Free and inexpensive healthcare resources...

There are many creative and effective ways for anyone to save on their medical expenses. Considering that the cost of healthcare is getting out-of-reach for the average American, it makes sense to look for the various cost-saving options. While I was an instructor at California State University, I would get regular requests for health information from people who simply can't afford the high cost of healthcare. This site is an attempt to make the information readily available to people who need it the most.

According to The Cost Containment Research Institute, Nearly 46 million Americans are lacking health care insurance. Many uninsured sick people who are ill, can not afford potentially life saving drugs or other important health-related items. According to The National Coalition on Health Care, Americans spend about 1/8 of their income on health care, or $4,000 for every man, woman and child in the country. Health care costs have been rising at about twice the rate of income, and health spending is projected to double again to $2.1 trillion by 2007. Fortunately, there are several effective strategies for reducing or eliminating the cost of basic healthcare.

Here are a few of the ways to save on your medical expenses:

• Free hospital care- many hospitals, nursing homes and clinics offer free or low-cost health care through the Hill-Burton Act passed by Congress. If you qualify, the Hill-Burton Act will cover most of your hospital expenses. For more information, contact: Office of Health Facilities, Health Resources and Services Administration, Department of Health and Human Services, 5600 Fishers Lane, Room 11-03, Rockville, MD 20857. Phone: 800/638-0742. Even if you don't qualify, your local hospital may have special funds that have been donated to provide care for low income individuals and families.
  Q&A: http://www.hrsa.gov/osp/dfcr/obtain/CONSFAQ.HTM
  Directory: http://www.hrsa.gov/osp/dfcr/obtain/hbstates.htm
  
  Also- RotaCare is a coalition of over 1,500 Rotarians, physicians, nurses, pharmacists, social workers, interpreters and other volunteers who provide free medical care to the medically underserved in a collaborative effort with hospitals, clinics, community and social service organizations and service groups. Their free clinics are available in the San Francisco Bay Area, Seattle, Washington, and New York State. http://www.rotacare.org/about.htm
  
• Saving on prescription drugs- Generic drugs can be one of your best health bargains. Ask both your doctor and pharmacist to administer them. Try to get a one to two day supply of a new drug that you are being prescribed so that if you have an bad reaction to the drug, it will not cost you anything. Many doctors receive free samples of drugs they are prescribing from the pharmaceutical industry. For more information about generic drugs, write to the: Generic Pharmaceutical Industry Association, 200 Madison Ave., New York, NY 10016.
  A list of prescription assistance programs and other health savings information is available at: http://www.volunteersinhealthcare.org/links.htm
  Below is a list of several large pharmaceutical companies who provide free and discounted medication to low income individuals that are listed below, (click here)
  Seniors- call the U.S. House of Representatives' Special Committee on Aging at (202) 224-5364. Ask for the free Information Paper on Programs to Help Older Americans Obtain Their Medications. This report describes the programs of drug manufacturers that have a special program of this kind. Read it carefully and then talk to your doctor if you think you may be eligible.
  Also: A nonprofit volunteer organization call "The Medicine Program" will work with your doctor to help find the programs that are appropriate for you. themedicineprogram.com
  Also: Many larger-dose pills are less expensive (by volume), and come already scored so they can be split for a smaller dosage. Ask if there's an over-the-counter medication that can do nearly the same thing as the prescription drug; they're usually cheaper.
  Background information: National Committee for Quality Assurance- For their free brochure, Choosing Quality: Finding the Health Plan That's Right For You at www.ncqa.org
  Finally, here are some discount mail order drug suppliers:
  Drugs by Mail, 5007 N. Central, Phoenix, AZ 85012. 800-775-6888. www.drugsbymail.com
  American Association of Retired Persons (AARP) prescription program, 800-456-2277.
  Merck-Medco Managed Care, LLC, 800-247-1003; www.merck-medco.com
  Medi-Mail, 800-331-1458; 800-992-3444
  Preferred Prescription Plan, 800-881-6325
  Express RX, 510-963-6400
• Clinical trials- Each year over 150,000 patients receive free medical care by some of the best doctors in the world. Many are older patients suffering from common conditions, like Alzheimer's, cataracts, and heart disease. This is possible because medical researchers get millions of dollars each year to study the latest causes, cures, and treatments for the diseases. If your condition is being studied somewhere, you might qualify for a clinical trial and get treatment for free. Click here for more information or go to http://clinicaltrials.gov/
  
• Avoid unnecessary lab tests- Always question the need for lab tests, especially if you have had the same test recently. Do-it-yourself tests are available for simple procedures such as vision testing, blood pressure, lung function, etc.
  
