What would you do if you had to go to a doctor but had not health insurance?

[BrokenGlass]

Please discuss.

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[TheRealMD]

Sadly... wait it off until it became urgent enough that an ER had to accept me. Not that I really see any other way.

Of course, I generally dislike the whole idea of ER being primary care when it's abused this way. Not really much else to be done until we "fix the system".

 

[blargh]

cry.

 

[scowdeva]

Well, I havent had health insurance so I was fifteen.....so I guess I dont run to the doctor for every case of the sniffles I get. I have only had to go maybe twice in that amount of time, both times just for infections that wouldnt clear up on their own (I am a firm believer in wait it out, see if it goes away in a couple weeks' time). The docs, knowing that I didnt have insurance, gave me free samples instead of making me fill a script. The only expenses I had were the office visits (round about 100 each, not crazy expensive when factored over the course of 7 years). All in all, me not having insurance has saved me $$$ so far, as I dont have to pay any premiums and only utilize a doctor when absolutely necessary.

EDIT: I guess I should have added that as a student, I absolutely cant pay for insurance in the off chance that something tragic happens to me. Neither of my parents have insurance either, which is a major concern of mine, but as a generally healthy 22 year old dont have health insurance on the top of my priority list (food is waaaaay more important!!!).

 

[jochi1543]

All in all, me not having insurance has saved me $$$ so far, as I dont have to pay any premiums and only utilize a doctor when absolutely necessary.

Yeah, but if you got hit by a car or found cancerous cells at your next pap, this would be a whole different story.

 

[8744]

cry.

Or...I don't know...and maybe this is just crazy talk...you might consider paying for it yourself. A doctor's visit isn't that expensive. 100 bucks? 150?

What, are you folks old, multiply co-morbid people with sixteen medical conditions? Divert a little of your iPod or your bong money and pay for it yourself.

Jeez.

 

[167649]

Sadly... wait it off until it became urgent enough that an ER had to accept me. Not that I really see any other way.

Of course, I generally dislike the whole idea of ER being primary care when it's abused this way. Not really much else to be done until we "fix the system".

Unfortunately, this is what most uninsured people do, simply because they have no chouce. And unfortunately, this is terribly expensive to our economy in the long run when we could have targeted the problem earlier and avoided a pricey acute hospitilization. And this contributes to overcrowded ER's being used as primary care centers. We need universal coverage.

 

[jochi1543]

Or...I don't know...and maybe this is just crazy talk...you might consider paying for it yourself. A doctor's visit isn't that expensive. 100 bucks? 150?

What, are you folks old, multiply co-morbid people with sixteen medical conditions? Divert a little of your iPod or your bong money and pay for it yourself.

Jeez.

$100-150? A doctor once accidentally mailed me the bill instead of sending it to my insurance, and it was $500 - for a visit I paid because I had a really sore throat and the school's health services were not able to figure out what the deal was or how to fix it. The visit included 1 lab test, but that's it. That's more than I pay for Canadian healthcare for a YEAR in one 30-min visit!

 

[BrokenGlass]

Or...I don't know...and maybe this is just crazy talk...you might consider paying for it yourself. A doctor's visit isn't that expensive. 100 bucks? 150?

What, are you folks old, multiply co-morbid people with sixteen medical conditions? Divert a little of your iPod or your bong money and pay for it yourself.

Jeez.

I am not talking about a young, healthy person. Let's say a person in question is in his 50s, and it will definitely cost him way more than $100 AND he cannot afford to pay that much.

 

[ADeadLois]

And this contributes to overcrowded ER's being used as primary care centers. We need universal coverage.

There's another side to that coin, however.

Part of the problem is that, ironically enough, ERs operate too efficiently relative to the rest of health care world. In other words, depending on the severity of your illness and your schedule, going to an ER at 2AM is probably a more efficient use of your time regardless of your insurance status. You get an X-Ray, scripts, etc. in a few hours, whereas if you try to make an appointment with your physician it could take a few days to a few weeks. Universal coverage would only amplify this problem.

 

[PeepshowJohnny]

If I thought I really needed it, I'd go to the ER. However, I'd be super paranoid and make it clear I'm trying to keep my bill low.

"I think I have pneumonia. Give me my CXR, blood cultures, and antibiotics. No, I'm not going to let you order cardiac enzymes to rule out a heart attack in a 20 year old with no risk factors."

 

[167649]

There's another side to that coin, however.

Part of the problem is that, ironically enough, ERs operate too efficiently relative to the rest of health care world. In other words, depending on the severity of your illness and your schedule, going to an ER at 2AM is probably a more efficient use of your time regardless of your insurance status. You get an X-Ray, scripts, etc. in a few hours, whereas if you try to make an appointment with your physician it could take a few days to a few weeks. Universal coverage would only amplify this problem.

