When You Don't Have Health Insurance (or Money)

Millions of people in the U.S. do not have health insurance, and more and more are losing their insurance when they lose or change jobs. When you have limited financial resources, priorities rapidly shift to the essentials, like food and shelter. Getting medical care tend to be low on the list. Nearly every day, someone will tell me that this will be their last visit due to insurance or financial constraints.

I tend to be highly sympathetic and do the best that I can to hold down costs, often by putting down a lower billing code and making sure to order only tests that are absolutely essential. When prescribing medications, I will look for samples (becoming increasingly scarce) or only use the less-expensive generics. I am often embarrassed by the costs of medical care. As a salaried employee of a large, health organization, there is little that I can do to

I am definitely less sympathetic when I know my patient has not changed expensive habits, like smoking, drinking expensive coffee, and eating out instead of packing a lunch. When someone asks me to bill them for their small, insurance co-payment and I notice they have a pack of cigarettes sticking out of their purses, I tell them how I feel. I am getting too old to let these "teaching moments" slide.

Setting reasonable priorities is not something that all people know how to do. And not all people are proactive and resourceful when it comes to trimming their personal budgets or finding affordable care.

Things you CAN do

1. Unless you have a true emergency (life-threatening) condition, stay out of the emergency room. If you have a primary care problem, like a sore throat or earache, this would be the most expensive way to get treatment. Call a few urgent care facilities (aka "Doc in the Boxes") for prices. They are certainly less-expensive than the ER.
2. Check your area for free clinics, or clinics that charge a sliding scale. There are fewer and fewer of these around, but sometimes you will be lucky.
3. Many counties have Public Health Departments that offer free or discounted medical services, especially immunizations.
4. Many uninsured and non-working people qualify for state-run insurances like Medicaid but never bother to check their eligibility. Children, especially, will benefit from this.
5. Find a good primary care provider or solo practitioner. Medical professionals who work for themselves set their own charges and have the ability to charge less or nothing at all. You will be surprised how many dedicated professionals will find a way to help you out during these tough economic times.
6. Ask for samples. Although pharmaceutical samples are also becoming increasingly scarce, even a few days of medication to get you started will reduce your overall health costs.
7. Ask for a generic prescription or for an alternative choice of medications known to be less expensive. Although medical providers often do not know what prescriptions cost at the various pharmacies, most will have a good idea if they are giving you an expensive one or a reasonably-priced alternative. Generics are just as good for a fraction of the cost. If your doctor wrote for a brand name, your pharmacist can substitute a generic equivalent in most instances.
8. Don't be shy about shopping around for a better price on your prescriptions. Call the pharmacy, read your prescription to them (if the writing is legible!), and ask how much it will be. Many large, chain pharmacies have huge medication discounts for certain commonly-used prescriptions. A prescription that costs $60 in one pharmacy may only be $18 at another.
9. Ask for a discount. A $75 office visit may only be reimbursed by insurance companies for a fraction of that cost. So, why should you pay more simply because you do not have health insurance? Even fees vary among private medical practitioners, so call around.
10. Be creative in your available resources. I am often surprised that people can afford to buy beer or cigarettes, but they don't seem to have money left for their own medical care. A one pack per day person would save over $150 in a month - a savings less-costly than of an average office visit.
11. If you have a credit card, most medical offices will charge your visit to the card, giving you up to a month to come up with the cash.
12. If feels good when you help someone, so if you are in serious need, it is okay to ask family or friends to help you out. Remember, you are asking for help to get medical care, not to buy a new toy. By helping you, they will feel better.
13. If you are a member of a church or synagogue, many will help the less-fortunate with reasonable, but unexpected medical costs. It doesn't hurt to ask for help. I have seen local churches buy glasses for children, or provide medical appliances for the elderly. Don't forget to thank others who help you, including God.
14. Practice medical self-care. The first-step in staying healthy is taking care of your self and practice healthy habits. Don't smoke. Don't take recreational drugs. Don't drink and drive. Always wear seat belts. Exercise and maintain a healthy weight. These things do not cost a dime.
15. If you have lost your job and are looking for a new one, try and find employment that will offer health benefits for you and your family.

Ten Things you should NEVER do

1. You should never ignore potentially-serious symptoms simply because you do not have the resources. Not only can your condition become worse (and more expensive to treat), you are potentially putting your life in jeopardy. If you feel you need medical care, find a way. You really can't die now and pay later.
2. Don't ignore preventative care, like mammograms and pap smears for women or prostate exams and PSA tests for men. And, keep up with your preventative dental visits.
3. You should never take someone else's medication. Every person and every disease is different.
4. You should never take expired or suboptimal (sub-therapeutic) dosages of leftover medications from prior prescriptions unless specifically instructed to do so by your medical provider. For instance, by not having a complete course of antibiotics - about ten days worth - it may not be possible to eradicate an infection. You may also create a resistant bacterial strain that is more difficult to treat.
5. Many people resort solely on alternative medicines, such as homeopathic remedies, vitamins, or herbs. Most are not scientifically proven by clinical trial, and any response may be merely anecdotal. It is okay to try them, but if you are not improving, you may need traditional medical intervention.
6. You should never smoke. Smokers have considerably more cancer-fears than other people. People who smoke worry that sore throats, lymph node enlargement, or chronic cough may be something serious. Sometimes, they are right - all the more reason NOT to ignore long-standing symptoms.
7. Don't rely solely on online health information sites (including WebMD) in an attempt to diagnose (and treat) yourself. Online health experts have no way of examining you, reviewing your medical history, or treating you based solely on your posting.
8. The same goes for being diagnosed (or treated) by your non-medical friends and relatives...don't do it. Just because people have similar symptoms or experiences, in no way implies that it is applicable to your case.
9. Don't rely solely on phone advice by your doctor or advice nurses. They can only make medical decisions based on what you have told them. Most advice will most likely be conservative. Don't expect to be definitively diagnosed and treated on the phone.
10. Never use the ER as your primary care medical facility. The ER is for life-threatening situations or medical conditions that cannot wait until your regular medical office is available. ER medicine is the most expensive care you can receive. Find a good family practitioner.

As an optimist, I know things will get better. We need to take care of ourselves...our families...and find time to help others. Together, we will get through this economic crisis.