December 2016 Ask the Expert: Financial and Career Concerns

December 1, 2016

Breast cancer and its treatments can make working difficult or impossible. This can have serious effects on your career and your financial health. But having information about your rights and about what resources available to you can help you get through this tough time.

In December, Living Beyond Breast Cancer expert Joanna L. Fawzy Morales, Esq answered your questions about your finances and your career, from your legal rights as an employee, to social security disability benefits, to where to turn for financial aid, and more.

Remember: we cannot provide diagnoses, medical consultations or specific treatment recommendations. This service is designed for educational and informational purposes only. The information is general in nature. For specific healthcare questions or concerns, consult your healthcare provider because treatment varies with individual circumstances. The content is not intended in any way to substitute for professional counseling or medical advice.

This provides general information on the topics presented. It is provided with the understanding that Triage Cancer is not engaged in rendering any legal, medical, or professional services by its distribution. Although this content was reviewed by a professional, it should not be used as a substitute for professional services.

I know I don’t have to talk about my history of cancer during a job interview, but if I do bring it up, can the employer legally choose not to hire me because of it?

Disclosure decisions are very personal. How much you choose to tell an employer, a co-worker, or even your family and friends about your medical conditioninfo-icon is up to you. Specifically, you do not need to tell a current or potential employer about your medical condition. There may be some reasons that you do decide to tell, but you can still control when, how much, and with whom you share information.

For example, you may decide to share some information about treatment side effects you are experiencing (fatigueinfo-icon, neuropathyinfo-icon, etc.), so you can have access to reasonable accommodations at work, but you may still choose to not share your cancer diagnosisinfo-icon. You may also decide not to share information about your medical condition during an interview, but then come to realize after you have started working that you need a reasonable accommodation and then choose to disclose your diagnosis. 

If you do decide to share information about your medical condition, the Americans with Disabilities Act (ADA) or a state fair employment law may protect you from workplace discrimination if you are eligible. This means that covered employers cannot treat you differently or make work-related decisions (hiring, firing, benefits, promotions, bonuses, etc.) based on your medical condition.

Some people feel very strongly about disclosing their medical condition in an interview. And while the law is protective, if an interviewer does act in a discriminatory way by not hiring you because of your medical condition, it is very difficult for you to know that was why they didn’t hire you.

This is a very nuanced issue and Triage Cancer has created a Quick Guide on Disclosure to help you think through some of these issues, so that you can make the best decision for yourself.  

If there are layoffs at my job, do I get any special protection that other employees who are being laid off don’t get, because I have cancer?

Generally, if your employer is going through layoffs, then you are not entitled to special protections that protect you from being laid off because you have cancer. But your state, your employer or your union contract might have specific rules on this topic.

As mentioned above, the ADA and state fair employment laws protect you from being treated differently because you have cancer when employment decisions are being made. For example, if you work for a company that lays off the entire IT department, but also lays off you, and you work in the communications department, that could be seen as discriminatory. But if the company lays off the entire IT department and your communications department, that is not likely to be seen as discriminatory.

Another example would be while you are taking leave as part of the Family Medical Leave Act (FMLA). If you are taking FMLA leave your job is protected, but if your company decides to lay off your whole department, you may still be laid off under the FMLA. Click here for more information.

If you are taking time off from work and are receiving disability benefits, your job is not generally protected. But if your employer has a policy that says they will hold your job for you for 6 months while on leave, then your job may be protected from layoffs during that time period. The details depend on the employer’s policy. 

What do you have to do to be eligible for COBRA?

COBRA is a federal law that allows eligible beneficiaries to keep their existing employer-sponsored health insurance coverage after experiencing a qualifying event. COBRA only applies to private employers with 20 or more employees, or state or federal governments. If you work for a smaller employer, you may qualify for coverage under a state COBRA plan. State COBRA plans vary greatly. Click here for information about your state’s law.

Qualifying events include leaving or losing your job or reducing your work hours, the covered employee enrolling in Medicareinfo-icon, divorce from or the death of a covered employee, or aging out of your parents' policy when your turn 26. With COBRA, you may be able to continue your employer-sponsored health plan for 18-36 months, depending on which qualifying event you experience.

COBRA Qualifying Event

Maximum COBRA Coverage*

Employment ends or hours reduced

18 months

Loss of dependent child status

36 months

Employee enrolls in Medicare

36 months

Divorce or legal separation

36 months

Death of employee

36 months

COBRA coverage must be very similar, if not the exact same coverage, you had with your employer-sponsored plan. But COBRA typically costs you a lot more, because you have to pay 100 percent of what the employer was paying for your coverage, plus a possible additional 2 percent administrative fee.

When you have a qualifying event, you can choose COBRA coverage. It is important to remember that COBRA is not an actual health plan. It is the right to keep your employer-sponsored health insurance for an additional period of time. Click here for more information about COBRA. 

I’ve always had good credit and have been very responsible about paying my bills in full and on time. But now I’m struggling. I’m worried that even if I can get back on my feet, my credit will be permanently damaged. How do I stop the costs of cancer from affecting me the rest of my life?

Cancer is expensive. There are some ways to deal with medical and other unexpected costs of a cancer diagnosisinfo-icon. You also have rights as a consumer.

If you are newly diagnosed or are currently in treatment:

  1. Make sure you understand your health insurance coverage. You want to know what your deductible is, any copayments that you have to pay when you get certain types of care, your co-insurance amount when you get medical care, and what your out-of-pocket maximum is for your plan.
  2. Talk to your healthcare team about what they know about your medical expenses and whether your insurance policy will cover those expenses. If you don’t have health insurance or you are not happy with your coverage, then you can look at your options at CancerFinances.org. Your healthcare team might also have information on how to keep your expenses down, and on local financial assistance programs.

