assistance.