Cancer patients without health insurance are charged significantly more for chemotherapy drugs and doctor visits than those with Medicare or other health insurance.

Cancer treatment is expensive. For patients without health insurance, those expenses can quickly spiral out of control.

One reason is that uninsured patients are responsible for their own healthcare costs. A less obvious reason is that cancer patients are not billed equally for the same services.

A new study from the University of North Carolina at Chapel Hill shows that uninsured patients are charged substantially more than insured patients. As much as 43 times more in some cases.

Using Medicare data from 2012, researchers analyzed the cost of oxaliplatin, a drug used to treat colorectal cancer. On average, uninsured patients were billed $6,711 for one infusion. The negotiated rate for patients with private insurance was $3,616. The Medicare rate was $3,090.

For some other chemotherapy drugs, the disparities were greater. Carboplatin is a drug used to treat ovarian cancer. Medicare patients were billed $26 per infusion. Uninsured patients were billed $1,124 for the same treatment.

Researchers also evaluated what cancer patients paid to see a doctor. Visits by Medicare patients were billed between $65 and $188. Patients with private insurance were billed between $78 and $246. The uninsured were expected to pay between $129 and $391 for their time with a doctor.

Details of the study are published in the journal Health Affairs.

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Lead researcher Stacie Dusetzina, Ph.D., an assistant professor at the Eshelman School of Pharmacy and the Gillings School of Global Public Health, finds the variability in healthcare pricing unreasonable.

“Patients need to have more information in order to know whether the price they are asked to pay is a fair price,” Dusetzina told Healthline. “To judge this you would probably want to know how much your doctor is paid for providing the same services to other patients.”

There’s no easy way for patients to do this. Uninsured cancer patients may feel sticker shock, but they lack bargaining power.

“There are efforts underway to increase transparency in healthcare pricing,” Dusetzina continued. “For example, websites like provide estimates of the cost for specific health services but may not provide information on the specific services that the patient needs (e.g., an infusion of a specific chemotherapy). Knowing what others are paying for the same services can help patients to start the conversation with their physician.”

For uninsured cancer patients, the burden is heavy. Inability to pay may mean skimping on treatment. Even at a negotiated rate, expenses can lead to crushing debt.

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“Prior to the Affordable Care Act (ACA), the primary reason for bankruptcy in the United States was medical debt,” Kirsten Sloan, senior policy director for the American Cancer Society Cancer Action Network, said.

“The ACA eliminated a lot of discriminatory practices in the insurance market that kept people from getting coverage,” Sloan told Healthline. “People with pre-existing conditions had trouble buying coverage. After a diagnosis, insurers could rescind coverage or impose annual or lifetime limits. These practices are outlawed by the ACA. It’s easier now for cancer patients to find insurance.”

Under the Affordable Care Act, almost everyone is required to have health insurance. That doesn’t mean everyone can find affordable coverage. Some people still fall between the cracks. This is especially true in states that declined to expand Medicaid.

Earlier this year, the U.S. Supreme Court heard arguments in the case of King vs. Burwell. Plaintiffs challenged the legitimacy of federal subsidies in states that chose not to create their own health insurance exchanges.

If the court rules for the plaintiffs, consumers currently receiving federal subsidies may lose them in 2016. Untold numbers of cancer patients could find themselves back among the uninsured. A decision in the case is expected in June.

Some cancer patients don’t qualify for a subsidy or Medicaid, but they still can’t afford coverage. That doesn’t mean you must skip treatment. It does require extra legwork.

Start with your doctor. Many medical practices include charity care in their budgets. Meet with your doctor and the practice’s financial counselor. Explain your situation and request a discounted rate. There’s a good chance they will help you work out a payment plan. If they can’t provide care, they will probably be able to recommend a practice that can.

Most hospitals have patient advocates trained to help you navigate treatment. Major pharmaceutical companies also offer financial assistance programs. Other organizations provide information tailored to cancer patients. Among them are the Cancer Financial Assistance Coalition and CancerCare.

The National Cancer Institute has a searchable database of organizations that provide support to cancer patients. Other good resources include the American Cancer Society and your local health department.

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