Good point and that is why universal coverage is much more complicated than it seems. My statement on needing universal coverage was vague because I dont want to get into that right now. But I do believe that we can design an infrastructure which provides UC and takes pressure off the ER system and uses it more for what it was meant for: emergencies.

 

[pcu]

Well you would have to come up with the money out of pocket. For a few office visits this might not be a concern. But if you have a chronic condition or are on meds etc things change a bit.

Take me for instance. I am turning 29 in 2 weeks and have not had health insurance since I was 22. Jobs I have had did not offer it and I was not able to afford it. I was doing OK for a bit then...

First I noticed some discoloration on a toe nail. No money for the doc an it seemed sort of trivial so like a big dummy I ignored it. A few months later I notice it's worse and kinda looking like nail fungus. So I go to the derm. Mind you I now nothing about health care (nor am I interested in health care) at this point in my life. He takes a nail clipping to determine if it is fungus so he can decide if he wants to start Lamisil. He seems pretty convinced but wants to check. I leave the office fairly certain I have a case of nail fungus.

A few weeks later he tells me its not nail fingus and I prompty get a bill for over a $100 for the nail clipping. I am pretty pissed off at this point. 1) I have no insurance and he made no mention of the cost of the test and 2) I kind of wanted to do the lamisil.

I honestly can't remember what (if any) alternative treatment options he offered. I was annoyed and pretty much out of money and so being young and stupid I chose to go on with life in ignorance with my fungusy toenail. Well over the next year or so it started spreading to other toe nails. This bothered me but I figured hey the only person seeing the nails was the g/f and she didn't seem to give a crap.

At this point it had been about 3 years or so since the first sighting of the apparent toe nail fungus and probably most of them were now affected. Now my fingernails were also starting to show the effects. This was much more troublesome psychologically to me as it was something I couldn't hide once it reached full blow status like my toes had. Fortunately this hadn't happened yet so again I ignore. But then something strange happened.

I started noticing my butt hurt (and I aint gay). Seriously though after sitting for periods of time my coccyx bone would hurt ALOT when I got up. Again this seemed very odd but with no money and no real life threatening distress I chose the old standby home remedy treatment...I ignored it. A few months later (26 years old at this point) I started noticing my body was just kind of hurting all over especially upon wakening. I remember trying to explain it to people by saying I felt like I aged 40 years overnight. It got to the point that I could not ignore it. My hands were hurting and this finally was truly affecting my quality of life in that it was turning into a disability as I could not perform simple functions.

So I went to a PCP. He listened to my history and S&S and immediately diagnosed me with psoriatic arthritis. On the one hand I was kind of happy as I finally had an answer. On the other hand I was just diagnosed with a chronic disease with no cure and I had no insurance.

I now see a Dr at the nearly free university clinic. I pay $5 for precriptions and visits. I take Methotrexate. The nails have not cleared (which really fricking sucks) but the pain from the arthritis is nearly gone. Because of the methotrexate I can no longer drink. So between the nails and the drinking my social life has certainly been impacted some probably more through psychological impact more then what others actually think of me or whatever. It's hard not to think others judge me based on the appearance of my nails.

Now would the end outcome have changed if I had insurance? Not really sure. I mean one would imagine the psoriatic arthritis would manifest at some point. But there is certainly a theme of ignorance running throughout this (now extremely lengthy) post.

 

[SketchLazy]

Please discuss.

Haven't had insurance for awhile. I go to the local free clinic if I really need to see a doc or need a vac.

 

[patrickd223]

I would call many doctors offices and ask what their self pay rate was. Choose the cheapest and go.

 

[limpkitty]

Go to the ER and give them a fake name. After all, per President Bush we do have universal health coverage that's free.

 

[167649]

Go to the ER and give them a fake name.

And then go to jail.

 

[lord_jeebus]

Go to the ER with a fake name and tell them I am an illegal immigrant, so the federal government can reimburse them.

 

[ryno]

And then go to jail.

but I got a fake ID though...

I'd be broke if not for health insurence, a major surgery I had cost over 50000 for insurence company, it would cost more if I had to pay it myself.

 

[lord_jeebus]

but I got a fake ID though...

I'd be broke if not for health insurence, a major surgery I had cost over 50000 for insurence company, it would cost more if I had to pay it myself.

Only in the United States would an uninsured citizen or legal immigrant have to declare bankrupcy over the cost of emergency surgery, while an uninsured illegal immigrant gets the government to pay.