• Use outpatient services as often as possible- Avoid checking into a hospital on a weekend, since surgery and tests are generally scheduled during the week. You can save one or two days of hospital charges by getting needed x-rays, lab tests, and blood work done outside the hospital, prior to being admitted.
  
• Use primary-care physicians- They are able to treat the vast majority of illnesses at a more affordable rate than specialists. For routine problems such as cuts, broken bones, sore throats and ear aches, go to a general practitioner rather than a specialist. They can always refer you if necessary.
  
• Get a second opinion- for serious procedures such as surgery. The surgery may not be necessary or there may be an alternative treatment that is less invasive. Medicare and most HMOs will pay for you to get a second opinion, in fact, sometimes it is required.
  
• Compare health insurance- A free service offered by many insurance companies uses a computer to evaluate dozens of different policies and sort them according to cost and features. If you can't find a local agent with this service, contact the source: Quotesmith, 50 North Brockway, Palatine, IL 60067. (800) 556-9393. (Also see the materials section of this course for more information).
  
• Health hotlines- Many states have health hotlines that will help direct you to health and human services in your area. In California, try the Department of Health Services, 916/445-4171; California Medical Association, 415/541-0900; Maternal and Child Health, 800/222-9999 or 916/657-1347.
  
• Solving insurance disputes- If you have a dispute with your insurance company, and are unable to resolve a payment issue directly with them, contact the state's insurance commissioner. If that does not work, find out if your local newspaper (or the nearest large city) has a consumer affairs column, (often that's all it takes to get the dispute resolved). If you ever need to complain about a health practitioner, contact your state's Department of Consumer Affairs or Health Department. See our section on prescription drugs for more information.
  
• Time savings- Call ahead to see if the doctor is running on time. If you have to take time off from work, this can help save money and balance your schedule accordingly. Seek telephone advice from your doctor whenever possible. Many doctors are happy to answer questions and provide advice over the phone. This can save on unnecessary visits.
  
• Read and research your condition- You will be able to make more informed decisions about your treatment and avoid unnecessary tests by becoming a partner in your health care decisions. Many resources are available on the Internet, including specific sites for various ailments. The National Library of Medicine is the world's largest medical research library, containing more that 4.5 million journals, technical reports, books, photographs, and audiovisual materials. Most of this information is available to the public. www.nlm.nih.gov
  
• Free or low-cost community health services- These include such things as flu shots, immunizations, health screening tests, etc. Many communities have non-profit health centers that charge on a sliding scale. Also, look for health fairs that provide information about various local health resources. For a extensive listing of free clinics throughout the United States, go to the National Free Clinic Directory site at: http://www.freeclinic.net/
  
• Dental care- Most states have special programs for senior citizens and others who have trouble paying for dental care. Call your state's Department of Public Health for more information. Also: each state's dental society keeps track of its own free and low-cost dental programs. Another option for low-cost dental care are the 50+ dental schools across the country. They offer quality dental care at a fraction of the cost of private dentists. Finally: avoid the root canal scam. Many financially-aggressive dentists are encouraging patients to have root canals when it it is not really necessary. Root canals cost much more than just having a cavity filled and require several visits to perform.
  
