Join us for a powerful conversation about navigating the complex legal landscape of cancer care with Joanna Duran and Monica Bryant, sister lawyers and co-founders of Triage Cancer! Hosted by Nirvana Tari, Chief Patient Officer of CareYaya, and Dr. David Casarett, Chief of Palliative Care at Duke Health.
In this eye-opening episode, Joanna and Monica reveal the shocking truth that 96% of Americans cannot even define the four most common health insurance terms, and why that knowledge gap is costing cancer patients and their families dearly. Discover how simply knowing the acronym of one federal law (the Women's Health and Cancer Rights Act) can instantly overturn insurance denials for mastectomy-related care, and why 99% of denied claims never get appealed despite many being overturnable.
From the hidden reality that the Family and Medical Leave Act is unpaid (and only covers 50% of Americans) to why your out-of-pocket maximum is the only number that really matters when calculating cancer care costs, this conversation arms patients and caregivers with the legal knowledge they desperately need but were never taught. Learn why you should not rely on your insurance company or HR department to protect your rights, and discover the critical difference between legal advice and legal information that every healthcare provider needs to understand.
Key insights include why universal healthcare remains politically divisive despite broad need, how state-level paid family leave laws are filling federal gaps, why doctors should not assume patients cannot or should not work during treatment, and the revolutionary concept that healthcare conversations must include financial and employment concerns, not just medical decisions.
Brought to you by CareYaya, America's number one rated solution for in-home senior care, providing industry-leading quality care at the most affordable rates. CareYaya is known especially for delivering the most reliable and affordable overnight senior care and 24/7 care in many major metro areas including Atlanta, New York, Los Angeles, San Francisco, and Washington D.C.
This episode is essential for anyone facing a serious illness diagnosis, family caregivers juggling work and care responsibilities, healthcare professionals who want to better support their patients' non-medical needs, or anyone who wants to become a more informed healthcare consumer before crisis strikes.
Episode Transcript:
to be here with my wonderful co-host, Dr. David Casserette, Chief of Palliative Care at Duke, for a conversation that's gonna go way beyond medicine. We're talking here with Joanna Duran and Monica Bryant of Triage Cancer about the legal battles that patients face, the hidden toll that caregivers are taking on, and how we can build a system that truly supports people when they need it most. How are you ladies doing today? Good, how are you? Thanks for having us. Thanks so much for being here. This is super, super exciting. As you guys know, we're going to go ahead and just get right into it with our lightning round. So for this, if you guys could both give me an answer, we'll go Monica first and then Joanna, and maybe try to keep the answer between less than twenty seconds. So, Monica, what's one thing you wish every patient understood about insurance denials? That they don't have to take no for an answer. I love that one. Joanna? that it's incredibly common and it's not unusual and that there are steps to take. I love it. All right, here we go. Biggest game changer in patient rights in the last five years. Monica? Ooh, five years. I'm going to expand to ten years and say the passage of the Patient Protection and Affordable Care Act. It was a game changer for access to health insurance for people. Ten out of ten. Love it. Joanna, what you got? If I'm stuck with five, I would say the Inflation Reduction Act and how it capped out-of-pocket prescription drug expenses for people on Medicare. Ooh, I didn't even know about that. I love it. All right. So, Monica, tell me about one policy change that would transform cancer care overnight. Universal health care. Ah, I wish. Magic wand, right? Joanna? Monica took the easy answer. I would say paid family and medical leave. I love it. I really, really do. And then one more. Something people would be surprised to learn about you outside that you're a lawyer. Monica? One of my hobbies is woodworking. Cool. You're going to have to show me some of that stuff. That's really awesome. It's all very utilitarian. Like I like to build shelves and planter boxes. It's not usually pretty. Oh, that's awesome. Joanna? I would say one thing that people would be surprised to learn about us is that we're actually sisters. I learned that after seeing your like, oh my gosh, what's it called? Your middle names. I was like, wait a second. So cool. Very, very, very cool. And you guys like, I guess this is outside of the lightning round, but like you guys just both were passionate about the same topics. I think we came into this work in an interesting way, but definitely feel like this is an important need that our skill sets lend themselves to. Yeah. All right. Well, while we're talking, Joanna, I would love to ask, so, you know, you guys have built Triage Cancer into this national resource for patients and caregivers. What gap were you trying to fill when you started this work? I think the broadest way to describe the gap as a lack of education, but from a really different perspective than most other patient advocacy organizations are approaching these issues. And if you'll indulge me for a second, I'll give you a pretty good example. When I was in law school and college, actually, I was actually working in a cancer center for a psychosocial care program. And one of my job responsibilities was actually to fit patients