 

[Jolie South]

my PCP is awesome and totally understanding. She gives you a discount if you're uninsured (I think it was around $60 for a visit) and tries to give samples/inexpensive generic meds when possible.

I would just go to her. I've never had a problem getting in. I can usually see her the same week that I call.

Anything more serious than a PCP can handle and I guess I would be SOL.

 

[BlackSails]

I would go to one of the free clinics in the area.

 

[chizledfrmstone]

Edit.

 

[Bacchus]

For those of you that are students, and don't have health insurance, how do you attend undergrad? My school is finally enforcing the mandated health coverage (either private or from the uni) and is putting registration holds on anyone that doesn't comply.

 

[jochi1543]

For those of you that are students, and don't have health insurance, how do you attend undergrad? My school is finally enforcing the mandated health coverage (either private or from the uni) and is putting registration holds on anyone that doesn't comply.

Same at my school. And it wasn't that expensive, like $390 for the entire year...less than I pay here in Canada, although the coverage here is slightly better since there's no copay (even $20 can be hard to come up with at times when you're a college student).

 

[8744]

$100-150? A doctor once accidentally mailed me the bill instead of sending it to my insurance, and it was $500 - for a visit I paid because I had a really sore throat and the school's health services were not able to figure out what the deal was or how to fix it. The visit included 1 lab test, but that's it. That's more than I pay for Canadian healthcare for a YEAR in one 30-min visit!

Whoa. Like someone pointed out, if you pay up front for the visit it will be significantly less than 500 bucks for most doctors. Your PCP sends the bill to the insurance company but do you think any insurance company will reimburse a primary care physician $500 for a simple sore throat? Not on your life. Your doctor probably gets anywhere from nothing to 100 bucks for that visit depending on how accurately it was coded by his office manager and how difficult his insurance company is to deal with. The problem is that you take no initiative to find out how much things cost. Or to say, "Doc, you don't need to do a lab test to diagnose my sore throat." The other problem is that you mentioned you had insurance and made no effort to pay up front, sending the doctor's staff into the automatic insurance billing mode.

I bet most people on SDN think nothing of dropping 50 bucks for a date or paying $300 for and iPOD. It's a question of priorties.

Look at it like this: The cost for health isurance for an average family with a fairly decent insurance plan that has a low deductible and a low co-pay is around $15,000 per year. On the other hand, the average family doesn't really need anything close to $15,000 worth of health care in a year. A couple of pediatrician visits, and annual exam, a few prescriptions here and there, most of which are probably unnecessary (like antibiotics for viral URIs) but since the familiy is not "paying," what the hell and we're not talking a lot of money for most people and especially not for young, basically healthy couples with basically healthy children.

Certainly for a young, healthy, intelligent (because presumably you're going to medical school one day) college student to "cry" because he doesn't have insurance is a complete over-reaction and something for which he should be ashamed.

"Cry." How about get off your ass and stop trying to get other people to pay your way through life. Car wreck? Major surgery" Catastrophic illness? Those are one thing and certainly few people can pay for an ICU stay out of pocket. But a sore throat? A cold? Some bacterial vaginosis? I know for a fact that many of my uninsured patients spend enough on cigarettes and beer in a month to pay for most of their primary care including most of their mostly generic drugs to manage their mostly generic and lifestyle related chronic conditions.

Or haven't you met the asthma patient still smoking two packs a day complaining that he can't afford his albuterol MDI or his advair?

 

[Bacchus]

panda, you keep it real.

 

[8744]

And then go to jail.

No one has ever gone to jail for giving a fake name, a fake address, or a fake phone number. I have many patients whose alleged realtives I call to get them to come pick up the patient only to find both the primary and secondary contact numbers are totally random.

I must wake up four or five innocent bystanders at three AM every single shift.

 

[8744]

panda, you keep it real.

Man. I'll tell you. There are a lot of people who are down on their luck and really need a helping hand. But there are many, many more who are just figgin' free-loaders. The problem with any charity system, and most of the health care reform proposals are schemes to extend charity, is that they will institutionalize free-loading.

The other thing is that our society is ridiculously over-doctored and over-litigated to the extent that we have abandoned all common sense.

 

[8744]

panda, you keep it real.

And I'll extend this question for you all to "discuss:"

Should an asthmatic who smokes his way through $300 bucks worth of cigarettes a month get a free albuterol inhaler from the Emergency Department or any free treatment at all?

Oh, they will say things like, "Well, my sister gives me money for cigarettes," or, "I borrow money for weed" as an excuse for not being able to pay for thier meds.

