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Avatar universal

How to Get Health Care While Uninsured

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.


http://thebillfold.com/2012/06/how-to-get-health-care-while-uninsured/
24 Responses
Avatar universal
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 associations dedicated 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.

Avatar universal
This guy makes it sound easy doesnt he? However my experience with this topic has been quite different.

Did you know? If you go to the ER, the hospital has an obligation to treat you IF it is a county hospital that accepts gov funds.

BUT: They can admit you, and get you stable,  but it is up to the doctor on call to decide if he wants to treat you or not, it you lack insurance? Because the doctor on call is paid separately and can make that decision for himself.
Avatar universal
You are correct, Teko. When I was bleeding the only place I could go was ER. Seeing a specialist w/o insurance costs close to $500. a visit, not including labs etc. It is not so easy.
649848 tn?1534637300
The article somewhat touches on what I've been saying for some years.  The whole health care issue centers completely on whether or not one has insurance, not the actual cost of care.  It is possible to get treatment without insurance and often to get it cheaper.

One example is my own lab work -- I have the opposite of Graves Disease; which is Hashimoto's Thyroiditis, which requires thyroid replacement medication, rather than anti-thyroid medication.  I, too, require periodic blood work to make sure my levels are adequate.  I, typically, have 3 tests done and the lab bills my insurance for nearly $900 for those 3 tests.  On the other hand, there are web sites from which I can get those same tests for < $100.  You order the test, they e-mail you a lab order, and tell you what lab to go to.  Once the blood work is done, they e-mail you the result. Yes, when I go that route, I have to pay for it, but it's affordable.  Why should lab work billed to my insurance cost 9 times more than I can get  by paying out of pocket?









Avatar universal
Your situation is one example of how it can be cheaper to pay out of pocket, but there are many situations where paying out of pocket is not possible.
Maybe there should be some work on the way insurance manages health care, but making it unavailable to people will be more detrimental in the long run, I believe.
Avatar universal
One thing I think is being overlooked in this article is the fact that hospitals seeing people in the ER that are not insured is putting them in a bankrupt status. Secondly, what is not mentioned here as well is that alot of the clinics are so backed up that you cannot get in to see a doctor when you need one, they have a backlog. Our local health department is referring patients to other areas for the same reason. They cannot handle the load. Then you have the emergency care things that you can walk into but again, they can only handle so much and does not necessarily reduce cost at all.

Bottom line is we are going to have to come face to face with this rapidly growing problem soon or it alone will shred our entire economy.
480448 tn?1426952138
BUT: They can admit you, and get you stable,  but it is up to the doctor on call to decide if he wants to treat you or not, it you lack insurance? Because the doctor on call is paid separately and can make that decision for himself. .

I actually have no problem with this...they have a duty to stabilize someone, take them out of immediate danger, which they will do.  But remember, doctors don't work for free.  Where's their guarantee for payment?

If you needed a $2500 repair on your car, and without it it wouldn't run...you're not getting your car back until you pay.  Doctors can't hang onto your gallbladder, or appendix, or whatever, until they receieve payment in full, so they sometimes have to make tough decisions.  

I don't know ANY trade that does the work without some kind of guarantee of payment.  No one expects those people to work for free, why should we expect doctors to?  Because it's a medical issue?  Remember, again, they have gotten the patient out of life threatening danger.  They shouldn't be obligated to do anything else, if they no idea if they'll ever get paid for their services.

That being said, in almost 19 years of being a nurse, I've never seen a self-pay patient be refused care.  You'd be surprised and how many docs do and WILL treat the patient anyway, and many have told me they're lucky if they ever see a penny.  

But still, my main point was, before I started babbling was that they DO have that right to not treat, if payment isn't guaranteed.  I don't think that's wrong.

I have gone uninsured more times than I have been insured.  I figure it out.  Sometimes it hasn't been easy, sometimes it required a lot of work.  There are a LARGE range of plans out there.  There are very affordable higher deductible plans that will in the very least cover a very expensive hospitalization.  With those kinds of plans, you have the security of being covered should something big and bad happen, but you have to pay out of pocket for most preventative/routine care.  I've actually found that routine care is very affordable out of pocket.  I've always gotten a cash pay discount...sometimes up to 25% off.  

I also have had no problem going out and insuring myself.   If I can do it, why can't everyone else?  

Just my 2.5 cents.
649848 tn?1534637300
Many of us are having to insure ourselves....... it's costing my husband and I nearly $1000/month to do.  I agree with everything else you said.  Where I run into trouble with the whole "buy your own insurance", is those people who can't get insurance, because of their pre-existing conditions.  Something has to be done about that.  Conditions that prevent one from getting insurance coverage are often the most expensive to treat.
480448 tn?1426952138
Barb, I agree wholeheartedly.  
Avatar universal
"I also have had no problem going out and insuring myself.   If I can do it, why can't everyone else?  "
Maybe because you have an income?
I know a woman who did very well for herself until she was dx with cancer. In order to treat, she had to leave her job. The cancer was not a quick fix, and eventually she lost her healthcare for lack of income.She ended up homeless and died at a hospice shelter.
I am not saying that people shouldn't be required to pay for health care. There are countries where it is subsidized based on your income level.
I don't pretend to have the answers but anyone who would refer to a woman like I referred to as an irresponsible freeloader (in so many words) will never get my vote.
Avatar universal
Trying to Minimize a Crisis:  
The Myth That the Uninsured Estimate is Overstated

http://news.wustl.edu/Documents/Uninsured-Myth.pdf

Describes who the uninsured are in this country.
480448 tn?1426952138
Well, that's very sad and terribly unfortunate.  So sorry that happened to her.  But, if she had no income, why wasn't she eligible for Medicaid?  She should have been.

