Some links and readings posted by Gary B. Rollman, Emeritus Professor of Psychology, University of Western Ontario
Thursday, November 22, 2012
How to Get Health Care While Uninsured | The Billfold
A couple of years ago, I had a cold for about four months. I thought I had somehow caught five colds in a row, which I thought was no big deal, because they were just colds after all.
But then I started dropping a lot of weight while eating a lot of chocolate cake. My hair started falling out, and I had the shakes so bad that my handwriting—which I used to be proud of—became illegible. My short-term memory stopped working. It was difficult to have a conversation, because by the time I neared the end of a sentence, I had already forgotten what I was talking about.
Things were bad, but I had no health insurance, which I thought meant that the only thing to do was try to ignore it, and hope that whatever was wrong with me would go away on its own. Each new symptom added another few hundred dollars to the imaginary doctor's bill in my head, which meant that as things got worse, I had more incentive to pretend that I had some sort of temporary bug that would eventually go away.
Then one day, I got up to go to work— at the time, I had a part-time job copyediting product labels and PowerPoint presentations—but I couldn't make it out the door. About halfway through my morning shower, I started panting, and my heart was beating out of my chest. It was as if I had just run a mile, when I had actually just walked 20 feet from my bed to the bathroom. There had been signs before this incident: The day before, I found myself so nauseous and out of breath during my four-block walk to work, that I turned around and went straight back home.
It took near-complete incapacitation for me to bite the bullet and go to the doctor. It turned out that I have Graves disease, a congenital, autoimmune hyperthyroid condition that I'll have for the rest of my life. Missy Elliot, George H.W. Bush and Barbara Bush also have it. Graves disease affects every cell in your body, so it gets bad if it goes untreated. But it's very manageable as long as I take my pills, see my endocrinologist and get a blood test every six weeks.
As a freelancer, I still don't have health insurance. But at this point, I've gone to a bunch of doctors, and have learned some things along the way about getting health care without health insurance. The more I know about the health care system, the less I do stupid things like get so sick I can't function anymore.
1. Doctors aren't just for the insured.
If you don't have health insurance, the immediate reaction is not to go, and to chew on a couple of echinacea pills and hope for the best. I thought of health insurance as some kind of entry card to the entire health care system, but it doesn't work that way. Plain old cash can get you through the door too. A trip to a doctor costs around $150–$200, or about the price of a nice dinner.
If you're too broke to go for nice dinners, then look for community health clinics, like Ryan-NENA in New York City, which has a sliding scale for people without health insurance. I used to go there for routine check-ups when I was a student, and they were very nice. I don't remember getting a bill for more than $5. If you're skirting the poverty line, which is an annual income of$10,890 for a single person, then you might qualify for Medicaid, and you should definitely apply.
The other thing to keep in mind is that unless it's a true emergency (severed limbs, heart attacks), don't go to the emergency room. Go to an urgent care clinic for things like broken bones, pink eye, and other non-life threatening illnesses, or a private walk-in clinic. They're more pleasant, faster, and much, much cheaper. Call ahead to ask how much, but they usually fall in the $150–$200 range to see a doctor. I went to one in San Francisco, and they were the ones who ended up diagnosing my illness. Last time I had a tear in my cornea, I went to this place in Manhattan.
Sometimes specialists don't cost much more than a generalist, depending on what you need. The endocrinologist I go to in New York charged $300 for the initial consultation, then $175 for each visit afterwards. While general practitioners are accessible and great, it's nice to have a specialist who knows a lot about my disease. If you've had insurance before, you may have heard that you need a "referral" before going to a specialist. That's insurance provider bureaucracy, and you don't need one if you don't have a health insurance company to answer to.
2. Always ask for a discount at the moment when you are handing over your debit card.
Even if you've made a huge deal since the moment you walked into the doctor's office that you don't have health insurance, they often won't give you a discount unless you ask for one, point-blank. If you've called ahead to make sure they give discounts, be sure to ask again at the counter. It's up to their discretion, but the discounts I've gotten have been around 20 percent off. And since I go to doctors pretty often, I've had a chance to test this out. When I'm too shy to ask for a discount, I usually end up paying more.
The trick is to remember that you're making them do less work because you don't have health insurance. They don't have to pay an administrator for filling out insurance paperwork. They don't have to wait for the insurance company to send a check. They don't even have to send out a bill. When the office gives you a discount, they're not just being nice: You've saved them from doing a lot of work, and deserve one.
3. Blood tests are very expensive, but they also offer big discounts.
I really hate needles, but the thing about blood tests that scared me the most was the bill. Before I got the right diagnosis for my illness, I went to a doctor who ran $1,200 worth of blood tests. They were all the wrong ones, and told me nothing useful, but I still had to pay for them. It was horrible. I didn't know that discounts existed, so I didn't know to ask for them.
These days, I still have blood tests every six weeks, but my doctor gives me a form to fill out called the "Patient Financial Assistance Application," which I send to Quest Diagnostics, a testing company. I declare my income, and depending on how much I'm making with my footloose and fancy-free freelance job(s), I fall into either the 50 percent off bracket, or the 75 percent off bracket. Instead of paying around $400 every six weeks, I pay around $100.
4. Drugs can be really, really cheap. Don't assume that you can't afford any medicine at all without health insurance.
As with everything else on this list, it all depends on what you have and what you need to treat it, but if the patents on your drugs have lapsed, the generic version will be dramatically cheaper. I got a prescription for alprazolam (generic Xanax) for anxiety related to a spike in hyperthyroid symptoms, and a bottle of 30 pills cost $20. Cheap.
5. Medical tourism isn't as sketchy as it sounds, and it is less sketchy than just being sick for years.
You know how health care costs so much more in America than anywhere else in the world? That's a huge topic that can and should be talked about, but here's how it played out for me. After getting a blood test that showed that my thyroid levels were completely out of whack, I was told that before I could start treatment, I needed to take two more tests. Large machines and radioactive liquids were involved. That sounded expensive.
I called a specialist to ask how much it would cost without health insurance. They estimated that it would be $3,000 to $7,000. Not just expensive, but prohibitively expensive.
I'm from the Philippines, and my cousin is a doctor there, so I called him. He was appalled at the price that I was quoted, and told me to go to the Philippines to get these tests. Here's why: Each of those two tests cost $20. For a total of $40, or the price of a cheap meal for two in the U.S. and—just to give you some perspective of relative prices—$40 is the price of a nice meal for two in the Philippines. Add the price of a ticket, some doctors fees ($14 per visit) and a trip to the beach, and I spent maybe $2,200. My doctor was the head of endocrinology at a big hospital there, and was educated in the U.S. She was, by far, the most capable and knowledgeable doctor I've dealt with so far. The experience was easy, pleasant and safe. There was even a man playing a grand piano in the lobby of the hospital.
There are risks (and probably some discomfort) to going abroad, sight unseen, to get medical treatment, so do your research. But with limited access to health care and rising costs in the U.S., medical tourism is something that millions of people do each year. I suggest involving your doctor in the U.S. Mine wrote down exactly which tests I needed to come back with, and I called my endocrinologist in the Philippines before booking my tickets to make sure that all the logistics worked out. If you don't have a connection in another country, there are whole associationsdedicated to facilitating medical tourism, and there are a couple of hospitals who have made their name treating foreigners, like Bunrumgrad Hospital in Thailand.
Everyone's health care experience is going to be different, but the aim of this is to demystify the health care system enough to help you start using it. Just because you don't have health insurance, it doesn't mean you're not going to get sick. Remember that you have options.