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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/
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/
That was an extremely well written and very interesting post. You tell a great story Brice.
Thanks for that.
Mike
Thanks for that.
Mike
If you asked my wife, I'm pretty sure that she would think that your husband and his buddies are related to me and mine. Must be a guy thing to want to blow things up... with that having been said, I have yet to be admitted to the hospital for some of my tricks with explosive gasses, under high pressure. With that being said.... I don't often play with explosive things other than lighter fluid and the bar-b-que grill....
I got burned with industrial drain cleaner, one night at work. We were closing down the bar and 3 sinks at one station were plugged up. We took turns plunging, but to no avail. Me, being the incredible genius I am went to the maintenance room and found "Industrial Drain Cleaner". Sounds like the perfect solution, no?
No... it wasn't. there were a few problems. #1. I didn't read the directions. #2. Directions clearly said, do not use in stainless steel sinks. #3. Do not dilute with hot water. #4. Do not use with any other cleaning products including amonia, bleach, or chlorine products.
The stainless steel sink was full of scalding hot water, and bleach. (Common practice for washing and sanitizing glassware in a bar.) I was standing over the sink, talking with the 4 last remaining customers when the sink erupted. Literally exploded scalding water, bleach and sulphuric acid all over me.
The first thing I noticed was the amount of hot water all over my stomach and thigh/groin region... then I watched as the vest I was wearing (which was saturated with the caustic fluids) began to change both color, size and consistancy.
I ripped my shirt and vest off to see a "burn" the size of a soft ball on the right side of my tummy. I rinsed with plenty of cold water, but the burn continued. Me, being me... I calmly put on a t shirt and finished closing the bar. (Here comes another act of genius.) I went downstairs to the cafe, knowing that those guys burn themselves all of the time. "Put mustard on it" one of the cooks said. Another guy gave me a paper plate and disposable spatula to "slather" on the mustard. I did so, and it initially brought a great deal of relief.... for about 10 minutes. Now the burn was becoming worse, and I had to wait for the crew downstairs to finish up before I could leave.
I had about 4 beers and they finished up. In the mean time, the smart person in my family (my loving and ever calm wife) calls, and I tell her of the little event, complete with applying French's Yellow Mustard to the wound. Of course, she says that I probably should not have done that and says that she is calling the ER. She calls back and says that the mustard was, as she knew, a horrible idea and that it would cause further damage.... she requested that I make everyone leave and head to the ER.
AS I arrive at the ER, I show the girl at the admitting desk my burn.... she gagged. The wound was oozing its own colorful ooze, plus the mustard, and flesh was literally sloughing off. She got sheet white and called for a nurse. The nurse kicked through the door as the admitting girl began to vomit. The nurse took one look at my tummy and about crapped a meat axe! "What did you do?"
As I began to tell the story, I could see that I had screwed up in a big way. The nurse grabbed me and dragged me to a table. She could see that my pants were "melting" too, and she asked me to take them off. (Fortunately, nothing real bad happened there... just a few spots, and the thickness of the denim probably saved me from some severe disfugurement.) The doc comes over and in a professional pitch I've never heard before said, "Jesus Christ man! What did you do? I've never seen a burn like that...."
It was then that I realized that this was going to hurt.... they began scrubbing the wound with a brush and a couple of different fluids. Because I had a few beers, I got nothing for the pain. It turned out to be an experience Ill never forget.... 8 days of changing bandages and applying silver sulphedizion (spelling error) and removing flesh at each attempt.
Fact of the matter was.... it was a workmans comp claim. Because of the time of day (2 a.m.) they were not going to cover the claim, because it was "unconventional working hours" and therefore could not have happened on work time or at the work place. Between workmans comp and my insurance company bickering back and forth, I ended up paying for the whole shebang out of pocket. $4500.... for an acid burn to my tummy.
They needed me to pay for that so they could treat the drunk kid laying in the bed next to me for trying to beat up one of my competitors bouncers. He lost the fight, but did manage to not have to pay for his a$$ kicking, because he left town the following day.
I got burned with industrial drain cleaner, one night at work. We were closing down the bar and 3 sinks at one station were plugged up. We took turns plunging, but to no avail. Me, being the incredible genius I am went to the maintenance room and found "Industrial Drain Cleaner". Sounds like the perfect solution, no?
No... it wasn't. there were a few problems. #1. I didn't read the directions. #2. Directions clearly said, do not use in stainless steel sinks. #3. Do not dilute with hot water. #4. Do not use with any other cleaning products including amonia, bleach, or chlorine products.
The stainless steel sink was full of scalding hot water, and bleach. (Common practice for washing and sanitizing glassware in a bar.) I was standing over the sink, talking with the 4 last remaining customers when the sink erupted. Literally exploded scalding water, bleach and sulphuric acid all over me.
The first thing I noticed was the amount of hot water all over my stomach and thigh/groin region... then I watched as the vest I was wearing (which was saturated with the caustic fluids) began to change both color, size and consistancy.