for mastectomy bras and prostheses after a mastectomy because of breast cancer. And I would do that and then have to bill insurance for those prostheses and mastectomy bras. And then I would have to fight with insurance because they would deny coverage for those items saying it's cosmetic, we don't have to pay for it. And around that time, I actually took a class in law school and I learned about a pretty random law called the Women's Health and Cancer Rights Act, which is a federal law and requires insurance companies to cover the cost of mastectomy bras and prostheses. And so I would get on the phone with the insurance company and I would say, like, I don't understand why this isn't covered. It should be covered under the policy because it's a private insurance plan. And they would say it's denied. And then I would say, well, what about WICRA? And they would say approved. And so all I would have to do is throw out the acronym of a law and it completely changed the outcome of the situation. know from a lawyer's perspective it's unjust it's that you have to know the law in order to be able to advocate for yourself and get access to the things that you're actually legally entitled to and so knowing your rights and understanding how the law provides those protections is really at the core of what we do as an organization at tree i love that i honestly you know that was First of all, thank you for letting us know that that law exists because knowledge is power. And you're absolutely right because also accessibility to this information is a huge issue as well. would never even know that this would exist. So you shouldn't have to be a lawyer in order to get the proper health care that you need. So thank you for the insight. We actually say that all the time, that you shouldn't have to be a lawyer to access quality care and maintain your financial well-being and your jobs and your homes. But our systems are complicated. And sometimes it does require knowledge of the law. And that really is, I think, what Joanne and I are so passionate about is taking that complex information and translating it in a way that someone who maybe doesn't have a legal education can not only understand it, but then practically use it to get what they need. That's the key right there to actually be able to use the knowledge that they have. Amazing. I love it. Great. I think you sort of anticipated our next question, but I'll ask it anyway, because I think there's probably more to delve into, especially now that I know I'm talking to two sister lawyers. There's probably a lot of stuff here. But I'm curious, the kind of work that you do broadly, which we'll hear about more, I think in other settings, environments, the environment that I work at in the health system, that's a lot of work that's done by social workers or nurses. And I'm curious, you're lawyers doing the work that people down the hall, nurses down the hall are doing where I work. What are some special skills that you bring as lawyers, certainly knowing the law, being able to describe it as you just said? Are there other kind of secret superpowers you bring to this fight? I guess you could call it as attorneys. I've never thought of them as superpowers, but I'll take it. I think, you know, Joanne has been doing this work even longer than I have, and I've been doing this work almost two decades. And I think what we've learned over time is that it's not enough to just understand the law. thing that I think we have really honed over years is the ability to translate the law in a way that people can understand it. And that takes different forms and it's not just one way. So it's about translating the law for the audience in front of us. And so that could be different for someone who is a caregiver versus a healthcare professional. So it's how can we explain the law in a way that they can then take it and use it the way that they need to. kind of like advocacy at its finest. I think that that is the core of our medical system. We just need more advocates in general so that patients can truly understand their rights, you know, what their doctors are saying to them and all of that good stuff. Can I ask one follow-up question that's sort of off the script? I mean, just make up a number. This is kind of an impossible question. And this is Joanna or Monica, either one. But what proportion of the work that you do with patients really has a strong legal backstop, like a piece of legislation you can point to as your winning argument versus you know, it's kind of a judgment call. Some insurance companies pay for this and some don't, and we're just going to make the best argument we can. And there's no federal legislation right answer, but we're just going to push as hard as we can. Does that make sense? I mean, how often do you have a law that you could, like for the mastectomy example, how often do you have a law that you could just hold up and say, look, we win? I wish it were that easy. So I would say, you know, I would Yeah, I would estimate like a solid ninety five percent of the time we're pointing to specific laws. When you're talking about insurance, it gets a little more complicated because, well, in any area of law, we're looking at federal law, but we're also looking at state law and sometimes even county or city level laws. So you have to understand it's also layered. But I think that even when there's an absence of a specific law that says, you know, insurance companies have to cover X, there are laws and practice areas and guidelines that help define what's medically necessary. And that's really the legal standard when we're talking about things that haven't been specifically laid out. And there's pros and cons to the fact that we do and don't have laws that specifically say things. When you think