By BRIAN SODOMA

It is the question that looms behind the many stories of the unemployed. Where can you find health care when you are down on your luck? Losing homes and dignity still take center stage when it comes to these situations, but health care is becoming a bigger challenge as many Nevadans await system changes.

National estimates for the uninsured run about 50 million. According to the American Medical Association, there are roughly 557,000 uninsured people in Nevada alone, or nearly 20 percent of the state's entire population. That number should be cut in half once new federal insurance reforms come online in 2014, some health care industry analysts predict. But until then, it is a long road for those battling unemployment and low income today.

Docs willing to help

Dr. Kevin Petersen, a valley surgeon, says there are some people who can be helped today, but they may not realize it. Petersen says about 15 million people in America are eligible for Medicaid or Medicare and don't realize they qualify. He comes across these people constantly in his practice and refers them to the state Medicaid/Medicare agency for support.

Petersen himself has put a focus on the uninsured or underinsured for both his practices, No Insurance Surgery and nonprofit Helping Hands Surgical Care, which he recently opened in November.

In 2006, he was likely viewed as a success story. His practice accepted all major insurances, and he was so busy he had little time for his personal life or for doing something he had always wanted to do -- offer a portion of his services for free to those in need.

Petersen gradually let his insurance contracts expire and formed No Insurance Surgery, catering to the uninsured or underinsured who may have a high deductible.

"There are more and more people out there with high deductible plans that need to look carefully at how they spend their money," he added.

For Petersen, that $15,000 hernia surgery can now be done for about $5,000, music to the ears of those with $10,000 deductible plans. The overhead of his billing department is reduced and he can focus on surgeries now, instead of wondering if or when he'll get paid. The scaled-down operation allows him to do about 40 surgeries a month. Now he has time to commit to Helping Hands Surgical Care, which uses donations to cover facility fees, and Petersen, along with other doctors in town, does surgeries for free. He now can commit to doing 10 percent of his overall work for free. For more information, log onto www.helpinghandssurgicalcare.com or www.noinsurancesurgery.com, or call 866-442-5409.

Petersen also says there are plenty of doctors who may not have completely shifted to his business model, but who are willing to see patients at a deep discount. It's just a matter of picking up the phone book, calling and asking.

"The system is heavily skewed toward the concept that everyone needs insurance. Because of that, a lot of patients get abused and discouraged the first couple calls they make and they're being turned away," he said. "But there are enough (doctors willing to take a lower fee) out there that if patients call around, they wouldn't have to call all day."

Dr. Andrew Eisen, associate dean for clinical education at Touro University Nevada, said the school offers scholarships to families in need of health care services. Its outpatient clinic accepts Medicaid and Medicare and the school offers free care to Shade Tree victims. Eisen is also involved with the Helping Kids Clinic (www.helpingkidsclinic.org), which provides free health care to children with barriers to access. For Helping Kids information, call 702-732-7001.

Like Petersen, Eisen said simply asking around can get you a helping hand quicker than you think. He also recommends asking someone in the health field, like a nurse or a friend who may work at a medical facility, where low- or no-cost care can be found.

"The health care community in Southern Nevada is trying to do what it can to help the growing number of people in need," he said. "Sometimes people feel embarrassed, but it's a matter of just asking for that kind of help."

Where to start

The state's Medicaid office is a good place to start when it comes to navigating low or no-cost health care solutions. If you do not qualify for Medicaid, Nevada Check Up is the next step. Under Nevada Check Up, an HMO insurance program for those who make at or below 200 percent of the federal poverty level, is offered.

Both Medicaid and Nevada Check Up offer medical, dental, vision and pharmacy coverage that can even cover some over-the-counter drugs. For information on Medicaid, Medicare (if you're over 65) or Nevada Check Up eligibility, call the Division of Welfare and Support Services at 702-486-5000 or 702-486-1646, or visit www.welfare.state.nv.us.

The Southern Nevada Health District, at www.cchd.org or 702-759-1300, can also provide a list of hospitals and care providers in town that offer free or reduced-fee care. This specific link (www.cchd.org/med-services) can take you directly to the directory. But the health district's website has other valuable information for those with limited resources who are in need of health services.

