You will not need a calendar or journal for financial records, just a big, well- organized file cabinet. It is essential to keep track of bills and payments. Dealing with financial records is a major headache for many parents, but keeping good records can prevent financial catastrophe. Financial record-keeping is most important in countries such as the United States, where most individuals are covered by private medical insurance. In countries with standardized healthcare, such as Canada, parents never receive a bill for their child’s cancer treatment. The following are ideas about how to organize financial records:

• Set up a file cabinet just for medical records.
• Have hanging files for hospital bills, doctor bills, all other medical bills, insurance explanation of benefits (EOBs), prescription receipts, tax-deductible receipts (e.g., tolls, parking, motels, meals), and correspondence.
• Whenever you open an envelope related to your child’s medical care, file the contents immediately. Don’t leave it on the desk or throw it in a drawer.
• Keep a notebook with a running log of all tax-deductible medical expenses, including the service, charge, bill paid, date paid, and check number.
• Don’t pay a bill unless you have checked over each item listed to make sure the charge is correct.
• Start new files every year.

Deductible medical expenses

It is estimated that families of children with cancer spend 25 percent or more of their income on items not covered by insurance. Examples of these expenses are gas, car repairs, motels, food away from home, health insurance deductibles, prescriptions, and dental work. Many of these items can be deducted from federal income tax. Often parents are too fatigued to go through stacks of bills at the end of the year to calculate their deductions. If a monthly total is kept in a notebook, then all that needs to be done at tax time is to add up the monthly totals.

The Internal Revenue Service (IRS) generally allows you to deduct any reasonable cost for procedures or expenses that are deemed by a doctor to be medically necessary. You may also deduct certain ancillary expenses with proper documentation; some of the costs that are currently deductible include wheelchairs, wigs, acupuncture, psychotherapy and counseling, and HMO fees, special education or tutoring costs for sick children, meals at the hospital, parking at the hospital, and transportation and lodging costs while your child is in the hospital.

To find out what can be deducted legally for the years your child is undergoing treatment, get IRS Publication 502 for the relevant tax year. You can download this publication from the IRS website at www.irs.gov or make a copy from a hard-copy master at your local library. You can contact an IRS representative at (800) 829-1040, Monday through Friday.

Canadian families are able to deduct many of the same medical expenses as U.S. families. To find out what can be legally deducted in Canada, visit the Revenue Canada website at www.cra-arc.gc.ca and type in the search term “deductible medical expenses,” or call (800) 959-8281.

If you keep a calendar, an easy way to keep track of tax-deductible items is to glue an envelope to the inside cover. Whenever you incur an expense that may be tax deductible, put the receipt in the envelope and file it when you get home.

Dealing with hospital billing

Unfortunately, problems with billing are common for parents of children with cancer. Here are two typical experiences:

It is impossible to prevent billing errors, but it is necessary to deal with them. Here are step-by-step suggestions for solving billing problems:

• Keep all records filed in an organized fashion.
• Check every bill from the hospital to make sure there are no charges for treatments not given or errors such as double billing.
• Check to see if the hospital has financial counselors. If so, make contact early in your child’s hospitalization. Counselors provide services in many areas, including help with understanding the hospital’s billing system, billing insurance carriers, understanding explanations of benefits, managing hospital/insurance correspondence, dealing with Medicaid, working out a payment plan, designing a ledger system for tracking insurance claims, and resolving disputes.
• If you find a billing error, call the hospital immediately. Write down the date, the name of the person you talk to, and the plan of action.

• If the error is not corrected on your next bill, call and talk to the billing supervisor. Explain the steps you have already taken and how you would like the problem fixed.

• If the problem is still not corrected, write a brief letter to the billing supervisor explaining the steps you have taken and requesting immediate action. Keep a copy of each letter that you write and all written responses.
• Every time you receive an EOB from your insurance company, compare it to the hospital bill. Track down discrepancies.
• If you are inundated with a constant stream of bills and there are major discrepancies between the hospital charges and what is being paid for by your insurance, ask both the hospital billing department and your insurance company, in writing, to audit the account. Insist on a line-by-line explanation for each charge.

• If you are too tired or overwhelmed to deal with the bills, ask a family member or friend to help. That person could come every other week, open and file all bills and insurance papers, make phone calls, write all necessary letters, and even scan your records into your computer for storage.
• Don’t let billing problems accumulate. Your account may end up at a collection agency, which can quickly become a nightmare.

Not all stories are so grim. People who are in a socialized healthcare system, some managed care systems, or on public assistance never even see bills. Many people with insurance encounter no problems throughout their child’s treatment.