I ripped my shirt and vest off to see a "burn" the size of a soft ball on the right side of my tummy. I rinsed with plenty of cold water, but the burn continued. Me, being me... I calmly put on a t shirt and finished closing the bar. (Here comes another act of genius.) I went downstairs to the cafe, knowing that those guys burn themselves all of the time. "Put mustard on it" one of the cooks said. Another guy gave me a paper plate and disposable spatula to "slather" on the mustard. I did so, and it initially brought a great deal of relief.... for about 10 minutes. Now the burn was becoming worse, and I had to wait for the crew downstairs to finish up before I could leave.
I had about 4 beers and they finished up. In the mean time, the smart person in my family (my loving and ever calm wife) calls, and I tell her of the little event, complete with applying French's Yellow Mustard to the wound. Of course, she says that I probably should not have done that and says that she is calling the ER. She calls back and says that the mustard was, as she knew, a horrible idea and that it would cause further damage.... she requested that I make everyone leave and head to the ER.
AS I arrive at the ER, I show the girl at the admitting desk my burn.... she gagged. The wound was oozing its own colorful ooze, plus the mustard, and flesh was literally sloughing off. She got sheet white and called for a nurse. The nurse kicked through the door as the admitting girl began to vomit. The nurse took one look at my tummy and about crapped a meat axe! "What did you do?"
As I began to tell the story, I could see that I had screwed up in a big way. The nurse grabbed me and dragged me to a table. She could see that my pants were "melting" too, and she asked me to take them off. (Fortunately, nothing real bad happened there... just a few spots, and the thickness of the denim probably saved me from some severe disfugurement.) The doc comes over and in a professional pitch I've never heard before said, "Jesus Christ man! What did you do? I've never seen a burn like that...."
It was then that I realized that this was going to hurt.... they began scrubbing the wound with a brush and a couple of different fluids. Because I had a few beers, I got nothing for the pain. It turned out to be an experience Ill never forget.... 8 days of changing bandages and applying silver sulphedizion (spelling error) and removing flesh at each attempt.
Fact of the matter was.... it was a workmans comp claim. Because of the time of day (2 a.m.) they were not going to cover the claim, because it was "unconventional working hours" and therefore could not have happened on work time or at the work place. Between workmans comp and my insurance company bickering back and forth, I ended up paying for the whole shebang out of pocket. $4500.... for an acid burn to my tummy.
They needed me to pay for that so they could treat the drunk kid laying in the bed next to me for trying to beat up one of my competitors bouncers. He lost the fight, but did manage to not have to pay for his a$$ kicking, because he left town the following day.
Amen, brice. Well said.
There ARE programs in place where hospitals and doctors will waive bills, and in SOME cases, it's absolutely justified and an amazing gesture. IN cases like you mentioned, it's just ridiculous, and NOT fair. In the very least, don't waive the whole thing...work out an arrangement, whatever, but the person (unless there are circumstances of poverty, etc) should at least make an attempt. The rest of us, who pay our bills are stuck paying in the way of higher and higher costs. Those waived bills don't just magically disappear, they make that up somewhere (again, $10 Tylenol, $50 bag of IV saline).
I have an example. Before I met (thank GOD, cuz I would have killed him) my husband, he was burned very badly. Get this...him and his pal thought it might be fun to make acetyline and oxygen "bombs" in garbage bags. I KNOW, I KNOW, SO hard to believe anything like that could go wrong with that kind of set up, right???
Needless to say, he ended up with several graft surgeries, in the burn unit for a week. He had no insurance. He NEVER asked about anything...social services came to him and told them they were going to waive his bill. Now, you'd have to know my hubby, but he's a lot like you...he's not one to skip out on a responsibility, no matter what (especially considering the circumstances and how he got there). He told them no thank you, but he would appreciate a payment plan, or something.
They DID end up giving him a decent discount off the top (it was like $130,000 to start with), and he paid on that, (WE paid on that) until the year before last. He actually told me not long ago he wants to start donating to their burn fund for children, to "give back", meanwhile with the inflated costs of healthcare, his bill was probably just right after the discount. Even still, his gesture is nice, and I'm going to look into it.
That's not the whole issue with HC, but its a good example, people NOT taking responsibility for themselves. Needing help, and skipping out on a bill you haven't even made an EFFORT to pay? Night and day.
There ARE programs in place where hospitals and doctors will waive bills, and in SOME cases, it's absolutely justified and an amazing gesture. IN cases like you mentioned, it's just ridiculous, and NOT fair. In the very least, don't waive the whole thing...work out an arrangement, whatever, but the person (unless there are circumstances of poverty, etc) should at least make an attempt. The rest of us, who pay our bills are stuck paying in the way of higher and higher costs. Those waived bills don't just magically disappear, they make that up somewhere (again, $10 Tylenol, $50 bag of IV saline).
I have an example. Before I met (thank GOD, cuz I would have killed him) my husband, he was burned very badly. Get this...him and his pal thought it might be fun to make acetyline and oxygen "bombs" in garbage bags. I KNOW, I KNOW, SO hard to believe anything like that could go wrong with that kind of set up, right???
