Survival Topics for the Uninsured

Copied with permission from Cure This. This is Part 1 and contains Topics 1-6 (of 10).

Topic #1: Stuff happens. Think ahead.
Find the time to learn about the medical, social, and monetary resources available in your area in case you have a major medical disaster. I discovered how difficult it can be to find help and information in a hurry. If you can, build up an emergency fund. It's easy to put off, but this sort of planning is as important to your family's welfare as any other crisis preparedness.

Moving has special challenges in this regard. When relocating, consider support systems and resources the same way you consider crime and cost of living. If you don't do this ahead of time, you should do this right after you arrive at your new place. Find and make appointments with new doctors ASAP, even if you have to pay for the visits. You need to establish relationships with them. Line up reliable baby-sitters. Look for ways to build strong ties to your new community. This might include investigating public programs, which vary drastically from state to state. Make new friends quickly by joining a church, club, or PTA. Don't count on friends from work. Unfortunately, those associations can dry up overnight if you lose your job.

This might all sound obvious, but I know from experience that the pressures and pleasures of a new city, new schools, and new jobs leave little time for anything else. If you are unprepared and disaster strikes, you may have to decide - like I did - if it would be best to stay put or to head back to your hometown.


Topic # 2: Meet Hill-Burton

Familiarize yourself with the Hill-Burton Act, a federal program started in 1946. With Hill-Burton, hospitals receive federal loans and grants in exchange for providing a certain amount of free care to needy individuals. I found out that not all hospitals participate in the Hill-Burton Act. Each hospital seems to have its own rules within the federal guidelines for eligibility, benefits, applications, and decision notifications.

For example, my husband's hospital paid 100% of the cost of care for qualified persons, and rendered their decision before admission or treatment. My hospital provides a percentage of the cost for qualified persons on a sliding scale, but does not make a decision until after an admission or procedure has been completed. Both of those facilities will also consider Hill-Burton funds for out-patient care and insurance co-payments, but apparently not all do.

Also, at some hospitals, it's far better to try for assistance earlier in the year before funds run out, while others may dole out free care monthly or quarterly. It pays to ask. If your admission is urgent, you might call other hospitals where your physician is on staff to check on the availability of funds. If it's not an emergency, you might be able to postpone it until the next disbursement period.

Topic #3: Pay Less for Prescriptions

Ask doctors if they have drug samples, especially for new prescriptions. It is awful to buy a month's worth of an expensive drug only to find it doesn't work or you can't tolerate it. Often, my doctors prescribe my meds based on what they know they get samples of regularly.

Look into pharmaceutical manufacturers' patient assistance programs. You can try the widely-advertised Partnership for Prescription Assistance website. However, my experience has been that PPARX underestimates a person's eligibility. Also, not all drug makers participate in PPARX. I have had much greater success going directly to the website of each individual company. You might have to search hard for the link to the patient assistance program or you might need to call. Not every maker has a program and programs vary wildly in requirements and benefits. You'll often find coupons instead of or in addition to assistance programs. Programs all require your doctors to fill out forms regularly. Ask your doctor to forgo some or all of the fees for this service.

(Pennsylvania has two programs called PACE and PACENET. These helpful programs benefit older residents, but your state may have similar ones. Although the age requirements presume you are eligible for Medicare, what's special about them is that they supplement or replace Part D for low income individuals. This might be helpful for future reference.)

As I have never actually used any of these options, I'll just mention them. Consider alternative medicine. It may be better and/or less expensive. However, this is a subject about which I know nothing. Mail order prescriptions are widely available via the Internet and could be worth exploring. I am aware that many people acquire their prescriptions by traveling to or ordering from Canada and Mexico. I wish I could comment on the quality of those drugs and the legality of this option.

Nowadays, Wal-Mart, Sam's Club, Target, and numerous grocery chains such as Krogers, Giant, Food Lion, and Safeway offer $4 prescriptions for generic drugs and other great deals. There may be other stores with similar bargains. Some of these companies have their $4 lists posted online. Ask your doctor to prescribe from these lists if possible. Ask your doctor or pharmacist if they have or know of any coupons for the medications you have been prescribed. Request generics where available.

Beyond that, prescription prices differ significantly from store to store and from week to week. With a monthly cost of $1200 to $1800, I could never afford to get a full month's worth of prescriptions all at once for my husband. Pharmacists are generally willing to fill partial prescriptions, by be aware that you may pay dearly for this.

