Underinsured? 11 ways to stretch health-care dollars
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Buy a critical-illness
policy. Almost unheard of three years ago, these policies
are becoming better known in the United States. (They are also popular
in the United Kingdom and Canada.) Such companies as MetLife, AIG
and Colonial Life offer them, among others. Most work in the same
manner: You pay a monthly premium, and when illness strikes, you
are given a lump sum to use as you wish rather than having payments
go to your medical-care providers. For example, MetLife's covered
illnesses include cancer, heart attack, kidney failure, stroke,
coronary artery bypass surgery and major organ transplant. Introduced
in March, MetLife's critical-illness insurance pays a lump-sum benefit
of up to $100,000, offering what the company says is "a way
to help maintain and protect (consumers') financial quality of life
while better enabling them to focus on their treatment and recovery."
The amount of insurance purchased, and the type of illness, determine
the amount of the paid benefit. However, cost of premiums may be
prohibitive for some.
Hire an advocate.
Companies such as Patient Care have sprung up to help people find
their way through the medical-coverage maze. It's a health-care
advocacy company that helps its members best use their health insurance,
and file claims and grievances. Employers offer Patient Care's services
to their employees for $2 to $3 per month, or individuals can sign
up independently for slightly higher fees.
If you're diagnosed with a serious and expensive illness
and don't already have critical-illness insurance, there are still
steps you can take to make your illness more affordable and less
likely to break the bank.
Start by analyzing your policy.
"Don't assume that things are covered," says Jane Cooper,
CEO of Patient Care in New Orleans. "It's important to understand
what is covered, and find out what you'll be reimbursed." For
example, some insurers consider chemotherapy under medical coverage,
while others make it part of your drug-prescription plan. How it
is accounted for can make a huge difference since "chemotherapy
can be one of the biggest expenses when you have cancer," Cooper
says. Read through your policy to find out what's covered and what's
not. Ask for help from your medical team and your human-resource
department. Even if the news is grim, knowing precisely what is
covered, and what is not, will help you to formulate a plan.
go it alone. If you're having trouble getting coverage for required care,
enlist the help of your doctor, the hospital provider and your HR representative.
Have them help make the argument that your treatment is a medical necessity.
promptly. If benefits are being denied, promptly demand an appeal or an
explanation. The longer you wait to protest, the less likely you will get approval,
Ask for help from family
and friends. Because many families can't afford a serious illness even
with medical insurance, they are turning to their local communities for assistance.
If you live in a small town, you've probably seen advertisements seeking charitable
contributions for people like Kim Zieglowsky. Consider setting up a bank account
at your local bank. See if there are any local charities or foundations that will
help. In the state of Montana, for example, the Payden Memorial Foundation aids
and gives financial support to families with children who have cancer.
Negotiate. Cooper says
it's rare, but hospitals and doctors may reduce their fees if you
make it clear you can't afford to pay the whole fee. "Sometimes
you can get a reduction, but it has to be done in advance, not after
the fact," Cooper says. Also don't be afraid to compare costs
and negotiate for lowered prices based on what the "hospital
down the street" is charging. You may be buying your life,
not a used car, but that shouldn't stop you from haggling.
Hire an advocate. Companies
such as Patient Care and HealthEquity can help advocate for their
members. You can find these and similar firms through a Web search,
but be careful to check references and otherwise certify that the
company is legitimate.
Appeal. If a benefit
is denied, appeal it. And if that doesn't work, "then it's
lawyer time," says J. Peter Fennell Jr., vice president of
employee benefits at Haylor, Freyer & Coon, an independent insurance
agent in Syracuse, N.Y.
Overall, the best way to succeed
is to be organized. Keep good records by filing each bill
or notice you receive from your medical plan. Take notes whenever
you are on the phone with your insurer: Jot down what was said,
the name of the person you talked to, the agreed-upon course of
action, your next course of action, and the action the insurer is
supposed to take. Also be sure to schedule appropriate follow-ups.
If a customer-service representative is supposed to get back to
you on the 15th of the month and doesn't, call him.
Unfortunately, being underinsured is becoming more
common. Each year between 10 percent and 15 percent of Americans
are hospitalized, according to Kaiser Commission. If you're facing
a serious illness, you need to take the necessary steps to receive
good care and to ensure that you are financially healthy when you
regain your physical health.