Hey, mother****er, how about you get yer' stinkin' sister to lend you some money for your blood pressure pills.

I note with interest that nobody ever complains about the cost when I write them a prescription for Lortab or Vicodin. They'll pay for that. That gives 'em a rush. Toprol? It doesn't do a thing for them.

 

[sonofschmilsson]

Only in the United States would an uninsured citizen or legal immigrant have to declare bankrupcy over the cost of emergency surgery, while an uninsured illegal immigrant gets the government to pay.

the govt. reimbursements to hospitals described are not unlike the same provided for uncompensated care to citizens.

the first part of your sentence, sadly, is an accurate statement.

"sadly" depending on your point of view, anyways

 

[mvenus929]

OP... hope he lives in NYC and can go to a public hospital, where most of the patients are uninsured anyway. I did learn something at my interview

I bet most people on SDN think nothing of dropping 50 bucks for a date or paying $300 for and iPOD. It's a question of priorties.

The only thing I'll drop $50 on without thinking is food. And it's usually a lot of food. Clothes (from Walmart and Target, of course) make a close second.

 

[sassalicious]

Please discuss.

I'm in that situation right now. I need my last Hep B shot. The school won't give it to me because I graduated in May and the Dept. of Public Health won't give it to me because I'm over 18 and not an addict or Hep. C positive.

It sucks because I have a decent though temporary job so I don't have any benefits. I don't even care about having to pay for the shot, but I am drawing the line at paying $75 for it. To be honest, when I did have insurance it pretty much sucked because there wasn't *really* an in-network doctor, the copay on Rx was high enough that I just got everything through the university pharmacy for way way cheaper, and the vaccinations I needed that weren't discounted ended up costing $750 or so.

What's nice is that the second I leave this country I have decent health insurance through my scuba diving insurance. Unfortunately the non-diving related medical coverage is only valid internationally. I suppose that means I could run to canada in an urgent non-emergency . . .

 

[Bacchus]

Man. I'll tell you. There are a lot of people who are down on their luck and really need a helping hand. But there are many, many more who are just figgin' free-loaders.

Agree 100%. Everyday I walk past a city-based clinic (I believe its reduced cost, not 100% free) and its packed with people. I don't mind that. People need healthcare and some can't afford insurance. What does piss me off is when Man X or Woman Y comes out of the clinic, lights up, pulls out the $3-400 cell phone, and jumps in the cadillac or SUV. You mentioned messed up priorities. Perfect example. And its happens more than people think.

 

[anybutpretty]

[Deleted]

 

[LizzyM]

I have a chronic condition that requires me to refill $750 in precriptions every month. Right now I'm covered under S-CHIP, but I don't know what's going to happen once I turn 21 and lose that coverage. There's no way I can afford private insurance, if I could even qualify for a policy given my "pre-existing condition." ?

If you are a full-time student, many schools will offer you health insurance, or access to what amounts to a closed panel HMO, for a very low premium. Pre-exising conditions don't matter. Same goes for some very large employers who can insure everyone from day 1 without regard for "pre-existing conditions". The important thing is not to let your insurance lapse. Get a job or full-time school lined up for when you turn 21. Obviously, $750/mo. is more than most folks can afford "out of pocket". Also, with that much medication, you need regular follow-up, too.

 

[45408]

if I could even qualify for a policy given my "pre-existing condition."

There are lots of people with "pre-existing conditions" that get health insurance. The insurance company will either make you wait a while before they'll cover that condition, or they'll just require you to have had insurance up until the point that you switch over to their coverage. You're not SOL.

 

[PreMD86]

If I truly needed medical care but had no health insurance, I'd get a part time job at starbucks. They subsidize 75% of the premium, and the benefits kick in after 90 days.
Deeply discounted health care and free coffee- now that's delicious.

 

[limpkitty]

And I'll extend this question for you all to "discuss:"

Should an asthmatic who smokes his way through $300 bucks worth of cigarettes a month get a free albuterol inhaler from the Emergency Department or any free treatment at all?

Oh, they will say things like, "Well, my sister gives me money for cigarettes," or, "I borrow money for weed" as an excuse for not being able to pay for thier meds.

Hey, mother****er, how about you get yer' stinkin' sister to lend you some money for your blood pressure pills.

I note with interest that nobody ever complains about the cost when I write them a prescription for Lortab or Vicodin. They'll pay for that. That gives 'em a rush. Toprol? It doesn't do a thing for them.

No he shoudn't get free care. The ciggarette companies that make billions off of people like him should pay for his care.

 

[IceMan0824]

No he shoudn't get free care. The ciggarette companies that make billions off of people like him should pay for his care.