For example, one of my husband's drugs was $350 for a month's worth, $250 for two week's worth, and $150 for one week's worth. Sometimes, I could only afford one or two pills before payday. Every single week, I called every single local drugstore and got prices for every single drug my husband took. I always had to go to at least three pharmacies to get the best overall price. Some pharmacists were nice about this and others weren't. Eventually, the owner of one small pharmacy said he would match the lowest price being given anywhere else. I still had to make the calls, but I sure did save time and gas money.

Topic #4: Save on OTC Drugs

There isn't much new I can tell you about OTC drugs. Shop sales, use coupons, look for stores that double coupons, buy in bulk and share with others, and try store brands. If you have prescription coverage, ask your doctor to write a script for OTC drugs whenever possible.

Topic #5: More-Affordable Medical Devices

Check with friends and family. Of course, try want ads, CraigsList, and FreeCycle. That's where I have seen $100 hospital-style bedside tables for $5 and free non-motorized wheelchairs. Put up ads at the supermarket. Contact the hospitals, churches, and local organizations. Watch for estate sales. Look for places that sell used durable medical equipment. You can sometimes rent this kind of equipment, but that is often the most expensive route in the long run. Ask at the doctor's office, at work, and at even your child's school. Most makers offer at least one of their glucometers at no cost. Just be sure to check the price of the testing strips before you order one. They vary widely.

Where I live, it is against the law and it carries a stiff fine to put used syringes and lancets in with the regular trash. My trash collection company charges a fortune to take them away. I discovered that the local hospital has a program to collect these items. They must be in safe containers, like coffee cans with lids, and be clearly marked with the person's name and phone number. It must also be noted on the containers that they hold hazardous medical waste.

We bought my mother's stair lift gently used for $2000 (including installation) at a company that sells them. After she died, we sold it there for the same price (including removal) minus a small commission. The one she had would have been about $6000 new. I got my husband's hospital bed for only $25 through a lead from the local veteran's center. A family member found us a free wheelchair through a former co-worker of hers. After my husband died, I called the school nurse. She happened to know of a child who was in desperate need of a hospital bed and wheelchair. I donated those to him. Various organizations like the Lions offer assistance with glasses and hearing aids. LensCrafters has a campaign during which they provide eye exams and new glasses to the needy at no charge.

Topic #6: If you think you're dealing with serious and/or long-term illness

Start a journal immediately and keep it with you. Record emergency phone numbers; names of doctors and hospitals; symptoms and diagnoses; allergies; treatments, doctor visits, and hospitalizations (dates, locations, outcome); prescriptions (names, doses, dates filled, efficacy, side effects, interactions, warnings, prices at different sources); phone calls (contacts, dates, reasons, outcome, follow-up); "significant events" like accidents, strokes, heart attacks, seizures, 911 calls (dates, treatments, where treated, outcome); programs (contacts, application date, outcome, follow-up); notes and anything else pertinent. Keep copies of medical reports and aid applications. You will refer to this journal over and over again.

I condensed the emergency and medical information into a spreadsheet and kept a copy in my purse, my husband's wallet, and on my refrigerator. Doctors, ER staff, and EMTs were thrilled when I was able to present this and I know it expedited my husband's treatment. Now I utilize the Vial of Life. This is a large pill container with a rolled-up paper inside listing all pertinent information. It comes with a bright sticker to affix to your front door that notifies emergency personnel where to find it. It also has Velcro on the outside so you can stick it anywhere. Some people keep it in their refrigerator. I have three, which is not uncommon - one in my purse, one in my glove box, and one on the outside of my fridge. I got mine free at the front desk of my hospital. There are several other similar products available.

Begin saving every medical-related invoice, cancelled check, and receipt in an organized manner, including for OTC drugs and parking/gas or bus/taxi fares for doctor/hospital visits. This may become vital when applying for programs, declaring bankruptcy, doing your taxes, and other circumstances. For example, my son was given better terms on his student loans because of our situation. Some students receive additional grants or tuition reduction. To get this benefit, though, I had to submit copies of everything I listed above to the financial aid department of his university - in a very large box.

Apply for Social Security Disability right away if it seems that the patient will not be able to return to work. Even the Social Security Office recommends this because there is a six-month waiting period for benefits once you have been determined to be disabled. You can always withdraw your application if things improve.

Cut back as much as possible on your expenses. Even with a great deal of help, without insurance, you will probably accumulate massive debt. You are likely to miss work or even lose your job. Use the money you save to pre-pay utilities and your mortgage (be careful - check with your mortgage company about the way to do this that is most advantageous to you), to build up your pantry, and to cover medical needs. Be aware that if you simply bank your savings that it may hurt you when you apply for help.