Tips for hard times When the health care crisis gets personal

ANN ARBOR, Mich. - As 2009 winds down, the nation continues to struggle with a brutal economy, leading to a rise in the number of patients who are unemployed and overwhelmed by medical bills. Experts at the University of Michigan Comprehensive Cancer Center offer these tips for coping.

If you need a safety net, use it
The sole purpose of public assistance is to help Americans in crisis. If you need help paying your medical bills, you may qualify for assistance, including Medicaid. For some, it can be difficult to admit they need financial help. "What greater justification does someone need to have besides acquiring a health care crisis like cancer?" said U-M social worker Chris Henrickson. "It's not your fault. It doesn't represent a failure on your part. You pay for these programs with your taxes, so that they're available when you need them."

Don't wait to ask for help
Resources may be available to help you pay your medical bills, but taking advantage of them can be tricky. Most cancer programs or hospitals have financial counselors or  social workers who can help you navigate the daunting bureaucracy of public assistance - but it's key that you start the process early. Deadlines are non-negotiable. Also, many other forms of assistance require that you apply for Medicaid first.

Appoint a financial guru
Coping with cancer and its treatment is tough, so if you aren't up to handling the financial aspects of your care, seek out a trusted family member or friend to help you. You will need to provide permission to allow this person to act on your behalf.

Get organized
Keep records of your medical bills and all correspondence with insurance companies. If you speak with someone by phone, write down the name of the representative you talk to and take notes.

Read your mail
It can be easy to let mail pile up if you're not able to pay bills or you're too tired to deal with them. But if Medicaid requests further documentation and you miss the deadline for responding, your case may be closed and you may wind up owing more.

Go in person
If your Medicaid caseworker isn't responding to you, go in person or send someone on your behalf. Some caseworkers are better at responding by e-mail; ask if that's an option.

If you don't understand a bill or letter ...
... from your insurance company, bring it with you to your next doctor's appointment. Visit the hospital's financial counselor or social worker and ask for help figuring out your next step.

Be nice
Never lose your cool with caseworkers or insurance representatives. "No matter how frustrated and angry you get, be nice, be patient and be understanding," said Dawnielle Morano, a U-M Cancer Center social worker. "Remember, caseworkers are overwhelmed, too. But they can be key members of your health care team if you work to develop healthy relationships with them."

Set up a no-interest payment plan
If you can't pay your medical bills in full, the hospital's financial counselor may be able to set up a payment plan. If you are disputing a bill with an insurance company, do the same thing. When the insurance company pays, you will be refunded what you've paid-and in the meantime, you will avoid having your bill forwarded to a collection agency. "People always say, 'If I pay, I'll never get my money back,'" said Linda Zywicki, financial counselor at the U-M Cancer Center. "That's not true. My job is to help you to get it back in a timely manner. I'm your connection."

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