• Take charge of your own health- many health conditions are directly or indirectly a result of lifestyle. Eating a balanced and nutritious whole foods diet can make a huge difference in your energy level and resistance to disease. Getting regular exercise can help to lower blood pressure and also help to make your body resistant to disease. The conventional "Western" model of health is quick to prescribe expensive drugs, but fails to provide very much preventative advice or treatment. Patients in many U.S. hospitals are fed a mediocre diet of Jell-O, white bread, processed vegetables and other nutritionally depleted foods. Taking charge of your own health requires an investment of time and money to make sure that you are getting the best quality food and exercise. Once you begin to feel the difference in vitality, you probably won't ever want to go back to the typical sedentary lifestyle with its nutritionally void diet and expensive medical payments.
  
• Self-diagnostic tools: Here are some resources to help you determine the appropriate level of care that you need: The American Academy of Family Physicians offers some excellent self-care flowcharts (do-it-yourself diagnosis). http://www.familydoctor.org/symptom.xml
  Prevention.com site provides information about various diagnostic tools. http://www.prevention.com/
  
• Common Hospital Billing Errors: Up to 95% of hospital bills contain errors, and most of these errors favor the hospital, according to John Connolly, EdD, former president of New York Medical College. Here is what to look out for:
  Incorrect billing codes- There are more than 7,000 five-digit codes for diagnostic tests, surgical procedures, etc. Don't trust the number. Look for the description of each procedure.
  Duplicate billings: These occur frequently with urine tests and other common tests.
  Redundant or shoddy testing: You should not pay for unclear X rays, blood tests ruined because of inadequate samples or any test that has to be repeated because of a mistake by the hospital lab.
  Unauthorized charges: Hospitals sometimes charge your credit card without you approval. Always insist on advance approval.
  Phantom charges: Watch out for charges for test that were ordered and then cancelled.
  Unrequested items: Often, these carry confusing names so they'll slip in uncontested. A $15 "thermal therapy kid" may be a bad of ice cubes. A $5 "urinal" may be a plastic cup.
  Unbundling: Routine procedures are sometime billed separately, and the sum of these parts is often greater than the whole.
  Arithmetic errors: They may be honest mistakes, but the hospital won't correct them unless you bring them to its attention. Don't pay the bill immediately upon your discharge from the hospital. Take it home and look it over carefully.
  Additional help: If you have trouble understanding your bill, visit the hospital billing office and ask for a "simple English" explanation. Be sure to also check for errors in your dates of stay, telephone and medication charges, along with costs associated with tests. While in the hospital, keep a diary of all tests, medications and procedures to help detect any errors.
  

Bibliography

Health Care Shopper's Guide, 59 Ways to Save Money. From the Office of the Attorney General, State of Maryland, 200 St. Paul Place, Baltimore, MD 21202.

150 Ways to be a Savvy Medical Consumer, by Charles Inlander. People's Medical Society, 462 Walnut St., Allentown, PA 18102 They also publish the book Getting the Most for Your Medical Dollar and other useful titles.

The Patient's Guide to Medical Tests, by Cathey and Edward Pinckney. Facts of File Books, New York, 1987. This book is a good basic guide to do-it-yourself medical tests.

Infomedicine, A Consumer's Guide to the Latest Medical Research, by Fred D. Baldwin and Suzanne McInerney. Little, Brown and Company, New York, 1996. A basic guide to medical research.

Fighting Back, A Guide to Challenging Health Insurance Denials, by Robert Peterson Jr. This book provides strategies for making health insurance companies pay your claim. Center for Public Representation, Inc., 121 S. Pinckney St., Madison, WI 53703. The Center also offers several other useful health-related books and guides.

How to Protect Your Life Savings From Catastrophic Illness and Nursing Homes : A Handbook for Financial Survival by Harley Gordon. 1995. Senior Planning Group Pubs; ISBN: 0964289601. An essential guide to what every American family needs to know about what won't be covered by healthcare reform--long-term care. The author, a nationally-known elder law attorney, explains the ongoing changes in Medicaid law and developing strategies to cope with these changes.

Lerner's Consumer Guide to Health Care, by Paul & Julie Lerner, 2000. Lerner Communications, Ltd; ISBN: 0966999924. Learn to be an effective consumer with this book. Includes sample letters, scripts for phone calls, key terms, and appendices of health and insurance departments in all 50 states. Paul Lerner conducted award-winning work for AIDS advocacy..

