Financial concerns of adults with cancer using patient navigation services offered through employer-sponsored...

Despite insurance coverage, cancer patients often face significant financial burdens. This study examined how commercially insured cancer patients utilize employer-provided virtual healthcare navigation services for financial concerns.

We analyzed chat conversations between care coordinators and members with cancer who used virtual navigation services provided by Included Health during 2022-2023-a third-party vendor contracted by employers to deliver navigation as an ancillary benefit. Included Health is not an insurance company and does not approve claims, determine coverage, or make payment decisions. Services included benefits routing, provider search, clinician referrals, care management, and expert medical opinions. Using natural language processing, we categorized financial discussions into four levels: no financial mention, financial inquiry, financial concern, and financial stress. We used chi-square and t-tests to examine differences across categories.

Of 18,001 eligible cancer patients, 27.4% (n = 4937) used navigation services. The most utilized services were benefits routing (49.9%), self-service provider search (42.5%), and care coordinator assistance for finding in-network clinicians (39.3%). Among members using chat functionality, 82% raised financial matters: 30% made financial inquiries (e.g., coverage verification), 37% expressed financial concerns (e.g., insurance payment issues), and 14% reported financial stress affecting well-being. The remaining 18% had no financial mentions. Members reporting financial stress were more likely to use concierge referral services (55.4% vs. 44.1%, p < 0.01), expert medical opinions (18.6% vs. 12.4%, p = 0.01), and case management programs (27.9% vs. 17.5%, p < 0.01) compared to those reporting financial concerns without impact.

The high prevalence of financial concerns among commercially insured cancer patients using independent, third-party navigation services demonstrates that insurance alone does not shield patients from financial stress. Members' willingness to discuss financial concerns with care coordinators indicates that virtual navigation services can serve as an important resource for identifying and addressing financial toxicity in cancer care.