If you have completed treatment and are dealing with medical bills, here are some strategies:

  1. Don’t ignore your bills. Open them, check them to make sure they are correct, and compare them against your explanation of benefits (EOB) from your insurance company. Then once you have confirmed the amount you owe, figure out how to pay your bills.
  2. Negotiate. Some providers or other creditors will let you work out a payment plan. Others will let you pay a lump sum amount that is less than you owe to pay off your bill. For example, you may owe $1,000, but your provider may let you pay $500 to pay off the bill.
  3. Think creatively. Maybe you can get help with your utilities. Then you can use the money you saved there to pay for out-of-pocket medical expenses.
  4. Look for financial assistance. Don’t assume that you don’t qualify. Click here to view financial assistance resources for everything from medical expenses to child care.
  5. Watch these videos for more ideas on how to manage your finances and avoid drowning in medical debt.

How is a “reasonable accommodation” defined? If I think what I’m asking for is reasonable but my employer doesn’t, where do we go from there?

A "reasonable accommodation" is defined by the Americans with Disabilities Act (ADA) as "any change in the work environment or in the way things are customarily done that enables an individual with a disability to enjoy equal employment opportunities." There are three categories of reasonable accommodations:

"(i) modifications or adjustments to a job application process that enable a qualified applicant with a disability to be considered for the position such qualified applicant desires; or

(ii) modifications or adjustments to the work environment, or to the manner or circumstances under which the position held or desired is customarily performed, that enable a qualified individual with a disability to perform the essential functions of that position; or

(iii) modifications or adjustments that enable a covered entity's employee with a disability to enjoy equal benefits and privileges of employment as are enjoyed by its other similarly situated employees without disabilities."

This is a very broad definition of what an accommodation can include. However, a reasonable accommodation must be reasonable. And that is going to be determined by your job responsibilities. For example, it would likely be unreasonable for an elementary school teacher to ask to telecommute to his or her job.

Click here to read more about reasonable accommodations. If you would like assistance with asking your employer for an accommodation, you can contact the Job Accommodation Network. For information about the ADA and your enforcement rights, you can contact the Equal Employment Opportunity Commission

Can something be considered a reasonable accommodation by one employer, but not by another employer, even if the kind of work being done is the same? My previous company let me work from home the day after certain treatments that made it hard for me to get to the office. But my new employer says I can’t do that. Does the fact that another, similar employer saw this as a reasonable accommodation give me more leverage to argue with my current employer?

Reasonable accommodations are determined by a number of factors, including your job responsibilities, your workplace, your workplace policies, your medical-related needs, and others. So, it is possible that an accommodation that is accepted by one employer might not work at another employer. But, if many of the factors are the same, it can help to show your employer how it worked at a previous employer and how you were still able to meet the employer’s needs. It can often be useful to put yourself in your employer’s shoes and propose a well thought out accommodation/plan that makes it easier for your employer to just say “yes.”

After everything I’ve been through, I feel inspired to change my career and start doing work helping people with breast cancer. I don’t have a medical degree though. What other kinds of careers could help people with breast cancer, and do you have any advice on breaking into those fields?

It is not uncommon to feel like a career change would better suit you after a cancer diagnosis. While there is not a specific field that we would recommend, we would encourage you to think about your skills and how you would enjoy using your skills to help others. You might find it useful to talk with a career coach. Once you find a career you are interested in pursuing, you may want to look into classes that can expand your skills (for example, computer programs, languages, etc.), or vocational rehabilitation programs in your area.

I quit my job Oct. 1, 2016, applied for disability and was approved. But I will not receive benefits for 6 months. In the meantime, my out-of-state hospital wants me to sign a financial contract and pay $190 per month on my $4,500 hospital bill. I have told them I am unemployed, but will pay more when my benefits begin. (I already pay $50 per month right now.) Legally, can they sue me?

Many healthcare providers, as well as other creditors, are willing to work with you if you are having trouble paying your bills. Working out a payment plan is a good way to meet your financial obligation while on a budget. If you are having trouble paying your bills, it can be helpful to communicate with your creditors to see what your options might be. Typically, creditors don’t sue for unpaid bills, but they can send your bills to a collections agency, and that can have a negative impact on your credit. Watch this webinar for more information about your consumer rights.

I have metastatic breast cancer, so it’s very important to me that there are no gaps in my health insurance coverage. I’m planning to change jobs soon. How do I make sure my coverage is continuous?

COBRA is a federal law that allows eligible beneficiaries to keep their existing employer-sponsored health insurance coverage after experiencing a qualifying event. COBRA only applies to private employers with 20 or more employees or state or federal governments. If you work for a smaller employer, you may qualify for coverage under a state COBRA plan. State COBRA plans vary greatly. Click here for information about your state’s law. The original goal of COBRA was to provide a health insurance bridge for people when moving between jobs. You can keep your COBRA coverage until your coverage begins at your new job. One of the downsides of COBRA is that it can be expensive, because you must pay the full amount of the premium that your employer paid for your coverage. If you find that COBRA is too expensive, you can look at other health insurance options. Ask yourself:

  • Can I move to a spouse’s health plan?
  • Am I eligible for Medicareinfo-icon or Medicaidinfo-icon?
  • Is there a marketplace plan available in my area that has similar coverage, but costs less?

Please note that some of these options might be impacted by the recent elections, and there may be changes to our healthcare system in 2017. For the latest information about your health care options, you can visit cancerfinances.org

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