Free Health Care, Free Medical Information and Free Prescription Drugs by Matthew Lesko, 1995. infoUSA, Inc.; ISBN: 1878346342. This book helps to uncover the more than 6,000 hidden opportunities for care and assistance available regardless of economic status.

Health & Medicine on the Internet, Annual Guide to the World Wide Web for Healthcare Professionals by James Davis. PMIC, Los Angeles, 2000. This extensive book is divided into chapters based on health conditions (Cancer, Eating Disorders, Infectious Diseases, etc), and provides links to thousands of health-related Web sites and their descriptions.

Health Online: How to Find Health Information, Support Groups, and Self-Help Communities in Cyberspace by Tom Ferguson M.D. Addison-Wesley, Reading MA, 1997. Here is a comprehensive guide to information on diseases and illnesses. The author explains how to locate online medical journals and interpret articles.

Mosby's Medical Surfari, A Guide to Exploring the Internet and Discovering the Top Health Care Resources by Scott Gibbs, etc. Mosby Year Book, Inc., St. Louis 1997 ISBN: 0815148178. A detailed but slightly out-of-date book that reviews over 450 sites.

The Doctor's Always in : A Guide to 1000+ Best Health and Medical Information Sites on the Internet by Jay S. Schneider, Theodore I. Lidsky Jay S. Schneider, Theodore. I Lidsky, June 1999. ISBN: 0966494903. Here is a comprehensive guide to medical information on the Internet that is oriented to the needs of consumers rather than medical professionals.

300 Incredible Things for Health, Fitness and Diet on the Internet -- Peter Lupus (Introduction), Ken Leebow (Editor); Vip Pub; Oct. 1999 ISBN: 0965866874. Here is a brief review of 300 health-related sites.

Shocked, Appalled and Dismayed by Ellen Phillips Vin Books, '99 0-375-70120-6. Learn how to write effective complaint letters.

Lerner's Consumer Guide to Health Care, by Paul & Julie Lerner Lerner Communications, Ltd; ISBN: 0966999924 ; Dimensions (in inches): 0.79 x 8.48 x 5.51. Lerner Communications, Ltd. P.O. Box 20697. Seattle, WA 981021. An extensive guide to the various aspects of low cost health care.

Free and Low Cost Prescription Drugs. The revised fourth edition booklet gives information on how and where to get free & low cost prescription drugs. Over Seventy-Five programs and 1,100 drugs are listed. http://www.institutedc.org/

Take This Book to the Hospital With You by Charles B. Inlander and Ed Weiner. People's Medical Society. ISBN 1-882606-70-1. Guide to surviving your hospital stayand avoid billing errors, malpractice, etc.

Dial 800 for Health. Compiled and tested by the Staff of the People's Medical Society, ISBN 0-9627334-9-0. From AIDS to diabetes, arthritis to poison centers, you'll find a toll-free telephone number where you can get helpful and healthful information.

Long-Term Care and Its Alternatives by Charles B. Inlander, Michael A. Donio and J. Lynne Dodson. People's Medical Society. ISBN 1-882606-56-6. Long-Term Care and Its Alternatives covers the options from everything from assisted living to home care, from skilled nursing to intermediate care.

The Savvy Medical Consumer by Charles B. Inlander and the Staff of the People's Medical Society ISBN 1-882606-31-0. Learn how to get discounts on your medications, insurance, etc. Protect yourself from unnecessary tests and much more.

Self-Care: Your Guide to Symptoms and How to Treat Them by Don R. Powell, M.D.1-882606-50-7. This book leads you step-by-step through the medical problems that typical people have and explains the self-care procedures you can take

Test Yourself for Maximum Health by Charles B. Inlander and Jim Punkre. People's Medical Society. ISBN 1-882606-11-6. Using simple self quizzes and questionnaires, you can gain a better understanding of your health status and health knowledge. Evaluate your family medical history, eating habits, level of stress and much more. You can even determine your risk for various ailments.

