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Medical Emergencies
Without Insurance
How to Get the Help You Need Without Going
Into Debt
By Teri Brown
When Kira Nunez's husband cut his finger, they both
knew it was bad. But they didn't know that it would require a surgery that
would impact them for the next four years. You see, the Nunezes were without
medical insurance.
"He had severed a nerve and partially severed a tendon and wasn't able to use his hand," says Nunez, mother of three from St. Aurora, Colo. "He was also in a huge amount of pain because of the nerve damage. The surgery worked just fine, and although he would have benefited from physical therapy, we weren't able to afford it. So he ended up with partial feeling in his finger and almost all his range of motion back."
According to the 2000 Census by the U.S. Commerce Department, more than 14 percent of Americans in 2001 were in the same boat as the Nunezes – without health insurance. Even scarier: Almost 11 percent of children were also uninsured. So how do these families cope when they are faced with a medical emergency and major hospital bills?
Help for the Middle Class
Dr. Kathryn Stewart, medical director for Care Management at Mt. Sinai Hospital
in Chicago, Ill., believes that how you deal with medical emergencies depends
heavily on what sort of problem you have.
"If it is a short-lived medical problem, such as a broken leg, and the family is middle class – owns their own home, makes a middle-class income – then my advice is to discuss the problem with their family physician, pediatrician or internist," says Dr. Stewart. "A primary care physician is trained to be a patient advocate, but also knows their way around the health care system."
The options available may differ from one community to the next. A physician should know the community best and how to proceed. When dealing with something chronic or catastrophic, such as gland disorders or cancer, options change, as you are facing a long-term expenditure.
"Again, the first step is to talk to the family doctor, but realize that there is probably no way to get the care you need without considerable expenditure of family resources," says Dr. Stewart. "After you spend down to poverty level, then you can qualify for Medicaid to pick up the costs of your health care, but you need to be impoverished for that to happen."
For Those at or Below Poverty Level
If the family is already at or near the federal poverty level, then it may be
time to seek out a Federally Qualified Health Center or a Rural Health Clinic.
The federal government offers these clinics a subsidy so they can provide free
or heavily subsidized care for people who do not have insurance.
"They also have developed a referral network for specialty care at subsidized rates and to assist patients in paying for medications," says Dr. Stewart. "But to qualify, you need to bring verification of income for the household in which you reside, and if you make a middle-class level of income, they will expect you to pay your full cost of care – which tends to be higher than it would be at your local doctor's office."
You should be able to find a listing of these local clinics at your area library.
Medical Care for Kids
Dr. Risa Lavizzo-Mourey, CEO of The Robert Wood Johnson Foundation, believes
that there is help for most uninsured children, if not their parents. The
foundation's Covering Kids & Families national initiative aims to increase
the number of children and adults who benefit from low-cost and free health
care coverage through the State Children's Health Insurance Program (SCHIP) and
Medicaid.
"There is help for most uninsured kids," says Dr. Lavizzo-Mourey. "Most of the nation's uninsured children are eligible for low-cost and free health care coverage. Every state in the country offers low-cost or free health care coverage for infants, children, teens and, in some states, even adults. Many working families with low-to-moderate incomes are eligible for the State Children's Health Insurance Program (SCHIP) or Medicaid. Although eligibility varies by state, many families earning up to $36,000 a year or more may qualify for low-cost or free children's health care coverage."
Dr. Lavizzo-Mourey cautions parents not to assume that they are not eligible if they have a job. "These programs are there to help working families," she says.
Working out a Payment Plan
The Nunezes' surgery ended up costing almost $5,000. There were bills from the
emergency room, the hospital where the surgery was done, the surgeon and the
anesthesiologist. The Nunezes explained to the hospital that they didn't have
insurance and would have to pay the bills themselves. "They weren't happy about
it, but what can you do?" Nunez says. "I called them all and told them how much
we would be paying them each month. For some, all we could afford was $5 a
month, but we paid it religiously. If you get behind they can send you to
collections."
The McCoys of Eagan, Minn., learned that it doesn't have to be a major emergency to sink the ship. Add enough little things together and you can find yourself swimming in medical bills. In rapid succession, the family had several medical problems and emergencies pop up without warning – right after they lost their main income health insurance.
"We managed to open a file with our local clinic, which bills us after services, but most of the time we ended up going to the urgent care clinic instead," says Rebecca McCoy, now an operations coordinator for an executive search and placement firm. "The urgent care clinic required payment at the time of services, but they were significantly cheaper, did more for us and often gave us free samples of medication to completely fill our prescriptions, since they noticed that we had no insurance and they knew medical bills were rather pricey to begin with."
The McCoys and the Nunezes learned how to work the
system through experience. Most medical offices will work with you if you show
good faith by paying every month. Have a written agreement, and if you get any
trouble, remind them of the agreement.
"A few times one of the offices sent letters, threatening to send us to collections, but I called and reminded them of our agreement and offered to fax them documentation," says Nunez. "They backed right down. It really helps to know your rights."
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Want to see more?
- A Balancing Act: Money Management Tips for One-Income Families
- Life Insurance: What Is It and How Much Do You Need?
- Facing Uninsured Pregnancy: You Can Make It Work
- Talk about it!
About the Author: Teri Brown is a senior contributing writer for iParenting Media.
