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Pine Country Publishing 127 Rainbow Dr #2780 Livingston, TX 77399-1027 928-607-3181

Health Insurance Part 3

By Jaimie Hall

Originally published in the July/August 2002 Workamper News. Updated 2007.

As we have seen in Part ! and Part II, finding individual health insurance coverage that is affordable is not an easy task. Many RVers choose major medical coverage, which covers catastrophic events and has a lower premium. The policy holder is responsible for the first $2,500 or more in expenses before coverage kicks in. The greater your deductible, the lower the premiums. Some of these policies do pay for one medical exam per year or for routine tests such as pap smears and mammograms (or a portion of them), even if your deductible has not been met.

Here are some suggestions and resources for reducing expenses if you have no health insurance coverage, or you haven't met your deductible.

Doctors

If your doctor's visit won't be covered by insurance, then it pays to comparison shop. When calling for an appointment, find out the charges. Ask for a discount for cash since the doctor's staff will not have to complete insurance paperwork.

Check with state and local clinics or clinics run by nurse practitioners or physician's assistants. Their fees are often less or may be based on a sliding scale. For routine exams or tests, you may be able to take advantage of community programs:

Planned Parenthood clinics offer lower-cost exams to women. Some states have programs that give free exams and tests to low-income women.

Health fairs offer diagnostic tests, like checking cholesterol levels, at reduced prices. (Use these to monitor your health, not in place of a doctor's visit.)

For an operation or procedure, you may be able to obtain the Medicare rate, usually lower than standard rates. Discuss this with your doctor prior to the procedure. DeAnna needed a partial knee replacement. By searching the Web, she found a site related to that operation. She contacted physicians listed there, asked questions, and negotiated a price beforehand at considerable savings.

You might be eligible to participate in a clinical trial related to your diagnosis. Several Web sites list these. At Centerwatch.com you can sign up for e-mail notification for new trials or medications in specific health areas.

Hospitals

Hospital expenses can be negotiated too. Prior to admittance, talk to your physician and the billing department of the hospital to find out how you can keep expenses down. For example, you might be able to have your operation done on an outpatient basis. You can often negotiate a lower charge, particularly if you can pay that amount in cash. Additionally, hospitals often have sources for interest-free loans.

Hospitals may have an obligation to provide free services in some instances to low-income patients under the federal Hill-Burton Free and Reduced-Cost Care Program. Obtain a free brochure at 800-638-0742. State or local laws may also apply. Hospitals may have funds set aside to pay bills of people who cannot afford to do so themselves. Ask if you qualify.

Make sure you get an itemized bill and then check it carefully. Mistakes are common. Check for procedures that were not done or items not provided. Look for "upcoding," where a patient is charged for a procedure that is similar but more costly than the one provided. You may want to hire a claims assistance professional to help you. Usually the money saved more than pays the professional's fees.

Prescription drugs

If you are not eligible for Medicare, you can receive help with prescription drugs if you have no prescription coverage and you meet income guidelines. A number of the large drug companies have established programs. The "Together Rx" card works for selected drugs from seven pharmaceutical companies. Income cutoffs are $30,000 for singles, and $40,000 for couples. Apply at 800-865-7211 or http://www.togetherrxaccess.com.

Programs available to those who meet income qualifications include:

Needymeds.com: tips on how to get free or discounted medications directly from drug companies. Check at http://www.needymeds.com by drug or program.

Pharmaceutical Research and Manufactures of America: http://www.phrma.org Look under "patient's directory." Search for programs by company.

The Medicine Program http://www.themedicineprogram.com will help you get a lower cost medicine for a an additional $5/prescription, saving you the legwork of the two programs above.

If you can't find a program for your particular medication, contact the manufacturer. You may be able to get some assistance.

Check with Medicaid for your state - (Links with contact information are at http://www.cms.hhs.gov/medicaid/stateplans). Income eligibility requirements vary tremendously. For example in New York, the state will pay some of the cost of drugs for couples with incomes of up to $50,000.

If you do not meet income qualifications for assistance programs yet have no prescription coverage, you can still save money.

Ask your physician for samples or if there is either a cheaper medicine or a generic drug that may give you the same benefit.

Compare prices at drug stores.

Check with the pharmacy to see if you can get a quantity discount if you buy a year's supply. Sometimes a pill that is double the dose is less expensive. You can then cut it in half.

Many RVers purchase prescription drugs in Mexico or Canada. (Make sure you are getting the same medicine.) Compare prices for each prescription. One online store for Canada is http://www.tcds.com/. You will need a doctor's prescription.

Other tips

Get a second opinion if surgery is suggested. The cost for a second exam could be offset by savings if another physician disagrees with the diagnosis or treatment.

Be proactive. Research on the Web to find good health practitioners and latest treatments. Newer procedures may be less invasive and less costly. For example, in the diagnosis of breast cancer, there is a relatively new machine called a mammotome, which is like a tiny vacuum cleaner that makes only a small puncture (rather than an incision) and sucks out the suspicious area in the breast. It is less than half of the cost of traditional biopsy surgery and has several other advantages for the patient.

I also highly recommend obtaining a copy of The Lerner's Consumer Guide to Health Care by Paul Lerner and Julie Lerner. It has excellent suggestions and resources for getting the best health care. Health professionals make errors and are often profit-driven so you must be your own advocate.

As with many other aspects of the RV life, there is no one-size-fits-all, nor are there easy answers. You must take charge of your health. And, it goes without saying, one of the best ways to reduce expenses for health care is prevention: eat right, exercise, and follow safety guidelines in your activities.

Resources

A.M. Best Company, the Insurance Information Source.

National Association of Health Underwriters (NAHU), an association of independent health insurance sales agents. Search by state or zip code.

National Association of Insurance Commisioners (NAIC) Find your State Insurance Department at this web site and carefully check out any company.

Department of Labor - Pensions and Welfare Benefits Information about HIPAA. (800) 998-7542

Finding and Keeping Health Insurance, free AARP Publication D17319. Order from AARP, 601 E. St., NW, Washington, DC 20049.

Medical Savings Accounts, IRS Publication 969.

National Committee for Quality Assurance (NCQA), Accredits and rates health insurance plans by state.

Georgetown University Institute for Health Care Research and Policy, Consumer guides for all states. Call (202) 6870880.

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