What to Do When It Hurts: Self-Diagnosis and Rehabilitation of Common Aches & Pains by Malcolm Read, M.D., with Paul Wade. ISBN 1-882606-66-3. Learn to diagnose your aches and pains.

Additional Links:

Consumer Reports Online- The online service of the nation's premier consumer magazine with occasional health-related information. http://www.consumerreports.org/main/home.jsp

Drug InfoNet- Extensive information, including package inserts, on popular pharmaceutical drugs, along with contact information for drug companies. www.druginfonet.com

Go Ask Alice, Columbia University Health Service- A web site for young women and men about physical and emotional health. www.goaskalice.columbia.edu

Health Care Financing Administration- The site of the government agency that administers Medicare, Medicaid, and Child Health Insurance Programs. www.hcfa.gov

Insurance News Network Web site- Lists ratings of the financial strength of insurers and managed-care companies, and provides other insurance information. www.insure.com

National Center for Complementary and Alternative Medicine- An informative resource on alternative medicine from the National Institutes of Health. nccam.nih.gov

National Committee for Quality Assurance (NCQA) This not-for-profit group accredits HMOs and other managed-care organizations. www.ncqa.org

SelfGrowth.com is one of the largest resources for Personal Growth and Self Improvement on the Internet. They provide hundreds of articles and organized links to over 4000 websites specializing in Personal Growth, Self Improvement and Self Help. http://www.selfgrowth.com/

Be sure to check out the Online Medical Research course materials section for many more links.

Used Medical Equipment Sources

http://www.bestuse.com/

http://www.pemed.com/

http://www.medmatrix.com/

http://www.1-medical-equipment.com/

http://websites.medmatrix.com/index.cfm

http://www.medused.com/

http://www.medicalresourceusa.com/

http://www.pemed.com

Using newsgroups to gather health-related information:

Here is some additional information that has been recently posted on various health-related newsgroups by average people sharing thoughts and ideas about saving on their medical expenses. Although this information is sometimes anecdotal, it does provide leads for possible solutions to your health care challenge. This is for information purposes only and should not be construed as medical advice.

Usually these newsgroups invite anyone to post a problem that is usually based on personal experiences. I would encourage readers to explore some of these health-related newsgroups (www.deja.com) and post your questions. Here is an example of several actual problems that were posted, along with a summary of solutions offered by others.

The Problem:

My husband and I have unfortunately just had a miscarriage. If that were not enough we are uninsured and the hospital bills look like they will be around $4,000. Has anyone ever successfully negotiated with a hospital for a lower bill when paying cash? Are there any money saving suggestions in general to help deal with a one-time, totally unexpected cost like this? Thanks for your help in advance. Autumn in Michigan.

Feedback:

A Doctor's Advice

I am a primary care MD and have many patients with no insurance. All of the hospitals in my state (Massachusetts) have financial assistance offices to help patients with financial hardship. At the very least, they can come up with a very generous payback schedule (its in their best interest as many people end up defaulting on big bills otherwise). More often than not, many people without insurance will qualify for some degree of free care. In Massachusetts there is a "Free Care" fund which all of the hospitals pay into (With money earned from paying/insured patients), and then hospitals can get $ from this fund to pay for the care of people who fall between the cracks (no insurance and do not qualify for other government health assistance programs). I've been very surprised at how generous this fund has been and who can qualify. Many of my working, but uninsured patients (the "working poor") have qualified to some degree (50-75% reduction in bills). Anyway, the financial assistance office at their hospital should know the "scoop" for what is available in their state/community. I hope this is helpful. I feel really badly for that poor woman who not only lost a baby, but now has big bills to pay. -- Gregg

Call Accounting

After my husband was in the hospital for chest pain, we ended up with several hundred dollars of deductibles etc. The thing to do is immediately upon receiving the bill is call the accounting office at the hospital and doctors offices (they send their own bills) explain that you do not have the funds to pay in full but would like to make monthly payments. We are paying the doctor $25/month and the hospital $20/month. The important thing is not to ignore the bill or send partial payments without talking to them first otherwise your bill will show as delinquent. -- G. H. RN

