Thanks to the Affordable Care Act, access to health insurance is easier than ever before in our country's history. Every single one of us should have health care (and are legally required to do so). There are a lot of "shoulds" in this world, and it is important to let go of some of them. Having health insurance is not a "should" to let fall by the wayside, and no one knows this truth more than an uninsured person looking at a bill from the emergency room.

Let's set aside all judgment about signing up for insurance and face the facts: some people don't have health insurance. And sometimes, these people have accidents and need health care fast. Here's a beginner's guide on how you can help someone without health insurance face the bureaucratic tangle of uninsured emergency care for a non-life-threatening situation. Please be aware that the advice below is only for non-life-threatening situations.

Scenario: Meet Nina

For the sake of sanity, let's address uninsured emergency care with a concrete example.

Meet Nina. Nina is a kind, hardworking woman who has a lapse in her health insurance coverage. And now, she's fallen and her arm might be broken. She needs care fast.

Transportation

Let's assume that Nina is conscious, coherent, and able to move herself. If you and Nina deem it safe to transport her without paramedics, this will save a hefty sum in and of itself. Ambulances are very expensive.

Note: If you are ever in doubt as to whether or not to call the paramedics, call them. Especially if there may be a head or spinal injury, it is imperative that Nina is transported safely. While you may save money on an ambulance bill by driving yourself, if Nina is injured further in transport, the bills for her care will be exponentially higher (not to mention the new health challenges she will face).

Where to Go: Urgent Care or ER?

If possible, take Nina to an Urgent Care clinic. These clinics are less expensive than hospital emergency rooms.

Regardless of where you go, grab a few things to bring with you:

Paper and pen. You will want to take notes on all conversations you have.
Nancy's ID
Zip-up hoodie and sweatpants for Nina. If Nina does not need to wear a gown, you want her to be able to take on/off her clothes easily and with minimal pain. Bring the change of clothes with you, no need to help her change at home.
Water Bottle.
Snacks. These are for you, until Nina is given the go-ahead to eat. Do not feed Nina. but know that you may need sustenance while you're there, and it is hard to keep a strong advocate mind when you are fueled solely by candy from the vending machine.

Ask Questions

As per usual, health advocacy starts with questions. Emergency room doctors can seem more brusque than other physicians, but remember that these folks aren't just tending to Nina's broken arm, they have a number of serious, possible fatal situations to handle. Be patient with all health care personnel who help Nina. Ask for and write down the names and roles (nurse, PA, MD, etc.) of everyone who comes into the room. This can be helpful to establish rapport, and also helps you keep track of who you've talked to and how they may be able to help. Be aware that Nina's health care providers are there to talk to Nina, they need to know her story and they need to know it fast. They may not like you asking questions and may not be particularly friendly. Cut them some slack, and continue to ask your questions politely until they are answered.

Some emergency room bills end up being very expensive for the high price of common items, like bandaids and antiseptic. This is by no means the rule at all hospitals, but it is good to ask. If Nina's wound is being cleaned, ask if they are going to bill Nina for the cleaning supplies. If so, Nina needs to verbally refuse these items. Document her refusal on your notes.

Remember that it is within Nina's rights to be kept appraised of what is happening at each step of the process. Each time someone comes into the room, ask what the next step in the process is. Be patient, Nina will definitely have to wait her turn for care, but knowing what to expect can help everyone keep calm.

Call Financial Services

Nina will receive a stack of papers regarding her payment options. Contact the number listed for Financial Services as soon as possible to discuss options. Be nice! Likely, you will be working closely with one representative throughout the process, and treating this person with respect will help you get the answers you need. As always, take copious notes from your phone call, including the name and contact info for the person you speak with.

In Colorado, the first line of financial support for patients is Medicaid. Ask the Financial Department if Nina qualifies for Medicaid based on her income.

If Nina does not quality for Medicaid, the next step is to look into CICP, the Colorado Indigent Care Program. This is also an income-based program, but the limits of need are typically different for emergency care visits than for regular care. Nina may not be eligible for CICP for regular care, but be eligible for some level of CICP assistance for emergency care. Ask the Financial Services Department about income limits for emergency care.

Apply for Financial Assistance

Fill out all paperwork required by Financial Services as soon as possible. Deliver the required paperwork in person and document the name of the person you submitted the paperwork to.

Many hospitals will help you set up a payment plan to cover emergency room bills. Do not let these bills pile up on your coffee table! Be sure to maintain good contact with the Financial Services Department and work with them to pay your bills on time, at a rate you can manage.

Follow-up Care: Specialists

Let's say that Nina is referred to follow-up care with an orthopedic surgeon to assess whether or not she will need surgery. Typically, the hospital will recommend a physician who has admitting privileges at their facility, in case surgery is needed. This is where things can get tricky. Nina my be eligible for financial assistance for emergency care, but not for surgical care. Ask the Financial Services Department what Nina's eligibility is for surgical care. If Nina is not eligible for assistance for surgery at this hospital, look for another hospital.

It isn't very much fun, but this is where doing the legwork can end up saving Nina thousands of dollars.

Call other local hospitals and ask about their Financial Assistance or Charitable Care programs. Once you know what Nina is eligible for, ask the hospital you choose for a list of orthopedic surgeons who have admitting privileges at their facility. While Nina will still likely be responsible for the full cost of the doctor's services, she can receive assistance for the facility costs, which are usually the highest portion of the bill.

Future Considerations

During the next Open Enrollment period, ensure that Nina signs up for health insurance. She can do so through C onnect for Health Colorado, our state's insurance exchange.

Remember that I am always happy to help answer questions about your particular case and help you in your advocacy efforts. Do not hesitate to reach out with any questions you may have!

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Health Advocacy: Emergency Care for the Uninsured