How to Deal with a Medical Crisis
Medical experts answer more than two dozen key questions—about second opinions, clinical trials, the limitations of insurance, and other significant topics—to help patients map a road to recovery
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How can I find out how much treatment will cost and what I personally will need to pay?
• Some insurance carriers have Internet-based tools that allow you to enter your benefit parameters—PPO or HMO, annual deductible, copayments, and so forth—then get a ballpark estimate of your total out-of-pocket cost. The actual cost can vary greatly from the estimate, of course, depending on any of a slew of factors. The figure from the online tool shouldn’t be considered anything more than a very rough approximation.
You can get a closer estimate from a representative at your insurance company. Unforeseeable, complicating circumstances may increase your final costs.
What resources are there for financial support?
• A major source for financial support is your future self. That is, if you set up an installment plan for payment with the hospital or physicians’ group, you can take some of the sting out of the bottom-line figure on the bills. “Paying for health care is very different from paying for your credit card,” says Kathleen Boss, the director of special initiatives at Gilda’s Club Chicago. “Most hospitals will set up some type of a payment plan with you, no matter if it’s five dollars a month or 500 dollars a month.” Call the hospital’s billing department to arrange a plan if you can’t pay all at once—before the bills are sent to a collections agency: This could damage your credit.
If you don’t and won’t have enough money to pay your hospital bills, ask the hospital about a financial assistance policy. Most hospitals provide some amount of charity care. You will need to fill out extra paperwork revealing certain financial details and attesting to your inability to pay.
Scores of charities offer assistance to chronically ill patients. Many of these charities are disease-specific, such as the Wilmette-based Leukemia Research Foundation or No Wooden Nickels, which helps cancer patients in Illinois. Others provide a specific kind of assistance, such as the HealthWell Foundation, which helps patients afford prescription medications. Hospital social workers can be a great help in locating the right organizations. Most can also be found through some light Internet research.
My problem isn’t really with paying the bills. It’s with the flood of logistical problems that accompany illness. What should I do about them?
• The burdens that come with a medical crisis can be staggering. Getting to and from doctor’s appointments grows into an obstacle when your driving ability is impaired by injury, fatigue, or medication. Errands like grocery shopping, cooking dinner, and ferrying children around require more planning and mental effort. Arranging for appointments or treatment can disrupt your schedule. Individually, these problems are small, but together they are monstrous.
A number of charitable organizations and houses of worship have programs to provide rides to patients in need. Also, many hospitals have shuttles with regular routes. Social workers at the hospital will know what’s offered and what might work for you.
If you are going to be hospitalized, social workers know places where your family members can stay to be nearby, sometimes at a discount or free through charities. If you are going to lose your hair, they even have leads on how to find a wig.
Keep a calendar. Even if you didn’t keep one before, the irregularity of appointments and the complexity of medication schedules can be a lot to keep in your head. If you have a companion who attends appointments with you, he or she might also keep the calendar for you.
What’s more, think back to all those people who, when you told them about your diagnosis, said, “Let me know if there’s anything I can do to help.” A lasagna waiting for you in your oven feels like a miracle when you get home from chemotherapy.
What’s going to happen with my job? And what legal protections do I have as an employee?
• You should talk through with your doctor what you will be capable of in the future, whether because of treatment side effects or because of disease symptoms. People react so differently that you may be able to work more than someone who has the same profile and diagnosis.
Short- and long-term disability programs are built into many benefits packages. Call human resources to discuss what your plan offers if you think there’s a chance you will need it.
Also, talk to your boss. Regardless of your disability insurance, you may be able to negotiate a mutual arrangement. “If you make everybody part of the team, everybody vested in it,” says Jeffrey Rabin, a lawyer whose practice focuses on Social Security disability bene-fits, “you have a better ability to get that time and consideration while you treat the illness.”
The federal Family and Medical Leave Act requires employers with more than 50 employees to grant 12 weeks of unpaid leave to an eligible employee who is unable to work because of a health condition. (This is the same law that provides maternity and paternity leave.) To be eligible, an employee must have worked for the employer for at least a year, logging at least 1,250 hours of work. The employer doesn’t have to keep your exact job open, but you are entitled to an equivalent job when you return.
The Americans with Disabilities Act guarantees that you can keep your job if you are able to continue doing it with reasonable accommodation on the part of your employer. “Reasonable” is defined through negotiation between you and your employer. As examples of reasonable accommodation, Rabin cites a new chair that reduces back pain or a change in work hours to avoid the anxiety of rush-hour traffic.
Several nonprofit organizations offer legal aid for patients. Equip for Equality represents Illinoisans with disabilities in need of lawyers. The Chicago-based Health & Disability Advocates matches attorneys with the financially needy and people with disabilities to help them secure health care and income assistance. A lawyer, a social worker, or Internet research can easily link you up with these or others.
“[Patients] should know not to be afraid to assert [the force of the laws],” Rabin says. “Sometimes they’re afraid they’re going to be fired if they go to the boss and assert any of their rights, and they’re not,” Rabin says.
illustrations: Harry Campbell