Ask About Charities Fund

Most states have a Charities Fund to pay unexpected medical expenses. It is intended for those who fall between the cracks - too much money for Medicaid, but unable to pay bills uncovered by insurance. Tell the hospital business office to submit your bill to the State Charities Fund. If they say they have never heard of it, or no such fund exists, call your State representative and make him earn his salary. He can find out for you. -- Eileen

You Can Negotiate

My job requires me to negotiate with medical providers. I can assure you that hospitals can, and will, negotiate charges. They would rather get paid by you than turn the bill over to a collection agency, or worse, write the charges off. I would explain your financial situation, and offer a lowball sum, maybe 25%. I would not expect to pay less than 50%. They will often discount to 2/3. if they want you to pay more than 75% ask for the person's supervisor. -- Adam W.

Hospitals Will Negotiate

I can assure you that hospitals can, and will, negotiate charges. They would rather get paid by you than turn the bill over to a collection agency, or worse, write the charges off. I would explain your financial situation, and offer a lowball sum, maybe 25%. I would not expect to pay less than 50%. They will often discount to 2/3. if they want you to pay more than 75% ask for the person's supervisor. -- Adam W.

Prompt Payment Negotiation

I worked for the last 15 years in health insurance claims and one of the projects I started was to negotiate a discount in exchange for prompt payment. Some hospitals are pretty cooperative, others are definitely not. The only way to know is to ask. You will probably need to talk to the manager of Patient Accounts. I was getting discounts anywhere from 2% to 20% (but, hey, every little bit helps!). The catch is, you usually have to promise to pay the balance in full within 30 days. It's best to call near the end of the month or quarter when they are trying to clear up their books. Before you call to negotiate, you should get an itemized statement from them and go over it with a fine tooth comb. Because a lot of the terminology will be foreign to you, it's really helpful if you can have a nurse friend look over it for you. You will be looking for anything that looks like it's been double charged or charged to you in error. I have found as many as 10 charges for something that was only used once. Your nurse friend will be looking for things that look inappropriate such as heart medications when you don't have a heart condition, etc. Oh, and when you look at your bill you will be disgusted by the amounts that they charge for each individual item (aspirin for $3 each, $2 band-aids, $6 toothbrushes, etc). Save yourself some stress and put it out of your mind. Hospitals are free to charge whatever they deem 'appropriate' for their supplies and there is nothing anyone can do about that. -- Sherry B.

They Don't Like Bill Collectors, Either

I'm so sorry about your miscarriage; to have to worry about a bill on top of that is awful. I used to work in hospital billing, and I know that most hospitals will negotiate a payment plan for the amount if you approach them. They don't want to have to send you to collection-it's much better for them to get the full amount, even if it takes longer (collection agencies take a percentage). I've seen payment plans as little as $25 a month. It can't hurt to try. Good luck! -- KW

Hospital Audit Department

My local hospital has an audit department and when a co-worker of mine asked them to audit her mother's hospital bill it was lowered from around $7,000 to close to $4,000. She was told that the hospital does not audit their bills before they send them and they are only audited if a patient requests it. -- PB

A Win/Win Solution

I don't remember where I read about this idea, but it was recently in a magazine or newspaper. It was about several people in different cities that had trouble paying for their hospital bills. They did not have the cash but used the barter system. One lady did data processing 2 nights a week for several hours and in 8 months had her hospital bill paid. Another lady did gardening work to pay off her bill and a man did some other type of work needed by his hospital. Everyone won. The hospital got labor and jobs completed and the people did not have to come up with cash. The hospitals are actually going to incorporate this barter system in their future plans as their are always some people without insurance or even who are underinsured. Instead of bankrupting families or stiffing the hospital, the patients can feel proud that they are doing their part to be responsible. -- Jana L

