How to manage health needs without insurance, from finding free drugs to negotiating ER bills

No health coverage? How to cope

NEW YORK — The health care overhaul passed earlier this year will help many uninsured get coverage starting in 2014. But until then, Americans who lose employer coverage may find buying insurance on their own unaffordable.

That means many of the 46 million Americans uninsured have to foot the bill for medical care.

If you don’t have health coverage and can’t afford to buy it, there are ways to cope:

PRIMARY CARE

The best time to search out medical care is long before an emergency. And there are low or no-cost options. Having a primary physician and going in for regular visits is the key to staying healthy and avoiding the emergency room, according to Elizabeth Forer, CEO of Venice Free Clinic, a network of low-cost health centers in the Los Angeles area.

People who have a primary care doctor when they lose their insurance should tell their physician about the change in status and ask if there is any flexibility on fees. Many physicians will offer a sliding scale or reduced payments to maintain the relationship.

“When something does go wrong you want to go to someone who you have a relationship with, who already knows your medical history,” said Forer.

Community health centers, partially funded by the federal government, provide uninsured Americans with a regular doctor who knows their health situations and can help them manage chronic diseases like diabetes or asthma. The clinics offer treatment according to the patient’s ability to pay and in some cases, for free. The closest of the 1,250 centers can be located at findahealthcenter.hrsa.gov/.

Within a few months of losing her insurance last year, Melissa Colton, 55, of Los Angeles, found the Venice Free Clinic. The center provided her doctor visits for $20 and medication for a small donation.

“I felt more taken care of there than at a regular doctor’s office,” said Colton, who has chronic health problems.

“I have asthma, and if I am not able to get to a doctor, and I miss my medication, I can end up in the emergency room,” said Colton. “I was outraged and completely freaked out.”

INSURANCE FOR KIDS

Even if you can’t afford to insure yourself, you might be able to insure your children. The federal government and states offer insurance for children through the Children’s Health Insurance Program.

The program helps families that can’t afford private coverage and don’t have insurance through an employer. Every state has a different program but assistance is usually available based on income limits. For a family of four, the limit is $44,100.

For more information go to: www.insurekidsnow.gov/.

PRESCRIPTIONS

If you can’t afford needed medications, start by talking to your doctor. He or she may be able to help with samples or in finding programs to get you what you need.

In addition, most community clinics provide low-cost medicine under the same roof or at nearby pharmacies.

Pharmaceutical Research and Manufacturers of America, the drugmakers’ trade group, provides free and low-cost drugs through its Partnership for Prescription Assistance www.pparx.org/. Individual drugmakers often have their own programs that offer free or reduced-cost drugs as well.

EMERGENCIES

Trips to the ER can be financially crippling for those without insurance. But if you have an urgent problem, don’t skip the ER.

Hospitals are often willing to make a payment plan and even write down much of the bill. But the patient has to take the first step. When the emergency is over, talking to the billing department ASAP will give you the best chance to reduce your costs.

“Once it gets turned over to a collection agency, the chances for charity basically go away,” said Dan Hawkins, policy director for the National Association for Community Health Centers.

Negotiating with the hospital is exactly what the insurance companies do. Insurers may pay only $3,000 for a procedure that a hospital will routinely bill an uninsured individual $9,000. Patients should ask that they be given the same rate as the insurers, said Forer.

“The billing department will tell you initially that you have to pay the full amount. Ask to speak to a supervisor,” said Forer. “Keep notes of these conversations. Be polite and persistent.”