Health Insurance|September 4, 2009 10:07 PM

If you need health care right now…

If you have no health insurance, and things are getting desperate because you or loved ones are already sick, you still have options.

When a child is sick, the first instinct of a parent is to rush to a hospital emergency room where patients can’t be turned down for an inability to pay.

Many people subscribe to the conventional wisdom that it is better to be handed a large ER bill that patients aren’t forced to pay, because a doctor’s office won’t see them until they front the money.

That conventional wisdom is wrong. The hospital may have to treat you, but that doesn’t mean it won’t bill you. At up to $600 an hour.

If you value your good credit rating, that’s a problem.

Emergencies need to go to the emergency room. But for routine medical care, finding discounted or subsidized care at a doctor’s office or clinic is much cheaper in the long run than going to the ER for a non-emergency, and then ignoring the bill.

Using a hospital emergency room for routine care “is a huge expense to everyone,” including those whose private insurance premiums are higher to cover the cost of the uninsured, said Michelle Adams, family health coordinator for Tri-County Health Department in metro Denver.

Instead, a survey by Colorado Public News found many doctors and clinics in Colorado offer hefty discounts – as much as 50 percent off — if you pay in cash.  Your credit card is usually as good as cash, because the doctor gets paid immediately by your credit card company. This is one time when it may be worth paying 20 percent interest, to get a 50 percent discount. Here are the details. (link to discounts story and chart)

Every hospital in Colorado has some kind of arrangement for discounts if you pay immediately, make arrangements to pay, or can’t afford it, according to the Colorado Health and Hospital Association. Check individual hospital websites and look for their policies on the uninsured. Here’s one for Centura, which runs 12 hospitals in Colorado.

Pregnant and no insurance? It’s easier to qualify for government-paid health care through Child Health Plan Plus or Medicaid when you are pregnant. Here’s a separate story for pregnant women. (link to baby)

But if that’s not an option, and you have a healthy pregnancy, you can consider going through a certified midwife program, which can lower the total bill from about $11,000 to $4,000. Here’s a video showing how one Colorado woman gave birth out of the hospital with a midwife.

You may be able to get instant health care coverage if you qualify for government-subsidized insurance programs such as Children’s Health Insurance Plan Plus, or Medicaid. Call your county health department or Colorado’s Health Care Policy and Financing Department.

“We started a presumptive eligibility program a year ago,” Adams said. “That means a mother can bring in her children and have them enrolled in temporary Medicaid that day.”

It allows enrollment specialists to approve the children for Medicaid or CHP even if the parent doesn’t have all the documentation — if it appears that the family will be eligible. It means a sick child can see a doctor that day. The doctor has faith that his bill will be paid by Medicaid.

Usually, if a qualified person calls the county health department or e-mail by mid-afternoon, they can make an appointment with a clinic for some time the next day.

Adams recalls a woman from Castle Rock whose son had asthma, and so applied for Medicaid. She didn’t know about presumptive eligibility, so while she waited for approval took her son to the emergency room.

“She would have been better off getting presumptive eligibility that day,” Adams said. “She could have gone to a doctor, gotten the inhaler” and established an ongoing relationship with the doctor.

It’s much harder for adults to find subsidized health care than children.

One place to try:  Colorado’s 138 federally-subsidized health clinics in the Colorado Community Health Network. They get money from the federal government, and their budgets are perennially perilous. They had 1.6 million patient visits last year, including 419,000 different patients.  With names such as Salud, People’s Clinic and Clinica Campesina, they charge on a sliding income scale.

About 45 percent of their patients qualify for Medicaid or another government program; about that same percentage are unemployed; and one in 10 does have private insurance.

They need to maintain that delicate balance to keep their doors open. Reimbursements from some patients, together with the direct federal funds, help to defer the costs of treating the uninsured.

If the family’s income is near zero, the bill is modest. Trouble is, the typical clinic has a waiting list in the hundreds and has seen a slash in its primary-care funds.

“This is a place the newly unemployed can come, but we can’t take all comers,” is the way Boulder Peoples Clinic CFO Tom Littleton, put it.

But making a neighborhood clinic the go-to place for the children in the family could help win the parent a coveted slot on the adult side of the clinic.

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  • If CPN (or whatever you call yourself) is going to do real investigative reporting, it will have to do better than this article implies. Here, you relate a story of a woman whose child could have been treated under “presumptive eligibility”. If she was qualified and applied, it was incumbent upon those to whom she applied to already be aware of “presumptive eligibility”, and not her.

    As things stand today, the health system “consumer” has to know more about the labyrinthine system than those who administer it. This on top of often limited facility in English.

    Add to that the fact that the very people who must understand so much more than most are in a socioeconomic category (aliens, elderly, impaired, etc.) that the assumption of their access to online resources (one your article also implies) is absurd. Who in this category is Internet savvy enough to Google the day away navigating the maze when a child or other family member is clearly ill? All of these possibilities are Monday-morning advice.

    There is only one true solution: a health system that doesn’t presume post-graduate understanding of bureaucratic systems and require online acumen. The cost will be manageable once people recognize the elephant in the corner: a going-nowhere multi-front military adventure and the expense of feeding it at Pentagon prices. That money could buy a lot of aspirin.

  • Oh, and a postscript. Your article makes tentative reference to “discounts” etc., but doesn’t follow through. That’s what editors are for — to keep things professional. There’s no substitute for another set of eyes.


  • Thanks for your comments and suggestions!
    The discount story can be found, above right, under the headline, “Doctors offer healthy discounts.”

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