Are You Covered?
Just because you have health insurance doesn’t mean you’re in the clear when it comes to covering all of your medical expenses. Some medical treatments — from IVF to acupuncture — may not be covered or may include out-of-pocket costs. An estimated one in three Americans with health insurance have reported difficulty paying for noncovered and out of pocket expenses. What options do you have if you find yourself, say, wanting to conceive a baby but with a bank balance that can’t cover the cost of one IVF cycle?
Luckily, going into debt doesn’t have to be the answer. There are affordable (if not well-publicized) options and opportunities. Here are five common medical expenses most likely to fall under the no-coverage categories and how you can cut down on their costs.
Infertility treatments are not always covered by insurance and when they are, benefits may be very limited. A survey conducted on large group health plans showed that 59 percent covered infertility evaluation, 35 percent covered infertility drugs and only 23 percent of the plans covered one of the most common treatments — in vitro fertilization. This is a blow considering that IVF can be costly: The average price for one cycle of IVF in the U.S. is $12,400, according to the American Society of Reproductive Medicine. But there are ways to cut costs.
RESOLVE, the national infertility association, provides a list of organizations that offer financial help to infertility patients who meet certain criteria. Some actually donate basic IVF services at their facility. One such organization is The International Council on Infertility Information Dissemination through their IVF scholarships program.
Others provide grants. The Tinina Q. Cade Foundation — Family Building Grant offers up to $10,000 a year per funded family. BabyQuest provides each eligible family up to two grants a year. And look for benefits your state may offer to residents. The New York State infertility demonstration program gives financial support to those not covered by health insurance. It also helps women who have exhausted their coverage.
Despite new research indicating that acupuncture can be beneficial for certain health conditions, many insurers still don’t cover it — and companies that do only pay for specific conditions or a fixed number of sessions. Treatments can average $50 to $100 a visit.
When looking at advertised rates, remember that most acupuncturists say there is plenty of room for negotiation, especially when they offer a “pay what you can” or “sliding scale” option. You can also consider a community acupuncture clinic. They cut costs by providing group treatments on a sliding scale — as low as $15 a session. For a community acupuncturist near you, check out the international cooperative called People's Organization of Community Acupuncture (POCA).
You might also be able to find treatment at an acupuncture school. In New York City, Pacific College of Oriental Medicine offers treatment by supervised students at discounted rates. Money from Flex Spending Accounts can often be used to pay for acupuncture expenses not covered by insurance, so check in on your policy.
Chiropractic care is considered a type of complementary and alternative medicine (CAM) and generally requires an out-of-pocket payment. But if you are in need of ongoing care, finding a clinic that offers a membership service or package deal may be just what your sore back desires. The Joint has offices nationwide that offer care at a lower cost by providing plans. One such plan includes four visits a month for $49, and only $12 per additional visit. And if you add a family member to your plan, their monthly cost decreases.
But be careful before you sign up for a long-term contract. Even if a chiropractor can legitimately help your problem, there’s no need to commit to a large specified number of visits. Again, that Flex Spending Account can come in handy.
Long valued as a way to ease stress, there’s research indicating massage can improve breathing in asthmatic children, relieve tension headaches and lower stress hormone levels in HIV-positive patients. However it can be costly — the national average for a one hour massage is $69. Since few health plans cover massage therapy, these costs can add up quickly, especially for patients with chronic problems. According to Massagethereapy.com, an educational site run by the Associated Bodywork & Massage Professionals, more than 90 percent of massage costs are paid out-of-pocket.
To keep massage expenses down, first, keep in mind that rates aren’t always set in stone, especially if you’re visiting a solo practitioner. That means negotiating for a price break is definitely an option. And if you are a repeat client, you’ll have more leverage.
Another option: Massage clinics or schools where therapists are trained. You have the option of requesting the professional from the instruction staff, a graduate or a student, and your fee will vary accordingly — typically it can cost you $35 for a fifty minute massage with a student; nearly half what you would pay for a professional. Some students are extremely talented, and once they graduate you may have an ‘in’ to a discounted rate at their new place of employment.
A birth doula can help plan your birth and assist during your labor with the goal of safer, more satisfying labor and delivery. Some research suggests that women who use birth doulas are less likely to require medical interventions such as C-sections or labor induction, and they report higher levels of satisfaction after labor than women who did not use doulas.
Unfortunately, health insurance providers rarely cover the cost of a doula. Start by checking into whether your hospital offers an in-house doula program. These programs can be very affordable with average rates ranging from $500 to $1,000. Also ask a trusted healthcare provider if they know anyone who accepts partial pay or even pro-bono clients. Doula Match is a great site that will help locate a doula at a price that’s right for you. Also look into your city and state programs. You might find doula groups that provide free or sliding-scale services to the community.
Insurance Benefits Hiding in the Small Print
This is where reading the details of your policy can save you even more money. Did you know that some health insurance plans cover...
- Gym Membership: Because regular exercise is likely to keep you healthy, more insurance companies are offering to help pay for your trips to the gym. Reimbursement is the usual route insurers take and many offer their members $100 to $200 yearly toward the cost of a gym.
- Nutritional Counseling: Following the advice of a good nutritionist can improve your health while lowering medical costs. More insurance carriers are finally seeing these advantages. Depending on where you live, seeing a nutritionist can cost anywhere from $100 to $200 a session.
- Smoking Cessation: Once upon a time, you were on your own when it came to kicking the smoking habit. That’s slowly changing, as insurers and employers become more proactive when it comes to your health. Before you spend hundreds of dollars of your own money, see if your benefits include a tobacco cessation program.