Finding and paying for care.

How coverage works

Every country pays for care differently: through public systems, insurance, or a mix. The questions to ask are the same everywhere.

• What is covered? Which services, medicines and tests your public system or plan pays for, and which it doesn’t, such as dental, eye care or some medicines.
• Where can you go? Many plans and public systems work through a family doctor or a list of approved providers. Going elsewhere can cost more, or not be covered at all.
• What will you pay? Insurance has its own vocabulary: a premium is what you pay to be covered; a deductible or excess is what you pay before cover starts; a co-payment is your share of each visit or prescription.
• Does anything need approval first? Some treatments and medicines need the plan’s approval before you have them. Ask before, not after.
• When can you join or change? In some systems you can sign up or change plans only at certain times of year, or after a change such as losing a job, moving or having a baby. Missing a window can leave a gap.

Finding low-cost care

Not having cover, or not enough, doesn’t mean there is nowhere to go.

• Community health centers. In some countries, publicly funded health centers see patients whatever their ability to pay, with fees based on income. In the United States, the government’s health center finder lists them.
• Free clinics and sliding-scale clinics. Often run by nonprofits, faith groups or medical schools. Call ahead to ask what they charge, who they can see and what to bring.
• Pharmacists. For many minor problems, a pharmacist can advise you free and tell you whether you need to see a doctor.
• Phone and online advice lines. Many health systems run a free line staffed by nurses who can tell you where to go and how soon.
• Emergencies are different. If it might be an emergency, call your country’s emergency number or go to an emergency department. Worry about the bill afterwards.

Reading a medical bill

Medical bills often contain mistakes, and the first bill is not always the last word.

1. Ask for an itemized bill.A list of every service, test and medicine, with dates and charges, not just a total.

2. Compare it with what your insurer says.If you have insurance, its statement shows what it paid and what it says you owe. The two should match.

3. Look for errors.Charges for things you didn’t receive, the same thing charged twice, wrong dates, or a visit billed as more complex than it was. Call the billing office and ask about anything you don’t understand.

4. Ask about help before you pay.Many hospitals and clinics have financial assistance or charity care, discounts for paying yourself, or interest-free payment plans. Ask before putting a medical bill on a high-interest credit card or taking a loan for it.

5. Keep notes.Who you spoke to, when, and what they said. Ask for anything important in writing.

In the United States, federal rules protect people from some surprise medical bills, and let people who are uninsured or paying for themselves ask for a good faith estimate before planned care. The Centers for Medicare & Medicaid Services explains them.

Your health records

In many countries you have a right to see your own health records and to get a copy.

• Ask in writing. Write to the clinic or hospital, or use its form or patient portal. Say which records you want and for which dates, and how you would like them, such as electronic copies.
• Expect to prove who you are. That protects your records from anyone else asking for them.
• Ask about cost and timing. The rules on fees and how quickly they must respond differ by country. Ask what applies before they start.
• You can ask for corrections. If something is wrong, ask for it to be corrected, or for your own statement to be added to the record.
• Keep your own copy. A summary of your conditions, medicines, allergies and test results is useful when you change doctors, travel or need emergency care.

Patient portals and video appointments

Online services can save a trip, as long as they are set up before you need them.

• Set up the portal when you are well. Use a strong password you don’t use anywhere else, and turn on two-step sign-in if it is offered.
• Results may arrive before the explanation. A portal can show a test result before your clinician has looked at it. If a result worries you, call the clinic rather than searching online.
• Before a video appointment, test the link and your camera, find a quiet private place, charge your device, and write down your questions and the medicines you take.
• Ask for what you need. An interpreter, captions, a phone call instead of video, or a family member or carer to join you. Many services offer these if asked.
• On a shared or public computer, sign out and close the browser when you finish.

Medicines and their costs

The same medicine can cost very different amounts depending on how you buy it.

• Ask about a generic version. Generic medicines have the same active ingredient as the brand-name version and usually cost less.
• Talk to the pharmacist. About cheaper alternatives, larger supplies, and whether your plan or public system covers the medicine.
• Ask the prescriber too. If you can’t afford a prescription, say so. There may be another option, and skipping doses without telling anyone can be dangerous.
• Assistance programs. Some manufacturers, charities and public schemes help with the cost of medicines. Your pharmacist or clinic may know which apply.
• Be careful buying online. A pharmacy that sells prescription medicines without a prescription, or can’t show it is licensed, may be selling fake or unsafe products.

Health scams

Scams follow whatever people are worried about, and health is one of the biggest worries there is.

The same rule applies: hang up, then call back on a number you already have, such as the one on your insurance card or your clinic’s official website.

• Miracle cures. Products that promise to cure serious illnesses, especially ones that “doctors don’t want you to know about”.
• Fake cover. Plans sold by phone or online that look like insurance but pay for very little. Ask for the full terms in writing before paying anything.
• Requests for your details. A call or message asking for your insurance or health number “to send a free test” or “to keep your benefits”. Real programs don’t cold-call for these.
• Payment to keep care. Anyone who says you must pay immediately, by gift card or payment app, or lose your treatment or cover, is a scammer.