Getting the Most Healthcare Out of your Personal Dollar

Posted by Nurse Linda in Life After Paralysis on September 15, 2021 # Health, Insurance, Lifestyle

dollar billsLast week’s blog included some tips about getting the most out of your healthcare dollar. This week let’s look at getting the most healthcare from your personal dollar. As you know, insurance or your healthcare paying mechanism, private or public, pays for what is required for healthcare but perhaps not everything that could benefit your quality of life.

Many things are typically not covered by health payors. Frequently, individuals ask how to get assistance with bowel programs, especially because this falls to family members or unpaid caregivers. Others need a van to get out and about. In addition, individuals need many treatments and equipment to improve quality of life that are not included in their healthcare plan.

As I mentioned last week, be sure to get a copy of your healthcare policy that you have contracted with a payor. It makes no difference if it is from private or public health insurance. This is the document that specifies what the plan covers. Call the number on the back of your health insurance card and ask for a copy. Often, they will direct you to a website for your exact plan. Read the plan in sections. It is easy to become overwhelmed when reading all this medical terminology. Also, you will get a sense of how the plan is laid out, so you will be able to look up exactly what you are thinking about in the future.

If you have requested therapy or equipment, have appealed negative decisions, and they have given a final verdict to your request, you are not without options. However, you will need to turn to other available alternatives.

Vocational rehabilitation is available in every state. This is a program to assist individuals in returning to work. They cover many items that payors may not cover as long as it is directed toward returning to work. For instance, they will assist with job training, education, finding and keeping a job. They also may assist with ramps to get in and out of your home and work with companies to provide the needed facilities at a workplace. Voc rehab can help figure out how to get around in the community, such as by bus or with your own van, as long as it is for work. Now, many more jobs are online, so there are even greater opportunities. Just remember, you need to frame your requests with the goal of work. These are state-funded programs. Unfortunately, there are usually long waitlists for services, so apply now. It may take a few years for admission to the program, but it is an excellent opportunity.

Many individuals sign up for funding through sites on the internet. Several websites are available. Be sure you check them out to ensure they are legitimate before you sign up. You do not need to have any donations taken from your account from illegitimate people. If you do find the right website for you, you are competing with thousands of individuals, all with very compelling stories. The competition to get noticed is intense, but many do succeed. Also, check with the Internal Revenue Service (IRS) both at the federal and state level as donations are often taxable. Taxable income can affect disability benefits.

There are legitimate companies that will help you with this type of fundraising activity. One is Help Hope Live. There are others. They will help you craft your story so that it interests donors. They do not change your story but help highlight different aspects that you may be too close to see. It is like having your personal marketing team. When the funds are collected, they then purchase what you requested and gift it to you. That way, you eliminate the tax burden, but you also have the benefit of professionals to get your story out to more people. They do charge a fee for services, but many find it well worth it.

Often overlooked is directly approaching people either through friends, community clubs, or religious organizations. If you have a significant social group, that is a good place to start. Often, friends might establish a foundation so individuals can make direct donations to an account. These accounts should be set up as foundations that benefit you to purchase therapy or equipment or even to help offset medical costs. Many individuals feel that this is a way of meaningful contribution. There might also be individuals who will hold fundraisers such as a dinner or restaurants that will donate a day’s proceeds to your cause. People are creative and think of all sorts of ways to fundraise successfully.

Community clubs vary in type. These include social organizations, neighborhood groups, philanthropic organizations, community boosters, and more. If you have been connected with any clubs or organizations such as fraternal or collegiate groups, contact the president or friends that belong. Ask for help. This can be hard to do if you are the disposition that has never asked for help before. Think about what you need. Just be blunt and say you need help.

Be specific about your needs. You need to have your requests well thought as it is difficult to add later to your initial need. Be sure to mention how their assistance can improve the quality of your life. Also, think about your request considering the group you are asking. For example, a heated pool to do aquatic therapy might be a real advantage to your recovery. Stick to what you need as opposed to a heated pool big enough for the whole family with a slide for the kids. If people are struggling themselves, they might view a pool as a luxury item instead of a needed item. Perhaps an exercise tank might generate more interest.

Religious organizations have the mission of helping others. Contact the lead clergy or lay leader to discuss your request. Again, you need to be very specific about your needs that pertain to your recovery. Even if you are not a member of a religious organization, they often are willing to help. In some communities, different religious organizations ban together for bigger projects.

The gifts received from these groups must be acknowledged. A letter of thanks is appreciated. If you are comfortable, follow up with a photo or video of you using the equipment. Updates about your progress will help these organizations realize the power of improving quality of life and will help others based on your success. It is a way to pay back. If you progress to the point that you no longer need what was given to you, ask the organization where they would like the equipment to go next.

A direct appeal is another way to obtain equipment and therapy. Some individuals request a news story about them with the local tv or radio stations. Contact an anchor who has some influence with the stations. Popular news people can attract interest in your story. They will follow up to see how things are progressing. Do not anticipate that people will send money directly to you. They will respond to a foundation or a specific bank account where the donations can only be used for the purpose specified.

If you have paralysis from a specific disease, organizations that support individuals can be helpful in providing equipment. Many have what is called ‘closets.’ Actually, these medical equipment companies clean and restore equipment on behalf of the organization. If someone no longer needs medical equipment, they will donate it to the organization that redistributes it to people with similar needs.

Often, there is personal care that needs to be accomplished. Payors do not cover that. These activities fall to the individual or their caregivers. You can hire someone to do these activities. Sometimes, volunteers will be found. Other times, you will need to pay for services. People will contact colleges or universities for a student in healthcare to come for an hour or two in the morning or evening. This used to be a very popular way to get extra help as there is a fee, but the student also gains experience. It can be rather difficult to find a student who has the time these days but asking is the only way to find out. I do see people asking for personal care help on apps such as Neighborhood. I also see responses from all sorts of individuals offering to volunteer if the hours are not too long.

I am sure many of you have creative ideas that can be shared. I know people can really get into a bind with requests of items that are truly needed for their success. Be creative. Talk with others. If we work together, these goals can be accomplished. Nurse Linda

Pediatric Consideration:

Recently, the Federal Government passed laws to expand health care for children. States have enacted this in different ways. Some states have put plans directly into place. Others have had lawsuits to stop it. But most of that has been worked out in the Supreme Court. Be sure to check your state funding periodically to see if there are new opportunities for your child. You will need to check the state’s website for more information as these plans are mandated by the federal government but enacted by each individual state, so the plans look a bit different depending on where you live.

There are programs that are pediatric-specific. A good place to start is with your healthcare professional, nurse, social worker, or insurance case manager. Even though these healthcare professionals work for different organizations and systems, they will be aware of opportunities in the community and beyond. Nurse Linda

Linda Schultz, Ph.D., CRRN, a leader and provider of rehabilitation nursing for over 30 years, and a friend of the Christopher & Dana Reeve Foundation for close to two decades. Within our online community, she writes about and answers your SCI-related healthcare questions in our Heath & Wellness discussion.

The National Paralysis Resource Center website is supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $8,700,000 with 100 percent funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS, or the U.S. Government.