Looking Beyond State and Federal Programs for Medical Expense Assistance
Hospital and pharmaceutical initiatives all exist to help cover your costs. Read on to learn how you can find the resources you need.
By Donna Sternberg, RN, OCN, Vice President of Patient Services; and Erin Moaratty, Quality Assurance Officer; with Nancy Davenport Ennis, President and CEO, Patient Advocate Foundation
If you are uninsured and do not qualify for Medicaid because your income exceeds the federal and state poverty guidelines and your state does not have any provisions or other state-specific programs, you will need to find a patchwork of programs or providers to cover the cost of your healthcare.
Options other than state and federal programs that may assist uninsured patients include hospital charity care and pharmaceutical indigent drug programs. Most hospitals offer some type of charity care or indigent care to the community. The hospital billing office or social services department can tell you how to apply for charity or reduced-cost services. Follow the instructions of the specific facility because each will have a different process. In some cases physicians associated with the hospital provide their professional services either free or at a reduced rate. Be upfront with the provider and the facility about your financial situation. They are accustomed to making payment arrangements and may have knowledge of other local programs to assist you.
You may also benefit from indigent drug programs offered through pharmaceutical companies. If the pharmaceutical company is contacted before you begin treatment—and you qualify for its program—it may be able to provide you with medications free of charge. This process must be initiated by your treating physician, and medical certification must be provided to the pharmaceutical company. These programs include, but are not limited to, injectables, chemotherapy products, and supportive care medications such as those for nausea and those that support the immune system.
It is not always possible to qualify for charity programs. If you do not qualify, you’ll want to make payment arrangements with all providers of service in advance. You are now a “self-pay” patient and do not have the advantage of prenegotiated discounts afforded to the insured population by the insurance contract. You can and should, however, ask all providers in advance what the costs are going to be and request a discount on billed charges. They may agree if you are prompt with payment, but they are not obligated to do so.
If you need help finding any of the types of assistance discussed in this article, contact the Patient Advocate Foundation (PAF). The PAF is a national nonprofit organization whose mission is to assist patients and remove obstacles preventing access to care. PAF services are free of charge to the patient. Contact the Patient Advocate Foundation toll-free at (800) 532-5274 or online at www.patientadvocate.org.