I have NO issue whatsoever with the people who REALLY cannot afford healthcare to be taken care of...100%.  

As far as having an income...the healthcare I've purchased in the past wasn't exactly cheap, I had to make sacrifices in order to afford it, and by sacrifices, I mean downgrading from 7000 channels a month on our dish TV, to 3000 (insert smile).  We had to sacrifice eating out, and other non essential things, and sometimes, even with those sacrifices, it was tough, but the point is, we did it, we made it happen.  I'm not Ivanka Trump with millions in the bank.  I'd classify us as middle to upper middle class.  Our income levels vary significantly with the construction ups and downs, so it can be tough, and has been at times.  Again, remember, I've been uninsured more than I've been insured, so I've been there.

IMO, a perfect system would ensure that those who really needed it were taken care of...and I mean REALLY taken care of, no substandard care.  Those who are not disabled, or in the poverty range should have access to good and affordable health care options that THEY choose, based on what they can afford and what their needs are.  

And, like Barb said, the pre-existing condition issue us a big big deal.  That needs addressed.  People shouldn't have to pay an arm and a leg (insert another smile) for health care because they have pre-existing condition, nor should it be hard for those people to find good coverage.  That's a big problem.  I have panic disorder, guess what's almost always on the exclusion list?  Mental health.  Other than that, I seldom seek medical care for much of anything.  Sort of leaves me screwed.

Right now, there are not enough compaies competing for people's health insurance.  The less companies in the game, the more they can charge.  I just don't think the answer is to have the government take over.  I like choices, I like options.  I like handling my OWN affairs.  I think everyone else, who isn't at or below the poverty level, or is disabled, should be able to do the same thing.  It's not IMPOSSIBLE.  If someone does have health insurance, there absolutely are options...they don't have to wait around until Uncle Sam gives it to them.  Again, my opinion.  I'm NOT calling anyone a freeloader, BTW...I would never be so heartless.

You will never get an argument out of me that are health care system needs tending to, it's NOT working the way it is.  I see it with my own eyes.  NO way should it be okay, no matter WHO is paying the bill, to charge someone $10 for a Tylenol when they are in the hospital.  Highway robbery.

And teko, I know that there are a LOT of people who are uninsured in this country.  Again, even more incentive to get companies out there into the fray, it goes back to supply and demand basically.  There are all kinds of options that aren't Obamacare, that don't involve fining small businesses if health care isn't made available to their employees, when the result of doing so would be to hurt the company financially in a HUGE way.  

My BIGGEST fear with Obamacare is that the QUALITY of our healthcare will suffer drastically, and I really think it will.  Historically speaking, when other countries have gone to a nationalized healthcare, research and development suffered terribly.  Cuts have to be made somewhere, as the expense for that kind of model is huge, unless of course you tax everyone to death, which most of us, even on both sides agree that's not the answer.

I have an example about the competitive market model.  Lately, the big chain stores (WalMart, Target, etc) have started the $1-5 prescription game.  What they did was choose a whole bunch of frequently Rx'd meds that were cheap...and they marketed the deals to the consumer.  People LOVED it.  The companies win, because they get that customer into the store, and they buy other things.  The Rx isn't where they're making most of their profit anyway.  It's the $20-50 in merchandise that customer will buy every time they go into the store.  The chains go back and forth, competing, offering incentives and other things.  Customers are happy with their $1 bottle of Amoxicillin, and the store made money.  The customer can choose which store has the best deal, and they will go back and forth...one store offers an Rx for $2, the competitor counters for $1....the first store then offers a "frequent flyer" program.  You get the drift.  

Kind of an unrelated example, but it came to mind.  Gas.  Everyone is always in an uproar about gas prices and how much $ the fuel stations are making.  My hubby is a specialized electrician, he does ONLY fuel stations, in many states, so he knows a lot about how that works.  A lot of people would be surprised to find out that the gas stations make very little, if any profit on the fuel...it's the soda, cigarettes, etc where their profits come from.  HOWEVER, the fuel stations stay competitive by raising or lowering their fuel prices by 1/10 of a cent.   They have very little wiggle room on their pricing anyway, since that's regulated.  BUT, the lowering of the price gets people into the store, so they can profit on the other products.

Kind of a convoluted example, but hope you get where I am coming from.  There is SO much more potential if healthcare was handled as a business, which is exactly what it is.  The problem is, people cringe to think of it that way, because well, lives and health are involved.  Understandable.   Let the people choose.  The more competition, the more choices, the more choices, the more affordable healthcare becomes.  Combining that, and stopping the outirght gouging that goes on in healthcare would be a start.  

Obviously, there are so many other options, ways people could get breaks on healthcare, could get incentives for various things....there could be state level assistance with the market...not regulation, assistance.  The possibilities are endless.

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