Ever skipped an annual physical or postponed surgery because you dreaded the bills? Insured or not, you're in good company.
According to the Centers for Disease Control and Prevention, 48.2 million Americans under age 65 did not have health insurance in 2011. Even a number of people with insurance didn't get off easy, as millions of them did not have dental coverage and many were underinsured—meaning medical expenses are still high relative to their income.
Research published by the Commonwealth Fund, a private foundation focused on healthcare improvements, forecasts that the Affordable Care Act—also known as Obamacare—could reduce the number of underinsured adults by 70 percent. Still, several provisions of Obamacare won't go into effect until January or later.
With the high cost of medical and dental care in the United States, some patients are finding creative workarounds to get the care they need. Here's a look at some of those strategies, as well as their potential pitfalls:
Financial assistance. Some hospitals offer payment plans for payment assistance, so it never hurts to ask. At the Woodhull Medical Center in Brooklyn, N.Y., artists and arts workers who live in New York City and earn an annual income of up to 400 percent of the federal poverty level can get healthcare on a sliding scale through the Artist Access Project. In exchange, the artists provide therapeutic services to patients or otherwise share their art with the hospital.
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Other providers have more traditional financial assistance programs. Mark Rukavina, principal at Community Health Advisors and former executive director of the Artist Access Project, says nonprofit hospitals are legally required to have a financial assistance program. Rukavina recommends patients also look into public assistance programs such Medicaid or the Children's Health Insurance Program (CHIP), which may be able to cover some medical costs retroactively. "Just because they've incurred a bill doesn't mean they can't be covered," he says.
David Williams, president of the Boston-based Health Business Group and author of HealthBusinessBlog.com, says larger, well-funded hospitals are more likely to offer a sliding-scale discount to patients based on income and family size. He says individual doctors are less likely to cut you a deal, but you can sometimes negotiate fees upfront.
Medical tourism. Patients Without Borders, a medial tourism group, estimates that 750,000 Americans will seek medical care outside the United States this year—a phenomenon known as medical tourism. Meanwhile, some patients travel domestically for elective surgery or dental procedures.
In theory, medical tourism can save money, but Williams cautions that it only makes sense in a limited number of situations. "The classic cases are for somebody that has some money and won't get free care in the U.S. and can get a hip replacement or knee replacement more cheaply in India or Singapore," he says. "It's important to have a family member with you when you're going through the medical system and when you're recovering. The further away that you go, the less likely that you can have a companion with you."
Crowdfunding. Crowdfunding sites like GiveForward.com and GoFundMe.com let patients or their families solicit donations online for medical treatment and associated costs. When Laura Weber heard her nephew's son might have water on the brain , a condition that can cause vomiting, muscle spasms, and brain damage, and require surgery soon after birth, Weber turned to GiveForward and raised almost $7,000 so the expectant parents could travel from Oklahoma to Boston Children's Hospital for care last fall. "This is a young couple without a whole lot of money and a high-risk pregnancy," says Weber. "I have a daughter with special needs, so I just really felt a lot of compassion and I knew how much money it can cost." Baby Liam was born, healthy, on Christmas Eve. In total, families have raised close to $35 million on GiveForward, according to the website.
Williams says crowdfunding for medical costs has potential, especially if the patient has lots of friends and a compelling story. However, he adds that crowdfunding—like other strategies—should be used in conjunction with checking bills for errors and negotiating costs where possible.
Daily deals. Offers for teeth whitening, LASIK eye surgery, and even medical check-ups have popped up on daily deal sites, including Groupon and AmazonLocal. A recent AmazonLocal deal for New York City offered a pediatric dental exam, cleaning, bitewing X-rays, and fluoride treatment for $100 instead of the regular price of $300.
Such offers can be appealing to those without dental or health insurance, but Williams cautions patients to avoid buying more than they need. "A lot of the dental deals include things that the typical patient—especially one on a budget—could go without, like X-rays," he says. X-rays can also open the door to upselling if they uncover an issue. "The value proposition that these sites provide [to doctors and dentists] is that you will get new customers and you'll make money from their repeat visits," says Williams. "But a patient may get a Groupon from another dentist, and they may only get this one opportunity, so they try to sell as much as they can right now."
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Vicky Choi learned this the hard way after buying a voucher for a dentist's office in Southern California without reading online reviews. She'd planned to get a cleaning, but the dentist tried to upsell her to a more expensive procedure she couldn't afford. After the dentist insisted a regular cleaning would be useless, Choi requested a refund from the company that sold her the voucher and went back to her regular dentist. "I was trying to avoid an $80 cleaning since I'm unemployed, but the old adage 'you get what you pay for' rings true," she says, adding that other reviewers on Yelp.com had a similarly frustrating experience at the dentist's office.
Daily deals make sense in some cases, but sticking with a regular dentist or doctor—even if it costs you more out of pocket—offers the longstanding trust and continuity of care offered by a provider you know.