about how fast medicine and science is moving right now, especially, if we had to change the law to update what a particular treatment was the best treatment for that particular medical condition, all we would do is be erasing laws. That's a lot of white out to be able to actually try to keep up with that. So the way that the laws are written is much broader to be able to incorporate what is medically appropriate at a particular time. Yeah, I agree. I had some experience with the medical cannabis industry and a lot of states have enumerated conditions for which medical cannabis can be prescribed and is effective. And so you've got these state legislatures that are essentially on the hook to keep an eye on what's published in the New England Journal to update legislation as new data comes out and it's just been a disaster. So yeah, I definitely hear you having a little bit of leeway is much more appealing and much more efficient in the long term than legislating every single treatment and intervention. And since you brought up state laws, I think that's an interesting point because even when there might be a law that exists in one state, there may not be a law that exists in other states. And we work with people across the country. And so sometimes when we bring up the absence of a protection because someone lives in that particular state, it is... helpful to remind people, to your point, that there is advocacy that's necessary. And if people want to see changes and improvements and additional protections in their state or at the federal level that don't exist, that is going to require them to actually be an advocate for that change. Absolutely. Absolutely. So, you know, kind of along the same lines, like maybe i'll direct this one to monica but was there a single moment with a patient or a family that kind of made you think this this is exactly why triage cancer needs to exist uh there is no possible way that i could come up with one single moment uh i will tell you candidly that there have been countless times where Joanna and I have been sitting next to each other, one of us hangs up the phone with a caller and we turn to the other one and go, what would that person have done if they didn't talk to us? And I don't mean to say that we're like these, you know, have superpowers, but it's about, you know, the fact that we often are answering questions that people didn't even know to ask. Yeah. And so to come up with a single moment, I can't. We have these moments all the time. And I'm thankful that we are able to provide that help to people. Well, I'm thankful that you guys exist, because honestly, like I kind of I really do understand what you're saying, because, you know, we we are running counterforce health right now where we're helping people fight denied health insurance claims. And, you know, this company has existed, what, like seven, eight months now. And, you know, already we have saved people like cumulatively millions and millions of dollars. in denied health insurance claims and i'm genuinely like what would have happened what if these people these people have just like not gotten the care that they needed would they be in medical debt for the rest of their lives would you know their entire like livelihood be ruined and it's like heartbreaking to think about these things and sometimes i'm like i wish we lived in a like world where these services didn't have to exist but i sure am grateful that they do Well, I just want to say we are too. Just yesterday, my husband is a firefighter. And he shared with me a post that he saw on social media from the wife of a fellow firefighter who was posting a GoFundMe campaign. And he showed it to me because in reading through that experience that her husband was going through, The immunotherapy that he was recommended for care was denied by insurance. And instead of understanding options for appealing, they started a GoFundMe campaign. And so I think it's a really good example of why there's such a need for help navigating those insurance denials. I mean, what is it like? Ninety nine percent of claims that get denied don't get appealed. And it's mostly because people don't have the time or the energy or they just don't know. Yeah, they literally don't even know that they can. Yeah. Wow. It's heartbreaking. Absolutely heartbreaking. Could I ask a follow-up question? I'll direct this at Joanna and then let Monica weigh in. If you could kind of have some magic time machine and you could, instead of working with patients who maybe have metastatic cancer, are fair ways down the illness trajectory. What if you could backtrack in time and talk to patients and their families a little bit before they're diagnosed? And you've got somebody who is going to get this diagnosis in the next couple of weeks, and you can see this journey ahead of them. Is there any advice you would give to patients and their families early on, like even before a diagnosis when this tsunami is about to hit them? Absolutely. In fact, we actually rolled out a whole program called triage health in the hopes that we can actually reach people earlier before they're diagnosed with chronic or serious medical conditions. And it's really about teaching people all the things that we teach people every day, but before they're in a crisis moment. So understanding how to pick the right health insurance for them, understanding how to actually get access to care like screenings and early detection services, understanding how insurance is supposed to cover those things. understanding how you can take time off under the law to be able to even go and get access to those screenings. So really, it's a lot of things that we talk about all the time is the things that we should all be taught in high school so that we can navigate adulting, but