The Covering Kids national health care initiative also can help with access to free care for your child. The Web page is www.nvckf.org and the phone number is 1-877-385-2345. The site notes that some 35,000 Nevada children are currently uninsured that may still qualify for Medicaid or other programs.

Through the cracks

There are plenty of stories, too, of the underemployed. Perhaps one spouse lost his or her job while the other is still working. Perhaps the unemployed spouse has found part-time work or other employment that does not match previous income.

There are some options for this group too.

Nevada Health Centers Inc. has 19 centers statewide, one dental clinic and seven WIC (women, infants and children) centers. The nonprofit organization is part of the National Association of Community Health Centers and gets a good portion of its $24 million annually from federal funds, as well as donors. The centers also accept Medicaid and primarily work on a sliding scale with fees.

A good portion of Nevada Health Centers patients are on Medicaid, said Shirley Hampton, development director. But the centers will not turn anyone away for ability to pay. The sites see roughly 52,000 patients a year and primarily serve the uninsured and geographically isolated in rural areas of the state. Visit www.nvrhc.org or call 702-307-5414 for appointments and more information about the clinics.

Access to Healthcare Network

Sherri Rice, CEO of Access to Healthcare Network, has put together one of the most comprehensive solutions for those who do not qualify for Medicaid. The service is not free, she emphasizes, but it is becoming more of a fit for the working poor and those on very tight budgets.

AHN is a nonprofit medical discount program, Rice explained. Members sign up for a monthly fee as low as $13 a month for individuals to as much as $34 a month for families. The state's insurance division regulates the program, but it is important to note AHN is not an insurance offering. Members simply pay the monthly fee to plug into a network of about 2,000 doctors, hospitals, urgent care centers and other health care offerings.

Members pay cash up front for services. The trade-off is a deeply discounted rate. A physician's visit is usually $40, specialists about $65. Hospital facility fees are only $400 a day with a $3,000 maximum and some $30,000 surgeries can be done for as little as $1,800, Rice said.

Eligibility is based primarily on one's inability to qualify for Medicaid or Nevada Check Up, proof of Nevada residence and an income on a sliding scale. For individuals, one can make between $10,000 and $28,000 to qualify. Families of three must make between $18,000 and $47,000 and families of four between $22,000 and $56,000.

Members are assigned a coordinator who explains where they can go for services and how much money to bring. This helps reduce overall health system costs, too, as very rarely are there inappropriate urgent care visits, Rice said.

Nonpayment or not showing up at an appointment without calling to cancel can result in expulsion from the program though. It is what Rice calls a "shared responsibility" initiative, where everyone, doctors, patients and hospitals need to follow through on their commitments.

Started in Washoe County nearly four years ago, AHN now has 12,000 members in Northern Nevada. The service came to Las Vegas a little more than a year ago and now has about 500 providers and 450 members. But AHN is growing daily, Rice said.

"Until the health care reform happens, these people really don't have any options," Rice added.

For more information about AHN, visit www.accesstohealthcare.org or call 877-385-2345.

Dental Care

The aforementioned programs also offer dental care. But the University of Nevada, Las Vegas' dental school is another way to access care for low or no cost.

"The price you pay is time," said Dr. Michael Sanders, chair of the clinical sciences program at UNLV. "It's a bit slower with students and faculty supervision."

Overall, Sanders said the fees range from between only 25 to 45 percent of outside fees. The only times people are turned away are if procedures are too complex. But routine service, crowns, fillings and implants all fall under the scope of practice at the clinic.

Dental program students also donate time at the Huntridge Teen Clinic (www.huntridge.org or 702-732-8776), which offers health care services to teens.

Dental students also offer a charitable day for veterans one weekend a month. Sanders said the biggest population at the clinic, which sees 60,000 visits annually, is the unemployed.

Call ahead, the professor warned. It sometimes takes a few weeks to plan the first appointment.

"Our goal is to serve every patient in front of us and never turn anyone away in pain," Sanders added.

For more information about UNLV's dental clinic, call 702-774-7400. The clinic is located at 1700 W. Charleston Ave.