Underinsured health care programs.
Patients will often find that their health insurance won’t pay for all of their medical expenses and these individuals will generally be considered underinsured. Many of these people are finding that they are faced with a number of challenges that are associated with high medical costs despite having some sort of insurance coverage. Sometimes a patient is just unable to pay the out-of-pocket costs, deductibles or fees that are not covered by your insurer. Studies show that almost 30 million families fall into this category of being underinsured. Several non-profit organizations and government programs listed below focus on helping with providing health care and paying bills for this classification of people.
Sometimes you may actually be able to pay the bill or a portion of your costs but the issue may be that your current insurance provider is denying payment on either your entire or a small portion of your claim. This can be caused when a company may not give approval for any services you received. The provider can also claim the services were not property ordered or required, that they were not notified in advance, or your specific benefit may have been capped out. This can be especially true for consumers with less expensive or not as generous health insurance plans. Unfortunately your insurer may deny paying your bills or not allow reimbursement for a specific service or treatment so you can fall into the under or uninsured category almost by accident. Read the fine print of your plan closely, as every insurance plan contains a detailed definition of services that they will not allow payment for. Some companies may consider these as non-covered services.
If you have an upcoming appointment or surgery scheduled it is always recommended to review your current health insurance policy in order to determine the length of any benefit cap and to ensure what you will be reimbursed for. Some of they key items to look for include you need to determine if the treatment being sought, or the specific benefit in question, has an annual or a lifetime maximum. If possible, you may want to delay treatment until you complete your review of the policy and also talk to your doctor or hospital beforehand as well. Another option for the underinsured is to negotiate directly with your medical provider for a prompt or self-pay discount.
Appeal decision from health insurance provider
State rules and regulations will also allow underinsured consumers to appeal any denial of coverage from your health insurance company. Many states will allow anyone to do this, even family’s that have more comprehensive coverage. You will need to provide additional information that may allow the health insurance carrier to reverse their decision.
The process requires you to prove that they are responsible for paying the medical bill(s) in question, so you need to be prepared. Consumers will need to determine the specific reason for the denial or rejection of your claim, and you will need to appeal based on that specific issue. Some consumers may find this process fairly intimidating and if so there are professionals that people can turn to for guidance.
If the denial from your carrier involves co-payments, deductibles, or co-insurance, then there are other tactics to try. Those steps include talking to your hospital, doctor or medical provider. Ask them about financial assistance programs such as full-charity care, prompt-pay discounts, self-pay discounts, partial and reasonable payment arrangements. Find a step by step approach, and get help appealing health insurance claims.
Resources for underinsured patients
Discounted dental care - The following non-profits can offer qualified individuals, with limited insurance policies, reduced prices or financial assistance on cleanings and other services.
- National Foundation of Dentistry for the Handicapped can be reached at 303-534-5360.
- American Dental Association has information on dental schools, which can provide discounted service to families, in particular children. Call 312-440-2500.
Eyecare and hearing programs - Many individuals do not have adequate vision or hearing insurance. Maybe their company doesn’t offer this coverage at all. The three leading agencies to call are as follows.
- Vision USA can help people who are considered underinsured and meet low income levels. Receive vision care services and basic eye health free of charge. Telephone number is 1-800-766-4466.
- Hear Now - The non-profit can help patients of all ages who are deaf or hard of hearing. If their insurance doesn’t pay for it, Hear Now can help people acquire hearing aids or other equipment. 1-800-328-8602.
- New Eyes for the Needy can provide new or recycled donated glasses to poor adults and children. 1-973-376-4903
- EyeCare America can direct consumer to facilities that provide eye care, treatment, and even educational materials. 1-800-222-3937
The underinsured can also really benefit from Co-pay assistance programs. These are generally offered to individuals who currently have health insurance but maybe their plan says they are required to pay a portion of their bill for prescription medications or chemotherapy. Each of these agencies will have their own application process and guidelines that need to be met.
- Patient Advocate Foundation's Co-Pay Relief - 1-866-512-3861
- Patient Access Network Foundation - 1-866-316-7263
- Healthwell Foundation - 1-800-675-8416
- Chronic Disease Fund - 1-877-968-7233
- Patient Services Incorporated - 1-877-968-7233
- National Organization of Rare Disorders, Inc. - 1-800-999-6673
- Leukemia and Lymphoma Society - 1-877-557-2672
- Breast and Cervical Cancer Program can offer screening and treatment. 1-800-232-4636
- Cancer Care Co-Pay Assistance Foundation - 1-866-552-6729
- Caring Voice Coalition, Inc. - 1-888-267-1440
- Managed RX - This is a nationwide pharmacy program that will waive a consumers co-payment requirement. They will also mail medications directly to consumers. Note people who have Medicare or Medicaid will not qualify. Telephone number is 1-800-799-8765.
Federal government resources are also available. The programs, organizations, and resources can help with many health care needs and costs. Some can coordinate direct medical care to the underinsured, and others are more for information, answering questions, or can help people address insurance company decisions.
- Veterans' Administration - Military members and their dependents can receive a broad spectrum of surgical, medical and rehabilitation care. Any treatment paid for will depend on the veterans needs and current insurance status. Dial 1-877-222-VETS
- The Hill-Burton Program is offered by the federal government. It can help patients locate hospitals or medical facilities, and the center can provide the low income and underinsured with free or low priced care. You do need to look into this program before entering a hospital or receiving surgery. 1-800-638-0742.
- U.S. Department of Health & Human Services offers various services for the least fortunate. One of the key resources available is a hotline for individuals to call in order to file complaints regarding their insurance provider, Medicare or Medicaid. It can also give information on entitlements, health care benefits, insurance and resources. The government can also direct people to federally-funded health centers regardless of the patients ability to pay their bill. 1-877-696-6775.
Clinical trials are another option that many people with limited health insurance policies pursue. They can be an effective way to access affordable medical care. While you always want to read the fine print of a program, and talk to your doctor, these can very well provide a way to access health care for the underinsured and the trial can often pay your entire bill.
- The National Institute of Health (NIH) - This coordinates various trials for patients and they have information on a number of available programs. 1-800-411-1222
- National Cancer Institute - This non-profit only has cancer related trials. Dial 1-888-624-1937
- Emerging Med - They offer resources, including a free online tool, for finding clinical trials. Phone 1-877-601-8601.