that we aren't ever taught. We only really learn these things once we're in a crisis moment, and then it's a whole lot harder. And can people find that at triagecancer.org or is that a separate entity? It's a separate site. It's triagehealth.org. And so people can access the information there. We'll go ahead and put all of this information in the LinkedIn comments as well for anyone who may be interested in learning more. And of course, just the Triage Cancer website too, because you guys are doing the Lord's work. So thank you. um so you know i feel like there's a lot of the times uh people who are working professionals and like super successful in their lives and careers very far away from the medical field um like a ceo at like a fortune five hundred company or something like that well maybe not maybe just like a just maybe just someone a working professional um they think that, oh, you know, HR and my insurance company is kind of going to handle this. What would you want them to understand about how much actually falls on the patients and the families and what they really need to truly prepare for? Maybe Monica, if you could take that one. Sure. I think that people really shouldn't be relying on their health insurance company or even their HR teams to understand what they have access to or what their rights are. I think insurance companies sometimes have case managers that can be very helpful. HR people can be very helpful in guiding people through the process. But I don't think that people should rely on others for a basic understanding of what their rights are or what benefits they have access to, that they really should be informed consumers of health care and informed employees, because who's going to be a better advocate for you but you? Absolutely. And would you say maybe a good place to start is just by going to the Triage Cancer website? Absolutely. And certainly if someone isn't in the cancer community, to Joanna's point, Triage Health. This is information that every single person should have at least a basic understanding of. We all should be making informed health insurance choices every single year if we have more than one choice offered to us, whether that's through an employer or if someone's going out and buying it on the marketplace. You need to understand what that coverage is, just like you would understand the differences between two computer types before you'd made a big purchase decision. We as consumers do so much research and spend so much time on big purchasing decisions. The same should be true for your health insurance because that choice, I mean, yes, I would also argue even more so because that choice is going to potentially dictate what care you get access to and how much you're going to pay out of pocket if you do need to access medical care. And the information is there. You just have to kind of go dig for it and find it if it's not as readily available as it maybe should be. Yeah. I'm just curious, why do you think people are so quick to accept the insurance that's on offer without scrutinizing it? I'm just thinking there's sort of this aura of trust. People don't understand it. People don't understand it. There is data that shows that ninety six percent of Americans can't even define the four most common terms used in health insurance. Yeah. You don't understand the words. How can you be a savvy consumer? Yeah, that's such a good point. But is that like, it almost feels purposeful at that point. It's like, you know, there's like this gap that they're trying to create of like, oh, you know, like using jargon and like bombarding you and being like, oh, you don't know what that means. Then, you know, just that's your fault. You get what you get at that point. So should there be sort of the equivalent of like nursing home compare or hospice compare, a star system that Medicare sets up that rates the quality of nursing homes in ideally easy to understand ways? Could you imagine? I mean, that probably is out there that you would know if anybody does insurance compare. Or you get a summary of benefits and premiums and comments, star ratings. Yeah. Yeah. There are star ratings in Medicare for Medicare plans. Right. And there are ratings in marketplace plans. But I don't think that there are for employer plans. yeah that's that that i mean even apple on their website has the comparison for between the different iphones that you want to buy and that's just like a cell phone but nothing to do with your health and well-being so that's hey maybe we should create that maybe we can go ahead and create that database and allow for people to make those decisions a little bit more um informed but you know uh i kind of want to we kind of go into more so the caregiving side of cancer, because of course, you know, you go through a cancer journey yourself, but your loved ones and the people around you are experiencing that to some extent too. And caregiving responsibility, of course, like emotional financial strength, things like that. So a lot of the times our caregivers are juggling jobs, children, and the health system all at once. What protections exist that most caregivers don't necessarily realize that they'll have, if any? Maybe Joanna. I think that when people think about caregivers, the law that probably pops into most people's head is the Family and Medical Leave Act, which is the federal law that allows caregivers to take time off work to care for a spouse, a parent or a child. But it is unpaid leave. So that's a real downside to the FMLA. I didn't know that. Yeah, I mean, it provides job protection and it provides health insurance protection if somebody gets their health insurance through their job, but it's unpaid. And the truth is, is that only about fifty percent of people in the US actually even have