Patient Advocate Foundation has developed a list of resources to patients seeking assistance with accessing their medications or help with the out of pocket expenses for their medications. Prescription assistance programs that cater to uninsured or underinsured patients can be found at websites to include:
Patients also require assistance with co-pays for medications where the out of pocket expense is still unaffordable. The co-pay programs that are routinely utilized by the case management team include:
In addition, over 40 states have a state pharmaceutical assistance program in place to assist individuals who lack health insurance and are ineligible for other government funded programs. These programs can be located at http://www.medicare.gov/spap.asp the programs are displayed by selecting the state in which prescriptions are needed.
The Disability Process
When a patient contacts PAF about a SSA claim, PAF can help the patient access claim status and, depending on the patient's medical condition, expedite the claim.
The first step in applying for Social Security Disability benefits is the initial claim; if denied, the next step is a Request for Reconsideration. When SSA sends a denial of claim decision letter to the patient, the patient should respond by appealing the decision. The appeal form that must be submitted for the initial claim is the Request for Reconsideration. If the claim is denied for a second time, then the patient must submit a Request for Hearing appeal form. These forms should be submitted in a timely manner following each denial of claim.
PAF case managers help the patient understand the process, including the importance of the completeness of their SSA file's medical information. The content of the patient's file can make a difference in the disability decision. If the patient is not represented by an attorney, PAF can get assist with preparation of the file for SSA determination.
Medical Debt Crisis
When a patient or family/friend contacts PAF for medical debt crisis issues, a case manager must determine the type and scope of the patient's medical debt. In cases where the medical debt is incurred at a hospital, the patient or family/friend is advised on how to apply for charity care through the facility's billing office. The patient will be required to complete an application and provide financial information in order to be approved for financial assistance. Most hospitals have a board that determines if the patient is eligible, and this process can take up to 30 days. During this period the patient can ask for the account to be placed on hold. Some hospitals are non-profit and more than willing to work with the patients. If the hospital is not willing to offer some type of discount, then the patient must make payment arrangements.
If the patient has a diagnosis that qualifies for co-pay assistance, the patient may be referred to PAF's Co-Pay Relief Program to determine program eligibility.
These programs are designed to assist patients with insurance that have co-payments for chemotherapy or prescription medications. The programs are administered by diagnosis and patients must qualify financially and medically.
Some states offer additional co-pay assistance programs that assist with medications and various living expenses. The case managers at the Patient Advocate Foundation will explain the available programs, provide the patient with the resources, and help initiate the application process. Case managers can also provide counseling and resources for co-payment issues involving medical bills by negotiating payment plans with the medical providers.