Hahahahahahaha. Good one.

 

[foreverLaur]

I'd be a goner. I've had three surgeries (torn meniscus, torn ACL, torn rotator cuff)

 

[PreMD86]

No he shoudn't get free care. The ciggarette companies that make billions off of people like him should pay for his care.

Hmm, so by that logic, you should hold columbian drug cartels accountable for every addiction rehab and treatment, or budweiser for every case of cirrhosis. I am personally in favor of free treatment, not because I disagree that the cigarette companies and smokers should share the responsibility, but because of the inevitable slippery slope that'll be created.
There is no way to conclusively prove that any disease is caused 100% by smoking, drinking, or eating badly- only that they increase the risk of some diseases. I can't fathom a health care system where one must take an insurance company to court to prove that a disease is less than 50% lifestyle related.

 

[45408]

I'd be a goner. I've had three surgeries (torn meniscus, torn ACL, torn rotator cuff)

Contact sports weren't designed with people like you in mind.

 

[Pigg-O-Stat]

Go to a community health center. It is completely free and generally very high quality.

 

[limpkitty]

Hmm, so by that logic, you should hold columbian drug cartels accountable for every addiction rehab and treatment, or budweiser for every case of cirrhosis. I am personally in favor of free treatment, not because I disagree that the cigarette companies and smokers should share the responsibility, but because of the inevitable slippery slope that'll be created.
There is no way to conclusively prove that any disease is caused 100% by smoking, drinking, or eating badly- only that they increase the risk of some diseases. I can't fathom a health care system where one must take an insurance company to court to prove that a disease is less than 50% lifestyle related.

And most people in the developed world can't fathom a health-care system in which people that need care are denied it because they can't afford it

 

[PreMD86]

And most people in the developed world can't fathom a health-care system in which people that need care are denied it because they can't afford it

I figured that can go unsaid, but

 

[Drogba]

There's another side to that coin, however.

Part of the problem is that, ironically enough, ERs operate too efficiently relative to the rest of health care world. In other words, depending on the severity of your illness and your schedule, going to an ER at 2AM is probably a more efficient use of your time regardless of your insurance status. You get an X-Ray, scripts, etc. in a few hours, whereas if you try to make an appointment with your physician it could take a few days to a few weeks. Universal coverage would only amplify this problem.

Well... you could stop treating non-emergent cases and referring people to clinics couldn't you? Countries with universal health care don't have this problem with ERs even though the wait time to appointments can be pretty long. I agree that people who have grown accustomed to getting care at the ER might be slow to change their behavior but after getting turned away a couple of times by EM docs maybe they would learn. Maybe I am being naive here and disregarding some complex policy issues, but why wouldn't this work?

 

[foreverLaur]

Contact sports weren't designed with people like you in mind.

haha... i spent my life doing gymnastics (13 years), basketball (AAU and school), volleyball (JO and school), and track (6 years)

 

[8744]

No he shoudn't get free care. The ciggarette companies that make billions off of people like him should pay for his care.

Or the mother****er can cut back a little on his cigarettes and beer (notice I'm not saying he even needs to quit) and buy his own medications. So while he's waiting for his tobacco money that may never come, what should he do in the meantime?

Your problem is that you cannot understand the concept of free will. Homie smokes and drinks because he wants to. He doesn't pay for his medications because he doesn't want to, that is, he has better things to spend his money on.

When I did my one year of family medicine I had lots of patients who wanted to quit smoking but were only held back because they couldn't afford the nicotine patches. Well, duh, the nicotine patches cost about as much per day as a one pack per day habit. Oh the mystified looks I used to get when I explained the simple logic of spending the money on nicotine patches instead of cigarettes.

Don't you folks get it? The majority of the Holy Underserved (PBUTHN) as well as many of you look at medical care like a city utility. Turn on the tap, get water. Turn on the switch, get lights. Go to ED, get health care.

 

[8744]

Well... you could stop treating non-emergent cases and referring people to clinics couldn't you? Countries with universal health care don't have this problem with ERs even though the wait time to appointments can be pretty long. I agree that people who have grown accustomed to getting care at the ER might be slow to change their behavior but after getting turned away a couple of times by EM docs maybe they would learn. Maybe I am being naive here and disregarding some complex policy issues, but why wouldn't this work?

Whoa. Do a quick internet search and you will find that France and the United Kingdom, just to name a few, have almost the exact same problems with over-utilization of Emergency Services for non-emergent complaints as we do.

And these countries, as well as Germany, are feeling the pinch of increasing costs.

And you are naive. And ignant'. Do a google search for "EMTALA" and report back to us what you find.