access to the FMLA. And then most people don't actually use it because they can't afford to. So even when they qualify for it, it's not that useful because most people can't afford unpaid leave. So we haven't seen the federal government solve that problem yet. We came pretty close in conversations around the Inflation Reduction Act. There was a move to add paid leave to that reconciliation bill, but it didn't happen. So states have stepped up and have passed state laws that provide paid leave for caregivers. It's an ongoing process. So even there are states that have already passed laws, but it hasn't gone into effect in their state yet. And then we have a handful of states where it's been law for a while. So I think that's something that people don't realize is the FMLA is unpaid, but there might be a resource available to them in their state. Do you have a suggestion for folks who are maybe wanting to find out if that's applicable for their state? What should they look up? So we actually have a chart of state laws on our website at triagecancer.org. And so you can actually look up the employment specific laws and find the chart for paid leave. OK, that's great to know. So everything can be found on the Triage Cancer website. I love it. That's great. Not everything, but we try. Thank you, guys. Maybe shift gears a little bit since we're starting to talk about caregivers and just looking in the comments, there's at least one question about caregiving. What are some of the caregiver questions that you get asked that are most poignant and most meaningful to you? I think one of the most meaningful questions is really like what am I missing doing to support my loved one? I also think that sort of one of the hardest things to talk to caregivers are about the lack of income replacement options. So if a caregiver has to take time off, to Joanna's point, if they don't live in a state with paid family leave, there really isn't a... There aren't a lot of options. There are a handful of them, but there aren't a lot of options. And I think that comes as a big surprise to a lot of people. Whereas if we're talking about income replacement for the person who's been diagnosed, they might have access to disability insurance. An equivalent doesn't exist for a caregiver. So fascinating to say that. I was working in Thailand a few years ago and was seeing patient after patient who basically had to give up their work on the farm, lose their job to take care of caregivers. And I mentioned that to one of the oncologists that that was so tragic. And this oncologist had trained at the University of Chicago. And she said, well, yeah, it is tragic. But keep in mind, the United States is no better. which was both true and humbling. I don't think we do that much better than other countries and rural areas that we really should be ahead of. We definitely don't. I think the other piece of that is we also know that there's a whole lot of data where when it's children who are diagnosed with a medical condition like cancer, one parent typically stops working. And so that person has a long-term career impact, but also the family income level also takes a hit as well. I do feel like to some extent there is still a stigma when it comes to caregiving. And when it comes to, you know, taking time off to care for someone and having those quote unquote resume gaps or whatever the case may be. But the thing is, the numbers don't lie. And there's, I think it's almost sixty million Americans are taking care of a loved one, whether it's a spouse, medically complex child or like their aging parent. So that's one in six Americans that are dealing with this. But it's not nearly talked about enough. And I feel like our government could be doing so much more to kind of like support. And it's great to know that these conversations are kind of being had behind closed doors, maybe not being quite passed yet, but at least it's good to know that it's somewhat top of mind, because especially with how quickly our population is aging, we kind of need to act quickly. And then that doesn't even touch on the fact that there are what are referred to as solo agers. So what if you don't have a family who can take care of you? How are we building a caregiver workforce in the United States to be able to manage an aging population, even when they do have family members who can support some of that caregiving? But then there's a lot of people who don't have anyone who can care. for them and that comes up a lot in the cancer community. Like when somebody has a transplant, they won't release you if you don't have a caregiver who can take care of you for the first couple of weeks. So what does somebody do in that situation? and that's really silly because folks stay in the hospital like what's cheaper to pay for somebody at home with a caregiver or somebody at a high level of care at a place like duke or stanford or harvard financially it makes no sense whatsoever but mentally it has like an impact on the patient too i feel like being in the hospital for that long can't possibly like help with the healing i feel like if you're at home generally you're gonna heal a little bit better especially when you have the structured support in place Yeah, there's haven't been that many really big innovations in caregiving. Nirvana's, the company that she works for, Careyaya, matches pre-health undergrads with older adults who need companionship. And it's not a one-stop shop. It doesn't solve all the caregiving needs, but that's to my mind, like one of the single biggest innovations in caregiving we've seen in the last ten years. There's just so much innovation going on in tech and other places, but this caregiving need that we all have, like everybody's just relying on overpriced home health aids that nobody can