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Hospitals and major clinics usually have social workers on staff who can help you make financial arrangements.

Another source for free medications is your physician's sample cabinet.

Alternatives to Insurance

The following excerpt is taken from Chapter 7 of Bipolar Disorders: A Guide to Helping Children and Adolescents by Mitzi Walsh, copyright 2000 by O'Reilly & Associates, Inc. For book orders/information, call (800) 998-9938. Permission is granted to print and distribute this excerpt for noncommercial use as long as the above source is included. The information in this article is meant to educate and should not be used as an alternative for professional medical care.

No matter where you live, there are alternatives to expensive medical care. Those who don't have insurance, or whose insurance is inadequate, will want to investigate these resources.

In some cases, creative private-pay arrangements may be possible with psychiatrists and other providers. Parents have traded services or products for care, and others have arranged payment plans or reduced fees based on financial need. The larger the provider, the more likely it is to have a system in place for providing income-based fees. The smaller the provider, the more receptive she is likely to be to informal arrangements, including barter.

My insurance coverage is very good: Blue Cross/Blue Shield. We've had no problems with having them cover the doctor and hospital and drugs. The only thing they don't cover is Lisa's therapist, because their definition of a clinical social worker is a social worker who has a master's or doctorate degree, has at least two years of clinical social work practice, and a license if required by the state. Our therapist doesn't have a master's, but has a license and over 15 years experience. Lisa has formed a very tight attachment to our therapist and neither of us want to change. To make it affordable to us, her therapist is only charging us half price to keep Lisa from having to go somewhere else. --Donna, mother of 16-year-old Lisa (diagnosed bipolar II disorder, post-traumatic stress disorder, and anxiety disorder)

Hospitals and major clinics usually have social workers on staff who can help you make financial arrangements.

Sources of free or low-cost healthcare or therapeutic services may include:

  • Public health clinics, including school-based health clinics
  • Public hospitals
  • Medical schools, and associated teaching hospitals and clinics
  • College special education programs (for learning disabilities and cognitive testing, and sometimes for direct help with educational planning and techniques)
  • Hospitals and clinics run by religious or charitable orders, such as Lutheran Family Services clinics
  • Charitable institutions associated with religious denominations, such as Catholic Charities, the Jewish Aid Society, and the Salvation Army
  • The Urban League, which provides counseling services for troubled teens in some cities and can sometimes refer clients for psychiatric care
  • United Way, an umbrella fund-raising organization for many programs that can often provide referrals
  • Children's Home Society, the Boys and Girls Aid Society, and similar local children's aid associations
  • Grant programs, both public and private

In the UK, special resources outside of National Health include:

  • MIND
  • The Mental Health Foundation
  • Community Trust associations, particularly the Zito Trust (0171 240 8422)--see the Mental Health Foundation web site and CharitiesDirect at for lists of many UK trusts related to mental illness, substance abuse, and related issues, including many that focus on particular ethnic or religious communities
  • The New Masonic Samaritan Fund (for members and families of Masons)
  • Samaritans (0345 909090)

Medical savings accounts

This is a new healthcare payment option in the US that may have benefits for some children and adults with bipolar disorders. A medical savings account (MSA) allows families to put away a certain amount of money specifically for healthcare costs. This income will then be exempted from federal (and in some cases state) income taxes. Unused funds continue to gain tax-free interest. These accounts can be used to pay for insurance deductibles, co-payments, prescriptions, and medical services not covered by insurance.

Families faced with paying out-of-pocket for an expensive residential program or experimental medication might be able to use an MSA to reduce their costs by an impressive percentage. You'll need to check the regulations of the specific MSA plan to see what expenses will qualify.

Help with medications

Low-income patients may be able to get their medications for free by providing documentation to charitable programs run by pharmaceutical companies. In the US, the Pharmaceutical Manufacturers Association publishes a directory of medication assistance programs. Doctors can get a copy of the PMA's official guide by calling (800) PMA-INFO. Alternatively, you or your doctor can call the company that makes your medication directly to find out about its indigent patient program:

3M Pharmaceuticals (800) 328-0255
Allergan Prescription (800) 347-4500
Alza Pharmaceuticals (415) 962-4243
Amgen (800) 272-9376
Astra USA (800) 488-3247
Berlex (800) 423-7539
Boehringer Ingleheim (203) 798-4131
Bristol Myers Squibb (800) 736-0003
Burroughs-Wellcome (800) 722-9294
Ciba-Geigy Patient Support Program (800) 257-3273 or (908) 277-5849
Eli-Lilly (317) 276-2950
Genetech (800) 879-4747
Glaxo (800) 452-7677
Hoechst-Roussel (800) 776-5463
Hoffman-Larouche (800) 526-6367
Ici-Stuart (302) 886-2231
Immunex Corp. (800) 321-4669
Janssen (800) 253-3682
Johnson & Johnson (800) 447-3437
Knoll (800) 526-0710
Lederle (800) 526-7870
Lilly Cares Program (800) 545-6962
Marion Merrel Dow (800) 362-7466
McNeil Pharmaceuticals (800) 682-6532
Merck Human Health (800) 672-6372
Miles (800) 998-9180
Ortho Pharmaceuticals (800) 682-6532
Parke-Davis (202) 540-2000
Pfizer Indigent Patient Program (800) 646-4455
Pharmacia (800) 795-9759
Proctor & Gamble (800) 448-4878
Rhone-Poulenc Rorer (610) 454-8298
Roche Labs (800) 285-4484
Roxane Labs (800) 274-8651
Sandoz (800) 937-6673
Sanofi Winthrop (800) 446-6267
Schering Labs (800) 521-7157
Searle (800) 542-2526
Serono (617) 982-9000
SmithKline Access to Care Program (800) 546-0420 (patient requests) or (215) 751-5722 (physician requests)
Solvay Patient Assistance Program (800) 788-9277
Survanta Lifeline (800) 922-3255
Syntex Labs (800) 822-8255
UpJohn Co.
(800) 242-7014
Wyeth-Ayerst (703) 706-5933
Zeneca Pharmaceuticals (800) 424-372

An organization called the Medicine Program can help you and your doctor apply to indigent patient programs. Call them at (573) 778-1118, email at, or see their web site.

Most of these programs require that you have no insurance coverage for outpatient prescription drugs, that purchasing the medication at its retail price would be a hardship for you due to your income and/or expenses, and that you do not qualify for a government or third-party program that can pay for the prescription.

Doctor's samples

Another source for free medications is your physician's sample cabinet. All you have to do is ask, and hope that the pharmaceutical rep has paid a recent visit. Samples can help tide you over rough financial patches, but you can't rely on getting them monthly.

Mail-order medications

In some cases, you can reduce the cost of your monthly medication bill by using a mail-order or online pharmacy. These pharmacies can fill your prescription and mail it to you, sometimes at a substantial savings. Medications may be available by mail-order within your country or from overseas. The latter option can be surprisingly inexpensive, and may provide you with access to medications that normally would not be available where you live.

Your doctor may have to fill out some paperwork before you can use these mail-order services. As with any other transaction by mail or over the Internet, you'll want to do as much as you can to check out the company's reputation and quality of service before sending money or using your credit card.

Communicating via fax, email, or telephone generally works best with these firms, which can usually send you a three-month supply in each order. If you are doing business with an overseas pharmacy, check customs regulations that might prohibit you from importing medication before ordering, especially if the drug is not approved for use in your country.

Some mail-order and online pharmacies were initially created to serve the market for AIDS medications, but have since expanded to cover a wide selection. Many will accept health insurance if you have a drug benefit--some will actually cover your medication co-payment as part of the deal.

If you are stationed overseas with the US military, contact your Tricare health benefits representative about mail-order arrangements.

Clinical trials

Some patients have received excellent medical care by taking part in clinical trials of new medications or treatments. Others have suffered unpleasant side effects or felt that they were treated like guinea pigs. Before enrolling your child in a clinical trial, make sure that you feel comfortable with the procedure or medication being tested, the professionals conducting the study, and the facility where it will take place. Be as fully informed as possible.

CenterWatch, Inc., is an international listing service for current clinical trials. If you don't have Web access, contact CenterWatch in Boston at (617) 247-2327.

Miscellaneous discounts

Don't forget, children with bipolar disorders and sometimes, by extension, their families may be eligible for a variety of discounts and special access programs for the disabled. For example, the US National Parks Service offers a lifelong pass that gives disabled individuals free entry to all national parks, as well as half-price camping privileges. If the recipient is a child, her family also gets the discount. Disneyland, Disney World, and many other theme parks offer special privileges to people with disabilities, such as not having to wait in line for attractions.

There are a number of programs around the world that help disabled people get access to computers and the Internet. One that offers free computers is Minneapolis-based DRAGnet; call (612) 378-9796, fax (612) 378-9794, or email

If your child needs medical care in a location far from home, but you can't afford the cost of a flight or hotel, following are some resources that may be able to help in the US or Canada:

  • AirCare Alliance: (800) 296-1217 (referrals for TWA Operations Liftoff and AirLifeLine)
  • AirLifeLine: (916) 429-2166 or (800) 446-1231
  • Corporate Angel: (914) 328-1313 (arranges flights on corporate jets for patients)
  • Miles for Kids in Need: (817) 963-8118
  • Continental Care Force: (713) 261-6626
  • Wings of Freedom: (504) 857-0727 (negotiates with commercial airlines for low-cost tickets)
  • National Association of Hospitality Houses: (800) 524-9730

Similar corporate programs may be available in Europe, Australia, and New Zealand; contact the public relations office of your national airline to find out more. You may also be eligible for an emergency travel grant from a social services agency to cover these needs.

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