I thought I would post this as it may help someone
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.