afford. And that's the model day in and day out. We really need more innovation in that space, I think. It really is. No one buys long-term care insurance either. Yeah. There's not even a way to pay for it. Right. No, absolutely. And then the thing is, it's it's it's an industry that's kind of been stuck in like the nineties, if not the eighties for so long where, you know, profits are constantly being put over people and it's resulting in the quality of care not being so great either. So it's not just that it's expensive care. It's that it's. not the greatest care either because, you know, our current typical caregiver is overworked, underpaid, and underappreciated. And that leads to really high burnout rates. And at a time where we need more and more and more caregivers because of how fast our population is aging, this is just not how we should be treating them. So, yeah, there's, of course, Keriaya is trying to kind of make a difference in the companionship side of things, but there's so much more that could still be done in this space. But I do kind of want to shift gears back towards insurance a little bit because I would love to know, you know, again, kind of like a magic wand type of question. But if you could redesign the insurance system from scratch with patients in mind, what would it look like? And I kind of want both of your takes on this because I'm curious to know if you have different answers. But Joanne, I'll let you go ahead and take a stab at it first. Well, Monica started by saying universal health care. And I think that feels very politically charged to say it, but a single payer health care system which is not focused on profit from a business model is really the best way to focus on access to quality health care. So I would say if you can remove the business from healthcare, then that's really the most effective way to create a model that patients in mind and that it has to be whole centered patient care. So it's not just about treating disease, but about preventing disease and addressing contributors to disease, like social determinants of health and looking at it from a more public health perspective. Right. You know, I wish that I could get that printed and put on a little wall like a motivational thing for people over profits. Please, please, please. Yeah, absolutely. I love it. Thank you. Monica, anything to add? Joanna really didn't leave me much more to add because I think that really is the key. For every law that gets passed to try to address barriers that are put in place, like utilization management, practices, insurance companies are actually pretty good at finding workarounds or additional utilization management practices. And so the law is sort of never going to be fast enough to keep up with the business side of health insurance. It's really good. Really, really, really good. We are running out of time here per usual because the conversation is amazing and I've been really enjoying it. So Dr. C, do you want to maybe take, pick one more question you would like to ask and I'll pick one more question I'd like to ask and we can then go ahead and jump in with our audience questions. Yeah, I mean, I need to make one up. This is fun. So, Joanna, you mentioned that universal health insurance has become sort of a hot button topic. And without making this too political, because this is obviously, it's been a hot topic for a while across administrations. Why do you think it is? Everybody needs health care. The government has a long track record of taking over industries and other organizations that aren't performing. Why is everybody so averse to this idea of universal health insurance? I think, unfortunately, because it has been politicized, there's always been a difference between people who think that government should be more involved in creating a system that speaks to equity and access to quality health care. And then there's people who think that that isn't the role of the federal government. So from a merely two sides of the coin, that's the perspective. But I think the politicization of the issue has come at a time where everything is being politicized. And so We hear people all the time say like, well, I don't want government in my health care. And then we ask them what type of health care they have and they tell us they have Medicare, but that they love their Medicare. Keep government out of my Medicare. Yeah. Yeah. No. And it's it's partly because people don't understand how our health care system works and where the government does play a role and does provide protections that maybe don't exist in other types of insurance, like capping out of pocket costs for prescription drugs. So there's there's part of the challenge and you know we say this all the time is if we're trying to educate people about the system and how to improve the system people have to understand the system first oh yeah and so that's that's literally the hurdle we try to climb every day is to try to teach people about the system so that it does lead to advocacy changes yeah great thanks I feel like that's kind of The thing we just keep coming back to is education and like, you know, knowing things. And so I guess kind of along those same lines, maybe what's a question that every patient or caregiver should be asking their insurance company? But, you know, most people aren't really, really doing. Monica, you want to take that one? I don't think there's a single question. I think it's a whole bunch of questions. I think it's making sure people understand all of the different costs involved. So what is the monthly premium? What's the annual deductible? What's the cost share? And most importantly, maybe this is the one question. Maybe this is the one question. What is the out of pocket maximum for that plan? And what's included in