There is growing awareness that patients experience worse clinical outcomes caused by “financial toxicity.”1

“Often times, we put more responsibility on the patient to figure out what they need in terms of resources to help cover costs of care. Our health and insurance systems are complex, complicated, and difficult to navigate,” says Jean Edward, PhD, RN, CHPE, an assistant professor at the University of Kentucky College of Nursing.

If a patient obtains health coverage, he or she is more likely to access appropriate medical care. “That in turn helps them maintain their health and keeps them out of emergency departments,” Edward observes.

The most successful financial navigation programs direct healthcare providers and staff to work together to address patients’ needs from the time they enter the system to after discharge. “We are pushing to improve cost of care conversations because patients trust their providers,” Edward explains.

Patients are more likely to contact financial assistance services if the provider brings up the option. Some patient access departments are taking aggressive steps to combat financial toxicity. At Moffitt Cancer Center in Tampa, FL, the patient access department made several changes:

The financial clearance unit automated repetitive tasks (eligibility and authorizations). “This allowed us to shift resources to help patients understand their benefits,” says Viviana Beland, director of the financial clearance unit.

Four FTEs used to handle eligibility and authorizations. These employees were switched to more patient-oriented functions. Two became financial counselors who screen patients for Medicaid, financial assistance, and payment plans. The other two became copay enrollment specialists (a newly created position to help patients enroll in copay assistance programs for which they qualify, depending on the drugs they are receiving).

When registering a new patient, staff find out the person’s financial status: insured, uninsured, or underinsured. Insured patients are informed of their benefits, deductibles, and maximum out-of-pocket costs. Patients with high out-of-pocket costs are referred for copay assistance enrollment. Uninsured or underinsured patients are screened for Medicaid eligibility, grants, or financial assistance programs. Patients with insurance who are out of network are informed of the higher financial responsibility. “This ensures patients make an informed decision,” Beland adds.

At the start of chemotherapy, patients receiving an injectable drug with out-of-pocket expenses are matched with assistance programs based on the person’s diagnosis and insurance. “Patient enrollment coordinators help patients to enroll in these programs,” Beland says. Some drug manufacturers make charitable funds available for patients enrolled in a copay assistance plan. “Patient financial services identifies the patient’s cost responsibility for the drug and bills this to the charitable arm of the manufacturer, alleviating the patient’s responsibility,” Beland reports.

For patients receiving oral drugs, copay assistance or free drugs sometimes are available. Copays or out-of-pocket costs for oral drugs are covered by the manufacturer in some cases, depending on the patient’s financial situation.

If patients lose insurance coverage in the middle of treatment, they are referred to the business office for financial screening. Medicaid or financial assistance are possibilities for this group. “Patients who want to apply for Social Security disability are guided through the process by our funding specialist,” says Andrew Talford, director of Moffitt’s patient financial services.

Patients scheduled for surgery are told of their financial responsibility in advance. Surgical patients can pay up front, set up a payment plan, or apply for financial assistance so there are no surprise bills.

More changes are underway to help Moffitt’s patients. “We are in the process of acquiring an estimation tool,” Talford says. “It will allow insured and uninsured patients to understand their financial responsibility before receiving services.”

The department also is offering electronic financial assistance. Patients can apply and submit necessary documents through a phone or tablet. “This will also allow real-time status updates via text or email,” Talford says.


  1. Edward J. Effective cost conversations: Addressing financial toxicity and cost-related health literacy. Clin J Oncol Nurs 2020;24:209-213.