A Negotiation Plan

To negotiate debt you must first do the following: 1. Look at how much money you can offer the creditor and/or when you will be getting the money. 2. Write a summary about your current situation, with what you can realistically afford to pay and make and offer to settle or make payment arrangements. Usually the creditor will accept 50 - 60 cents on the dollar or a reasonable payment arrangement. Remember, don't promise what you can't pay. Sometimes, it also helps to have a mediator to help stand in for you, especially if you are uncomfortable negotiation. In that case, you can find a negotiator in your area or call me, and I will be glad to help for a nominal fee. -- IDC

The following feedback relates to insurance questions and problems:

Try for Catastrophic Plan

If you can't afford a regular insurance policy, consider a catastrophic health insurance plan. I know that at least Blue Cross Blue Shield of Illinois has a good plan. While it doesn't cover doctor visits or anything, it does help with hospital bills and other major expenses and the premiums are very cheap (I think I paid $20 a month). -- Jen B.

Most States Have a Plan

In Washington State, there is a state insurance fund for people who are unable to obtain private coverage. I am not sure of all the details, but know that most states do have such a fund. The coverage is not as extensive as a private carrier, but it would provide her with some catastrophic type coverage and give her an option until she is able to find private coverage. This fund is separate from the Medicaid (or welfare health) program so she should qualify for it. I would suggest that she contact the Insurance Commissioner's Office in her area. -- Steve F.

Editor's note: readers from a number of different states had similar advice.

Find a "Group"

I too, live in CA and up until 10 months ago I was the group insurance administrator for a company of 300 employees. If the writer of the question (or the victim of insurance companies as I see it) was covered for 6 consecutive months PRIOR to searching for medical insurance, she cannot, by law, be declined by any insurance company for any reason, including pre-existing conditions. I suspect, however, by her post that she had gone some period of time without coverage. Given that, her best bet is to become affiliated with some kind of group that offers its members medical insurance. For instance, my husband is a real estate appraiser. as such, he belongs to FREA (Foundation of Real Estate Appraisers) which offers group insurance for all of its members. Real estate agents have similar organizations they can belong to. Many, many professions have related clubs and organizations which offer health insurance. If she cannot find one related to either her or her husband's occupation, then I suggest she start up a small business---maybe Mary Kay, Avon, Tupperware, anything that will allow her to apply to organizations for small business owners. most of those offer group health plans. As long as she tries to obtain health insurance through a group plan, it is unlikely she will be denied. Most group plans are set up so that members, upon initial enrollment, cannot be denied. -- Jackie M.

Pre-Existing Clauses

We too had a similar problem with the insurance companies because of our daughters health. You should talk with the insurance commission in your area. Also, if your illness is something that will be with you for the rest of your life, you could ask for a preexisting illness clause. This means that the insurance company will not cover any bill related to this illness but will cover the other expenses. -- V.

Health Benefits Counselor Could Help

You may want to contact your local county agencies to see if they have a Family Health Benefits Counselor. I used to be one for the Public Health department in a County in Wisconsin. Different states may have them not all counties have a Family health benefits counselor. They provide information, referral counseling and advocacy for families in order to obtain health care financing through public and federal programs. You may want to see if your state has a risk insurance plan. Wisconsin has H.I.R.S.P. Insurance. They will accept persons who have been denied insurance for reasons of pre-existing conditions or if you are a high risk patient. Also, your medical centers should have a patient assistance program to help with the cost of your medical bills. They can either take a percentage as payment in full or sometime write off the entire bill if you are indigent. I have helped many folks who have enormous medical bills as a Family health benefits counselor it takes patience but being persistent with agencies and asking for help is the key. Kevin D.

The following feedback relates to pharmaceutical drug questions and problems:

Prescription drugs are very expensive, especially for those with chronic or complicated illnesses. There are a few things you can do to reduce your bill at the pharmacy.

Start at the doctor's office. Ask your physician if he knows how much the prescription should cost. If he doesn't, ask the office staff to call the local pharmacy while you are there to check prices. This is often a great eye opener for most physicians. Cipro 500mg (an antibiotic) can run over $150 for a 10 day course in our area and there are no generic substitutes. If you can't afford the drug, insist on something else. It only works if you take it! Ask if they carry any samples of the drug. Offices and hospitals receive samples for free from the drug companies so don't be bashful about taking them. Find out if they would be willing to switch to a comparable but cheaper drug if your pharmacist recommends it before you get to the store.