that out of pocket maximum? because that's a dollar figure that represents the most you're gonna pay out of pocket for your healthcare for the year. And so a lot of times we will have physicians or people tell us that their physicians have said, I can't tell you how much your cancer care is gonna cost. I don't know. We don't know yet how much your total cancer care is gonna cost. Right, yeah. which is fair. They might not know the actual cost of it, but guess what? That cost doesn't actually matter to the patient. There you go. What matters is what's their out-of-pocket maximum. you know, we went back to knowledge and that I think is such a key piece. And listen, that out-of-pocket maximum might be a very high dollar figure and that might be stressful by itself, but you've taken that stress from, okay, now how am I gonna pay for this cost, this expense, which is a different type of anxiety potentially than I have no idea what that cost is gonna be. That's a really good point. Is there like, maybe is there like, a number that like people should be like, okay, if it's above this, then definitely don't go for this plan. Or like, is there like something like, is there like a guideline that like people could follow maybe? Or is there something that's like normal or like average maybe that they should know about? Joanna, you want to take that one? So I don't think that there's a normal number. Um, and we sort of have exponentially seen out of pocket maximums increased over the last five years even. Um, there is a cap on the out of pocket pocket maximum for all the plans sold in the marketplace plan. So each year there's a different dollar figure where plans are not allowed to have an out of pocket maximum higher than a certain amount that doesn't exist in employer plan. So employer plans can frankly pick their own out of pocket maximum. So I would say if somebody was looking and had. an employer plan with an out of pocket maximum higher than a marketplace plan that they might actually want to be looking to see what their other insurance options are. And we say that all the time, like even if you get insurance through an employer, it is valuable to look at all of your options and pick the best plan for you. Yeah, I love it. That's great. And it's good to know that there are safety nets kind of in place, but it makes you a little weary knowing that it could be a million dollars or it could be like a hundred thousand dollars and you just should probably ask and figure out what the actual answer to that is. I do want to give our audience some good ones. Yeah, there are some good ones. There are a couple that we've kind of talked about. You know, Ethan asked about a piece of advice we give to someone starting their caregiving journey. So we kind of talked about that. Look at Maggie's. oh we'll do maggie's all right that sounds good we have uh thank you for being here and sharing your experience and insights yes of course i did have that sentiment um i'd love to know what some or she'd love to know what are some things that you that give you hope when you think about the future of caregiving or cancer care i love that we've kind of had i've been talking about the positives but yeah this kind of will lift us back up uh maybe um monica I think something that gives me hope is how many awesome advocacy organizations exist and what great work is being done in those advocacy organizations. I will also say something that gives me hope as I'm feeling as though we are having more and more conversations around the inadequacies of protections and safety nets. And that I think is the first step necessary for change. We have to talk about the problem before we're going to actually see some change. One thousand percent. Joanna, was there anything you wanted to add to that or did her sentiments change? I would definitely agree with that. I think also because this question was sort of broad, it also said cancer care. I think we've seen massive advancements in the science and the number of, you know, I used to be able to actually and I'm not a doctor, but I used to be able to name most of the chemotherapies that were available to treat cancer. And like I there's no way I could now. And so that really speaks to how far we've come. Even in twenty five years, it's a completely different landscape. Wow, that's incredible. You know, yeah, the science is advancing every single day and that genuinely puts the biggest smile on my face because people are getting to live longer lives, more fulfilled lives and live with cancer. Like cancer is no longer like you have cancer. This is final. Like it's like people are actually like living their lives and going about their days with a cancer diagnosis, which is beautiful and amazing. And you know what, maybe in a hundred years from now that like people will live with cancer for fifty years and it's, they'll be completely okay. This one is another one that I like. We have Esther who is hoping to become a future occupational therapist. And she's wondering from your perspective, what's one legal issue that every future healthcare provider should be aware of even early on in their careers? Joanne, I'll think on you this time. That's a really tough one. I mean, I think maybe actually I would tie it back to appeals. I would say that every healthcare provider should understand the appeals process because If a healthcare provider is prescribed care for a patient and an insurance company has said no, that provider really needs to understand how to make sure a patient gets access to the care that they need. And the appeals process is the way to do that. Monica, anything to add there? I think I would agree with that. I think the only other thing I would add is to not make assumptions about patients' ability to continue working or not. We