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Hospitalized without health insurance? Bills mounting? Now what?

Updated on October 7, 2009

No one wants to end up in the hospital without insurance. Yet, every year, more than 2 million Americans find themselves in this situation. If this is you, expect your visit to last, on average, 4 days and cost you $21,442. That's according to the Agency for Healthcare Research and Quality.

According to the same source, roughly six percent of patients nationwide are admitted to hospitals without health insurance. In some areas, uninsured patients comprise thirty percent or more of a hospitals annual visits. To cope with this problem, many hospitals have created departments that specialize in securing Medicaid or other financial assistance for their patients. Smaller hospitals often hire outside firms to provide this service.

Known as Medicaid Eligibility Specialist or Medicaid Eligibility Advocates, representatives from these organizations can be invaluable in helping you navigate the often complicated rules and procedures that govern the world of assistance programs.


The Process

Typically, Medicaid Eligibility Advocates will be referred to you by hospital Financial Counselors and come to your room the day after you are admitted to the hospital. They will screen you for assistance programs and, if you are eligible, complete the necessary applications. They will then submit your applications to the appropriate agencies, help you gather supporting documentation like hospital bills and medical records and follow-up with the agencies to ensure the proper processing of your paperwork. They may also help you appeal your case if you are denied or supply referrals to Social Security Disability Lawyers that can help you apply for disability.

What Programs are available?

Depending on your state of residence, there are an amazing number of programs that may help you pay for your hospitals bills. Eligibility for these programs is generally based on family size, income and assets. There are also programs that target special diseases (like Breast and Cervical Cancer) or special cirmcumstances (like Victims of Crime).

Medicaid based programs are a good place to start your search. Links to your states website can be found here. In addition to Medicaid, may states have specialized programs that provide assistance to low income uninsured hospital patients. In Ohio, the program is known as HCAP, in Georgia it's the Indigent Care Trust Fund. Check with your Eligibility Advocate, Hospital Financial Counselors or Caseworker for more information.

In order to maintain their non-profit status, all non-profit hospitals have some version of a hospital charity program with eligibility based on income. In some cases, hospitals may even be willing to pay your COBRA premium if you are within the 63 day window of eligibility. In the unlikely event that you have cash available to pay your bill, hospitals may offer you a prompt pay discount usually amounting to 10 percent of your bill.

Where do you start?

The most import thing to remember is that most assistance programs are very time sensitive. While most states allow three months for an application to be filed, some states require an application while you are still in the hospital. If you have not heard from a financial counselor the day after you were admitted, ask your nurse to have one visit you. If your financial counselor does not specialize in Medicaid, ask for a Medicaid eligibility specialist.

When speaking to your Medicaid eligibility specialist, make sure you get their contact information and copies of any documents they ask you to sign. Once you are discharged from the hospital, follow-up with your Medicaid eligibility specialist on a weekly basis until you are approved. Be courteous but persistent as they may have many cases they are working on. If you receive a denial letter from any assistance program, immediately call your Medicaid eligibility specialist to let them know as they will be instrumental in filing your appeal.

Final thoughts

The best solution is not ending up in the hospital without health insurance in the first place. If you have children and little or no income check with your local Department of Human Services also known as DHS, DSS, Family Independence, Job and Family Services, etc.

If you don't have a pre-existing condition, health insurance can be surprisingly affordable if you choose a plan with a high deductible.

If you do have a pre-existing condition, until we have some type of reform, my thoughts and prayers are with you. Current programs are prohibitively expensive and often have limited enrollment. Check with your States Insurance Commissioner for more information.


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    • suziecat7 profile image


      5 years ago from Asheville, NC

      This is an excellent Hub - great info.


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