Out of My Pocket: Self-Paying for My Health Care

There have been times when I was able to get what’s called emergency Medicaid, financial coverage for urgent situations including pregnancy (each state has its own plans and requirements). I was on emergency Medicaid for a few of my deliveries, and for others I’ve done home births.

After my last child was born, I could feel that something was wrong. I don’t hesitate to get care when there’s a problem. It was my gallbladder. I was still covered by emergency Medicaid, so I went to the emergency service that was close to me. But I didn't feel like I would get the care that I needed there (you can shop around). I have friends who are nurses at Emory University Hospital in Atlanta and decided on that facility and got the best care.

Is this a forever plan? I’m 44 now, and there might come a time, as I get older, when I’ll rethink medical insurance and weigh the options to find the best solution for me.

Insuring My Children

Our children have qualified for the state of Georgia’s PeachCare for Kids. Seven of my kids are still living at home and have coverage through it. The program offers uninsured kids medical, dental, and vision care, medication, emergency services, and more. As with many traditional forms of medical insurance, orthodontia isn’t covered, and for my kids who needed braces, I had to negotiate and do years-long payment plans.

It’s a great program, but it can be hard to find doctors who accept this insurance. There’s a provider list online, but it’s not always up to date. You need to do the legwork to find the right doctor who’ll accept this insurance. A lot of times, I’d locate practices that do but that aren’t taking new patients. That’s frustrating. I find that I use urgent care when my kids are sick, like when one daughter had swimmer’s ear or another had pink eye. I do this primarily because there can be a days-long wait to be seen at a provider’s office. It’s better to do a five-minute telehealth or MinuteClinic visit.

Making Self-Pay Work for You

Here’s what I’ve learned from my more than two-decade self-pay journey:

Consider your health care status before you choose self-pay. Though self-pay can be an option when you’re young and in good health, I wouldn't necessarily say that it’s the route to go when you're older and need more care.

Do your best to stay healthy. Through training clients, I've seen a lot of people struggling with health issues that come from them not taking care of themselves. I work out every day and eat right not to look good, but because I know that it's proven to give you a better quality of life. It doesn't prevent every health issue, but overall it really helps. About 85% of my diet is minimally processed foods with proteins like chicken, cottage cheese, and Greek yogurt.

Look for community health care services. With some of my pregnancies, before I chose a provider, I would go to a free clinic offering services like ultrasound. This can help cut your costs.

Negotiate beforehand. To get the best price for a service you need, always reach out to the financial office directly in advance to talk about costs. Many offer lower rates for self-pay patients. You might also ask if there’s something they can do for you beyond the self-pay discount, like, “Does my income bracket help reduce costs further?” Once you know what the charges will be, negotiate a payment plan to pay the bill over time, years if necessary.

Question the need for tests and procedures. When I had my second son at age 22, I was self-pay and felt intimidated by the provider who wanted me to have (and pay for) an ultrasound even though the one I had a month before was fine. I summoned the courage to say, “I know you're trying to give me the best care, but I'm self-pay and I don’t feel that I need another one now.” Remember that you’re hiring these professionals and you’re paying for their services, so you can speak up about what you believe you need or don’t need. On the other hand, sometimes tests are important to get: I recently paid for a routine blood test to check my health status.

Get over the stigma of getting help. Benefits like emergency Medicaid and state insurance programs for kids are there for you when you need them. Our tax dollars fund them. You paid into the system, so use it if you need to. The problem with government-funded programs is that you’re often made to feel that they don't want you to be on them. It can be difficult to get what you need because they make you go through all these hoops, but you just have to push through.