Physical illness is a drain on your body; it’s part of the human condition. Unfortunately, our nation’s seriously ill must deal with their symptoms while at the same time manage the complicated financial reality of being sick. Modern-day healthcare requires sick people and their loved ones to navigate difficult medical jargon, coverage complications and endless phone calls.
There is a better way though; as someone familiar with the healthcare industry, I am aware of the valuable resources that can aid people in need. When my father fell ill, my family relied on my insider-knowledge to survive the most difficult time in our lives. A perfect example was when my father needed costly speech and physical therapy during his recovery from brain surgery. His insurance did not cover therapy and we were scrambling to put together the money for the upwards of 200 dollars per session necessity. Using my knowledge of healthcare programs, I decided to apply for an aid program, offered by Baptist, which covered speech and physical therapy if you meet their requirements for aid. This not only helped my family afford the therapy but transformed my father’s quality of life.
The more that I talk to people about such free services the more I realize the astonishingly few number of patients that know about free medication, procedures and diagnostic services available in our community.
I wrote this guide to spread the word about the resources that are out there for you or your family. I focus here on connecting the uninsured and the underinsured with unadvertised programs that allow the ill to focus on getting better and not on being able to afford medical treatment.
Pharmaceutical companies fund many of these programs. Clearly, these for-profit companies derive some benefit from these programs — be it public-relations, advertising, or research. That being said, when people are in need, they welcome all help.
Read this guide and spread the word!
Pharmaceutical company Merck funds programs to assist with medical expenses incurred by patients who use Merck medications.
Merck’s programs assist patients with the cost of Merck medications and by investigating the patient’s benefits for free. During a coverage investigation, Merck communicates with the patients’ doctors and analyzes their policies to accurately determine if the Merck medication prescribed is covered, partially covered, or not covered at all. If an insured patient cannot afford the copay (of a partially covered medication), Merck may offer copay assistance. Merck may also provide FREE medication to qualified patients who are not covered for a particular medication.
Merck also offers help with prior authorization. For example, if an oncologist prescribes a Merck drug that will be obtained through the patient assistance program, Merck will contact the patient’s doctor to request authorization and will transmit that authorization to the patient’s hospital or insurance company. These programs could mean less legwork and more affordable care for sick people and their families.
The website might be confusing, as their program descriptions can all sound exactly the same. Programs differ mainly the type of medication that can be provided. For example, the Merck access program provides assistance for patients needing KEYTRUDA, EMEND, SYLATRON, INTRON® A,–all oncology drugs. To find out what program to use based on your needs please use the links provided below.
Finally, the Merck Bulk Replacement Patient Assistance Program provides free vaccines and medications to facilities that primarily serve low-income, uninsured patients.
Norvartis’ easy-to-use website can help you find a suitable financial assistance program if you need a Novartis medication. The website also has information about clinical trials, which can provide patients with new medications for free. Call (1-800-340-6843) for information regarding oncology clinical trials. If you have questions about Novartis Oncology Patient Assistance Program, call: 1-800-277-2254. In addition to assisting with oncology drugs, Novartis provides aid for any drug listed on the website below. Insured persons will receive coverage for one calendar year, after which the patient will have to re-enroll.
See below for other pharmaceutical companies offering assistance programs. If your company isn’t on this list, find out who makes your drug and Google the company name + “assistance program.”
Pharmaceutical Assistance Programs
Pfizer : 1-866-706-2400, Pfizer RxPathways
GlaxoSmithKline : different numbers for the various programs, GSK Patient Assistance Programs ( website includes vaccine assess programs and reimbursement help for GSK drugs)
AstraZeneca : 1-800-AZandMe (292-6363), AstraZeneca Patient Assistance Programs
Diagnostics and Procedures
Several hospitals provide financial assistance for medical services. See below for a quick summary.
Baptist offers programs for a wide range of services. Step one is to submit an application to the general application page ( linked below). It is important to note that this financial assistance is only provided for diagnostic services (labs, MRIs etc) and medical procedures , such as surgery and does not apply to specific doctors, pharmacy, or medical equipment to take home. However, this help does include speech and physical therapy, treatments which are frequently needed but rarely covered!
In order to receive aid from Jackson you will need to book an assessment appointment at any of these locations:
- Dr. Rafael A. Peñalver Clinic :971 N.W. 2nd Street, Miami
- Jackson Memorial Hospital :1611 N.W. 12th Avenue, Miami
Jackson South Community Hospital : 8950 S.W. 152nd Street, Suite 104, Miami
- Jefferson Reaves, Sr. Health Center : 1009 N.W. 5th Avenue, Miami
- North Dade Health Center : 16555 N.W. 25th Avenue, Miami Gardens
- Rosie Lee Wesley Health Center : 6601 S.W. 62nd Avenue, South Miami
The number listed for financial assistance is 305-585-2222 but good luck trying to get someone to answer the phone. My advice is to call the appointment line (305-585-6000) and make an appointment for financial assessment so you can have all your questions answered in one visit.
It is important to note that you must live in Miami-Dade to benefit from financial assistance. Once you have made an appointment a financial representative will help you with payment options and funding eligibility. Also note that they ask for immigration information only to determine qualification and will not reported it to third parties.
Jackson has a couple of programs of interest although they are ABSOLUTELY horrible at advertising any of them online or on site.
Jackson Prime is one of their signature programs (also called carecard) where qualified patients can access services (primary care, pharmacy, blood test) at a reduced cost. This program is only available to those without insurance. This program informally acts as insurance that can be used only at Jackson.
Jackson also offers “price packages”, which reduce the cost for certain procedures for self-pay patients that do not qualify for their charity programs. If you are thinking about having a procedure done and you do not qualify for financial assistance and you do not have insurance, make sure they give you the “packaged price” (remember to say you are self-paying). Sometimes this price is several thousand dollars cheaper.
Lastly, Jackson offers the Cuban/Haitian Refugee Program which provides primary health care services and outpatient/inpatient services. Qualifications include: Be born in Cuba or Haiti, been in the United States more than 8 months and have one of the following immigration statuses: Asylee, Parolee, Refugee, or Trafficking victim. Call 305-585-6000 to make an appointment to see if you qualify. Once a patient is enrolled they will have no out-of-pocket cost for services mentioned above.
Throughout my search for information on these programs representatives told me that if you have insurance you will not quality. However, I suggest that everyone go to the financial assessment interview to see if assistance is available. In my case, I had called Baptist for my father’s speech therapy after his cancer operation and was told several times that he did not qualify because he had insurance. Then I visited the office myself and found out that because his insurance didn’t cover his therapy, he did qualify. Don’t give up.
Mercy Miami Hospital offers many forms of financial assistance for patients without healthcare insurance and also for under-insured individuals whose out-of-pocket payments are a considerable financial burden. Mercy has two programs designed to assist patients:
- Charity Discount Policy ( description taken from the website linked below)
The following classes of patients may qualify for a charity discount:
- Under-insured patients (i.e., those patients with some form of third party payer coverage for health care services but such coverage is insufficient to pay the current bill) when indigency is established, and the out of pocket responsibility is $1,000 or higher.
- Uninsured patients (i.e., those patients with no third party payer coverage for health care services whatsoever), which have advised that they are unable to pay their account balances.
- Uninsured Discount Program :
The Uninsured Discount is limited to patients who have no third party payer source of payment or do not qualify for Medicaid, Charity or any other discount program the facility offers. The amount of the discount offered may vary by location based on state requirements, patient income levels and local rates.