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Underinsured? 11 ways to stretch health-care dollars -- Page 2

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.

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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.

Don't 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.

Act 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, Cooper says.

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.

-- Posted: June 28, 2005




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