The Price of Health Care

The way my blog is set up on the Yahoo! Health page, I can read your comments but can't respond to them directly and personally. After my blog on postmenopausal bleeding (Vaginal Bleeding after Menopause), there was a comment that caught my attention and brought to mind a problem that faces many in this country--the high cost of health care.

This reader said that she was indeed experiencing postmenopausal bleeding, but that she didn't have health insurance and so she's unable to find a way to get the services I had recommended. (These were, for the record, a checkup ASAP; a Pap smear and perhaps colposcopy if indicated; an endometrial biopsy; and a pelvic ultrasound).

50 Million and Counting

She's certainly not alone in being unable to afford all these tests--with over 50 million Americans uninsured, the number of people lacking health insurance in the U.S. has reached an all-time high.

But there are options, and I spend a tremendous amount of my clinical time seeking out supplemental sources of financial support for the patients I see who are uninsured or underinsured and cannot afford the care they need.

The State of Health Insurance in The United States

Hospitals, health care facilities, and health care providers generally charge a set amount for their services. For patients with insurance, the cost of that care will automatically be billed to their insurance company--but with this condition: Their insurance company has already determined what it (the insurance company) considers is a reasonable price for that service, and it will not pay more than this amount to facilities and providers.

In other words, set prices or not, facilities and providers agree to accept the amount for services that the insurance company deems reasonable and has agreed to pay.

If You Are Uninsured

Things are different. You will just be billed the caregiver's original set amount, without any downward adjustments being driven by what an insurance company deems reasonable.

So, because of this lack of adjustment, an uninsured person in the U.S. may actually end up paying more for a procedure than would their neighbor who has insurance (and who might be more financially secure). Many facilities won't even see uninsured people who aren't first willing and able to pay up front.

What Are Your Options?

There are ways to get care if you are uninsured--some facilities, for example, have sliding-scale pricing plans--but you may have to do some homework and footwork.

Planned Parenthood.  For all facets of women's health, Planned Parenthood is the foremost sliding-scale care provider. This means that Planned Parenthood isn't just for young woman who want to obtain birth control. Planned Parenthood provides a variety of services, including

• Menopausal care
• Annual women's health exams
• Mammography referrals, with mammograms often covered by grant money from the Susan G. Komen Foundation or other sources
• Other preventive health screening

Local health departments. Most local health departments also provide low- or no-cost women's health services. And if they don't, they'll usually have a list of people and places that do.

Grants. A number of grant programs are also available to help with mammograms and breast exams for low-income, uninsured women, depending on the health issues a woman is facing. Many facilities have access to the National Breast and Cervical Cancer Early Detection Program grant from the CDC that provides diagnostic screening procedures related to breast and cervical cancer (such as mammogram and colposcopy).

Hospital funds. Many hospitals (particularly large university institutions) have a certain amount of money set aside for those who cannot pay. Patients usually must apply for these funds and meet certain criteria to qualify. Often, too, if you get a large bill after a hospital stay, you can call in and talk to a financial counselor at that facility about setting up a payment plan. Sometimes your bill will be reduced as well--often so that it reflects what the cost would have been if an insurance adjustment had been made.

Catastrophic care insurance. Another option to consider is some of the affordable policies available for catastrophic care. While they won't cover your minor care needs, they will be available if you come down with a catastrophic illness.

One Last Bit of Advice

I don't recommend showing up at a hospital's emergency department unless you are having a true emergency. If, however,  your problem is a genuine emergency, it is a violation of federal law for that emergency department to turn you away.

The ED is required to provide emergency care to you regardless of your ability to pay. Since they are only obliged to take care of your emergency, they won't be addressing any of your long-term, chronic problems--and you will get a bill later. (See my recommendation above, about calling and talking to a hospital's financial counselors.)

So What's My Answer?

To answer the lady who asked me how to get the care she needs, I say: "Please keep trying!"

I know you are frustrated. You may even have to travel some distance to a more metropolitan area that has more resources to offer. You may have to set up a payment plan. But don't give up. There are resources out there. They just can be hard to uncover.