Financial Assistance

COBRA premiums can be incredibly expensive—up to 102% of what you and your employer were once paying together (and in some cases, this amount can be even higher)! But despite the cost, it can be really important to exhaust your COBRA coverage in order to be eligible for certain protections afforded by HIPAA and other laws. For more information on COBRA, you can contact the Department of Labor, Employee Benefits Security Administration at http://www.dol.gov/ebsa.

While there are financial assistance programs offered through some private charitable organizations that may be able to reduce the cost of COBRA premiums (some of which are available here: https://www.disabilityrightslegalcenter.org/about/documents/NationalFinancialAssistance2011.pdf), one option that may be available to help people pay for the costs of COBRA in certain states is the Health Insurance Premium Payment Program (“HIPP”). HIPP is a Medicaid program that pays for the private health insurance premiums for certain individuals with high medical costs.

HIPP programs are not offered in every state and eligibility requirements vary. Generally, to participate in a state’s HIPP program, an individual must qualify for Medicaid and have an existing medical condition that has been determined to be a cost-effective condition for the HIPP program. For more information on which states offer HIPP programs, please view our handout on the topic, here: https://www.disabilityrightslegalcenter.org/about/documents/NationalHIPP2011.pdf

It sounds as if your doctor is not a contracted provider under your insurance contract. If that is the case the doctor is not subject to the insurance company, the insurance company's rules, regulations, policies and procedures have no jurisdiction on the non-contracted provider. Therefore, the non-contracted doctor has no legal obligation to send a claim, receive payment from the insurance company, or appeal a denied or partially paid claim. Everything reverts to the contract between the patient and their insurance company. That contract requires the patient to submit their own claim, however they can decide to submit a claim but it is only as a courtesy to the member. If the doctor is contracted with your insurer they must submit your claim for you and this scenerio should be reported to your insurer.

Keep in mind if you are using a non-contracted provider you will be subject to higher out-of-pocket cost since they do not have a pre-negotiated rate with your insurer. PAF has a great publication on Usual, Customary and Reasonable Charges (UCR) a result from using an out-of-network provider/facility. http://www.patientadvocate.org/index.php?p=439

Thank you for your response. I actually met you last year at the Society of Integrative Oncology (SIO) conference. I am very well of the integrative therapies out there and teach it to my clients. In addition, I used to work at youcanthrive as a integrative patient navigator/health coach but the program is limited to 3 months. I was hoping that maybe there was something more long-term. As you know these services can become quite costly. The women I work with are all in an underserved community and would never be able to afford anything other than meditation or fitness in the form of walking where there is not cost at all.

I really enjoyed this session! Thanks Annie!!

Much continued success to you and all the work you are doing.

These women can go to the NLN, which has funding for garments for people who cannot afford them. As to treatment (CDT), I would say they can ask if the treatment center has funding for people who can't afford it.

Start by talking to your doctor/medical professional. Explain your financial situation and ask if he/she can reduce fees. You'd be surprised how open some are to this. Some doctors will give you a 20% discount on their fees if you pay within the first 30 days of service. All you have to do is ask.
If you are to be in a hospital or surgery center and you will not be using your insurance, you can negotiate with them. You can start by offering 60% of their fee and then settle on paying 70% of their fee.
If you have Medicare and your doctor/medical professional does not take Medicare, ask for a discount. It may not always work but it's worth trying.
Doctors, hospitals, surgery centers and other medical professionals would much rather be paid upfront so if you do not have insurance and are negotiating a cash pay, you are in a pretty good position to negotiate a discount.
You can always ask for a payment plan. I have done this myself. Not a discount but at least you don't have to pay everything up front.

My insurance wouldn't pay either, but Merck had a program to furnish it to patients in those circumstances. Don't think we ever had to buy a single dose - they mailed them to me before each scheduled chemo. Your doc should contact them for you an arrange that.

Negotiating fees are, at this stage, limited to your discussions with hospitals, and providers. Manged care firms negotiate with the buyers of the plans, which are the company or government sponsors of those plans. So, the providers or hospitals with from which you are receiving treatment may be amenable to negotiation depending upon your income and how high your deductibles and/or co-pays are. It's a delicate discussion of course, but you may be able to approach, say, the billing office. The concept of Consumer Directed Healthcare is not to make things easier or more economical for a member/patient: In reality it's just more verbiage used in shifting the costs of healthcare onto the wallets and purses of those members/patients.

Here is some additional information from the American Society of Clinical Oncology: http://www.cancer.net/patient/All+About+Cancer/Managing+the+Cost+of+Cancer+Care/Financial+Resources

There are multiple strategies that may be employed to help with unpaid medical bills. You may want to discuss options with your treatment facilities on ways to reduce or eliminate your out of pocket expenses:

For assistance with Part A or B cost, apply for financial assistance through the billing office at your provider’s office or medical facility.

You may first need to apply and be denied for Medicaid or one its programs, such as Qualified Medicare Beneficiary (QMB) or Specified Low-Income Medicare Beneficiaries (SLMB) Program to qualify for financial assistance from the hospital. To apply contact your State Department of Social Services in the State where you reside.

Co-pay relief programs may be able to cover some of your pharmaceutical co-payments. Check with each program to see what is covered. You can also contact Patient Advocate Foundation’s Co-Pay Relief Program at 1-866-512-3861 to see if you qualify for assistance with your co-payments or explore websites such as www.pparx.org for a list of programs by disease.

Negotiate discounts or payment plans with the hospital or medical provider. Some providers will offer a discount for prompt payment of your balance.

Drug replacement programs may be available to assist you by providing medications to your physician’s office specifically for your use. Discuss these programs with your physician.

Contact a disease specific organization to see if there are any financial grants available to assist you. These programs vary widely and may pay for transportation or other related expenses. Patient Advocate Foundation’s National Underinsured Resource Directory can lead you to the best resources for you needs. Visit http://www.patientadvocate.org/help4u.php

For assistance with Part D cost, apply for Extra Help through www.ssa.gov that offers qualified individuals with extra help to pay for the monthly premiums, annual deductibles, and co-payments related to the Medicare Prescription Drug Program.

Some states offer a State Prescription Assistance Plan. Explore the site http://www.needymeds.org/state_programs.taf to learn more about the your state.

Discuss generic alternatives with your physician if brand named drugs are too costly.

We encourage the review of our publication, A New Approach: A Simple Dialogue between the Patient and Provider about the Cost of Medical Care available at http://www.patientadvocate.org/pdf/pubs/a_new_approach.pdf.