Call local pharmacies and compare prices. Have the drug name, dosage and quantity available when you call. If you can't read the prescription have the physician, office staff or pharmacist write it out for you. You have a right to know what you are taking. Buy only one or two days worth of a new medication to see if it will work. If you need to change drugs after two days you have only bought the amount you have used. No more half full prescription bottles getting wasted. You can buy several pills at a time of any prescription but must stick with the same pharmacy until that prescription is completed (not including refills). If you have insurance make sure you are paying your copay on the cheapest amount possible - it may be cheaper to buy the drug without insurance. I buy prenatal vitamins for $20 for 100 tablets. These are covered by my insurance with my $7 copay for 30 days/pills. So 90 tablets would cost me $21 using my insurance but $20 for 100 tablets without insurance. Find out the base price of the medication before you hand in that card!

You will also be asked about generics. By federal law generics have the same amount of active ingredients as brand name drugs. The difference is in the substances used to fill or pack them. You should discuss with your physician the use of generic drugs. Any drug that must maintain a level in you bloodstream i.e. antiseizure meds, anticoagulants, certain cardiac meds, certain antipsychotic meds, must be maintained in the form you started. Switching from generic to brand name or vice versa could be fatal. The active components are the same but your body may react differently with the 'filler' and absorb not enough or too much of the active ingredient in the same dose.

For those with chronic illness, check into bulk buying or mail order services. AARP, Good SAM Travel Club, MedExpress are just a few nationwide companies. These save money and most deliver directly to your door. Call the company that produces the drug you are taking. This can be found in the Physicians Desk Reference at your physicians office or the pharmacy. In true financial hardship most companies will provide the drug at no charge if you qualify for one of their programs. You don't have to have a low income - many will consider a temporary change in your situation as adequate for short term help. These programs can't be used for a ten day prescription but for long term drug therapy, considering the time it would take to qualify.

Research over the counter medications that were once prescription strength. Over the counter adult ibuprofen comes in 200mg strength while prescription strength is 400 - 800mg a dose. Bought on sale, it may be cheaper to take the over the counter meds in the same strength, but remember to calculate the price per pill. Several stomach preparations, arthritis medications and other drugs are now over the counter in reduced strengths.

Free and Discounted Medication:

Here are some of the larger pharmaceutical companies who provide free and discounted medication to low income individuals. According to the publication Free and Low Cost Prescription Drugs, by the The Cost Containment Research Institute (cited above), most major drug companies provide free medications, but rarely, if ever publicize it. Generally drug companies require a doctor's consent to provide the medication and proof of the patient's financial hardship.

Apothecon PO Box 4500, Princeton NJ 08543 (800)321-1335

Aventis, PO Box 9950, Kansas City MO 64134 (800)727-6737 Patient Assistance: (800)221-4025

Bedford Laboratories, 300 Northfield Road, Bedford OH 44146 (800)562-4797

Bristol-Myers Squibb Company, PO Box 4500, Princeton NJ 08543, (800)332-2056 Patient Assistance: (800)437-0994

DuPont Pharmaceuticals Co., 974 Centre Rd - Hickory Run Bldg, Wilmington DE 19880, (302)992-5000 Patient Assistance: (800) 474-2762

Eli Lilly and Company, PO Box 25768, Alexandria VA 22313, (800) 545-5979 Patient Assistance: (800)545-6962

Novartis Consumer Health, PO Box 52052, Phoenix AZ 85072, (800) 257-3273 Patient Assistance: (800)257-3273

Merck & Co. Inc. PAP, PO Box 2240, Pittsburgh PA 19486, (800) 672-6372 Patient Assistance: (800)994-2111

Roche Pharmaceuticals, 340 Kingsland Street, Nutley NJ 07110, (800) 526-6367 Patient Assistance: (800)285-4484

Wyeth-Ayerst Laboratories, PO Box 8299, Philadelphia PA 19101, (800) 395-9938 Patient Assistance: (800)568-9938