hear a lot from people that their healthcare providers basically tell them why you can't work or why would you work, just go out on disability. And there's a whole bunch of reasons why that's challenging. And so I think I would want healthcare professionals to really think through what their patient's goals are related to work, and then to understand what rights and benefits those patients might have access to to continue working if that's what their goal is. That's a great- Which is odd because, yeah, I know so many doctors in particular who faced significant diagnoses but continue showing up to work every day because it's their life, they need the income, they need the tuition benefits for their kids, whatever. So it's mystifying to me why those people who show up despite a diagnosis of lung cancer, for instance, and are out on the wards, why don't they give patients the same benefit of the doubt? But yeah, I think we tend to be protective of our patients. There's a whole lot of reasons why people work. outside of a paycheck and benefits. I go to work because it brings me joy and a sense of purpose. I think it is just important. Again, if the patient's goal is that they do want to take that time, then yes, of course, let's talk about disability insurance and job protection leave and all of those things, but to not start with the assumption. Yeah. If I was told, Hey, like you can't work because you should go on disability. I'd be like, I'll probably deteriorate way faster if I don't continue to work because like, it's like gives you that energy and like fresh air in your lungs every day. And it's, um, I don't want to say it, but sometimes I feel like I maybe am a little bit of a workaholic, but it's good because I love it and it brings me joy. So that's, yeah, I definitely get that. And when you, especially when you feel like you are making a difference, that really does make a difference. This is another good one, kind of along the same lines, but maybe slightly different. But Brinley's asking, as a student interested in healthcare, what do you guys think is the most important ways law and medicine need to work together better? Monica? I would say that providers can't assume that talking about the law with their patients is someone else's job. Okay. For example, we hear a lot of doctors when questions around financial well-being or employment rights come up, the doctors will say something to the effect of like, oh, you should go talk to the social worker. Guilty, yeah, because I don't want to say anything wrong, which is really, really likely if you get me talking about insurance. Sure, and certainly we're not suggesting that a healthcare professional be giving legal advice, but there's a difference between advice and information. And having a conversation with their patient about goals and wishes and concerns around finances and employment could potentially inform treatment decisions. Absolutely. Yeah. And so it can't be somebody else's job. It has to be everybody's job, in my opinion. Sometimes just wear blinders like we're going to look at the EKG and then write a prescription. And that's that's our lane. But imagine about looking at somebody's survivorship outcomes and how, you know, financial toxicity actually has physical and mental impact on a patient. You know, you can provide a patient with the best treatment, but it those things are going to impact their survivorship outcomes. Proactively having conversations, even if you don't know the answers to those questions, but bringing up the topics for conversation and then making sure that patients get referred to the entity or person who can have the right answers, like having the conversation is key. Absolutely. A thousand percent. And I'm going to just do one last one here. Paula is asking who's interested in being a future physician. She's wondering how you guys see the role of, oh, I like this, legal advocacy evolving as cancer treatments become more advanced and therefore more expensive. You guys are kind of talking about how the innovations are happening, but maybe there's, there might be like a, you know, I guess a downside to that. But what do you guys think about that question? Maybe I'll let Joanna start with this one. I think that the advocacy role of healthcare teams specific to access to cancer treatments is gonna end up being around access to quality insurance coverage and how those treatments are being paid for and making sure that there's equitable access as well. across all types of insurance, because I think in the United States, that's a factor as well. So I would say it's not just legal advocacy, but maybe it's also legislative or policy advocacy to make sure that our systems are set up to make sure that those really amazing advancements are accessible. Pulse to reform. I love it. Any two cents or last minute thoughts you'd like to add, Monica? I think she said it perfectly. Well, I think you guys both said everything perfectly. This was such a wonderfully insightful episode and we probably have about fifteen more questions that we could ask you guys, if not fifteen million. Maybe we'll have to do a follow-up episode in a few months. Maybe once a new policy passes or something like that, then we can reconnect and chat some more. I really, really, really appreciate you guys being here today. Thank you. This was so much fun. And we learned a lot. I hope you had as much fun as I did. We did. It was a great conversation. We appreciate it. Well, thank you guys. And I'll put all the information for our audience in the comments regarding triage cancer and the amazing work that you're doing. But thank you guys for those at home for listening and for my wonderful co-host, Dr. Casserette, for being so amazing for usual. Bye, everybody. Thank you both. Thank you.