Needless to say, he ended up with several graft surgeries, in the burn unit for a week. He had no insurance. He NEVER asked about anything...social services came to him and told them they were going to waive his bill. Now, you'd have to know my hubby, but he's a lot like you...he's not one to skip out on a responsibility, no matter what (especially considering the circumstances and how he got there). He told them no thank you, but he would appreciate a payment plan, or something.
They DID end up giving him a decent discount off the top (it was like $130,000 to start with), and he paid on that, (WE paid on that) until the year before last. He actually told me not long ago he wants to start donating to their burn fund for children, to "give back", meanwhile with the inflated costs of healthcare, his bill was probably just right after the discount. Even still, his gesture is nice, and I'm going to look into it.
That's not the whole issue with HC, but its a good example, people NOT taking responsibility for themselves. Needing help, and skipping out on a bill you haven't even made an EFFORT to pay? Night and day.
That's exactly what I am talking about! The system, as it stands, depends on people who will pay their bills.... period! We went long periods of time (and still do to this day) without enjoying life's luxeries, just to pay the bills.
I've never had to not get treated.... But I have always had to pay!
I've had to pay workmans comp claims and wait for them to all get sorted out and wait long periods of time for any reimbursement. I've had to fight with insurance companies over itemized bills that accrued during surgeries and got stuck paying for schitt that should have been covered (like having to use 3 instruments instead of 1 during hernia surgeries).
The system needs people that pay their bills. Apparently we are those people....
I've never had to not get treated.... But I have always had to pay!
I've had to pay workmans comp claims and wait for them to all get sorted out and wait long periods of time for any reimbursement. I've had to fight with insurance companies over itemized bills that accrued during surgeries and got stuck paying for schitt that should have been covered (like having to use 3 instruments instead of 1 during hernia surgeries).
The system needs people that pay their bills. Apparently we are those people....
Wow, Brice it did not work out for me that way, Im still paying on a 38'000 dollar bill from when my man went in with kidney stones and they admitted him and the doctor would not treat him due to no insurance. They gave him mega drugs for 3 days till the pain subsided, pumped him full of flomax and sent him home. Two weeks later, we got a bill for a bed and thos major drugs. After another week the stone finally passed on its own. Im not doing something right! We both work and do not fall into the payfield to get anything free, and if we dont pay OUR bills, we will go bankrupt!
My whole adult life, I've had to make concessions in order to pay the bills, including medical. In fact, my wife and I... fully insured, have just now paid off a running medical bill that took almost 18 years to do. Both of us insured... making the lot of us, double insured. 18 years to pay the bill.
The system is set up and dependent on people like me, who will pay their bills.
Same hospital, same doctors.... a douche bag I know walked into the ER having a "heart attack". They run every stinking test they can on this guy, and what it all boiled down to is "anxiety".... yes, anxiety! (Not that anxiety cannot be a serious issue...)
In the end, this guy ran up a bill of over $12,000 dollars. He went to the hospital administrators and said, I can't pay and they waived his bill. This happens all of the time here, and in the mean time, medical care for people like us (my family) keeps rising.
A girl who worked for me was skiing. Took a trail she had no business on, hit a bump, landed on her back and ruptured a kidney. She was stabilized locally (they stopped the bleeding) and then life flighted her to a bigger medical complex to undergo a surgery to try to save the kidney. They couldn't and had to remove the kidney. Her bill? Nothing.... both places waived all fees including an ambulance and air ambulance. This was over $100k. They (the hospitals and the girl) agreed that she'd never be able to pay the bill off and just waived it.
In the mean time, raising 2 accident prone kids (and me being accident prone myself) get charged every red cent.... and we pay the frigging bill. If we don't, we get ruined financially by the system. So its ive lean and pay the bill, or let them ruin us financially.
The system depends on people like my family. I guess we are too proud to not pay our bills....
The system is set up and dependent on people like me, who will pay their bills.
Same hospital, same doctors.... a douche bag I know walked into the ER having a "heart attack". They run every stinking test they can on this guy, and what it all boiled down to is "anxiety".... yes, anxiety! (Not that anxiety cannot be a serious issue...)
In the end, this guy ran up a bill of over $12,000 dollars. He went to the hospital administrators and said, I can't pay and they waived his bill. This happens all of the time here, and in the mean time, medical care for people like us (my family) keeps rising.
A girl who worked for me was skiing. Took a trail she had no business on, hit a bump, landed on her back and ruptured a kidney. She was stabilized locally (they stopped the bleeding) and then life flighted her to a bigger medical complex to undergo a surgery to try to save the kidney. They couldn't and had to remove the kidney. Her bill? Nothing.... both places waived all fees including an ambulance and air ambulance. This was over $100k. They (the hospitals and the girl) agreed that she'd never be able to pay the bill off and just waived it.
In the mean time, raising 2 accident prone kids (and me being accident prone myself) get charged every red cent.... and we pay the frigging bill. If we don't, we get ruined financially by the system. So its ive lean and pay the bill, or let them ruin us financially.
The system depends on people like my family. I guess we are too proud to not pay our bills....
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