A is for Access to Affordable Healthcare

Posted by Tupeak_Hope on Saturday, April 1, 2017

A is for Access to Affordable Healthcare

Accessible healthcare has been in the news a lot lately. This is just one story of a recent challenge of accessing appropriate healthcare that I am choosing to share. Nobody, and I do mean nobody, should ever have to choose between food/shelter and healthcare. This is not an acceptable definition of accessible healthcare!

Approximately five weeks ago, my neurosurgeon decided I could finally return to physical (and other) therapies, after three months of post-operative healing time, following multiple simultaneous neurosurgical interventions in my cervical spine (neck). Alas, I had no way to get there, so it took me all this time to figure out how I would get there and to save the money to ensure I could get there and back three times a week, at a minimum. So two weeks ago, I finally scheduled the first of the three therapy evaluation appointments.

The physical rehabilitation facility I chose for my outpatient care was also the same facility I spent over a month in post-operatively, as well as previously both as an inpatient and outpatient for nearly two decades. So I am quite familiar with their level of care, and that being the case I would go nowhere else.

When I scheduled the initial appointment I was informed about their “charity care program”. This program is financial needs based and can help reduce or even eliminate costly bills beyond what your insurance may cover. They sent me the paperwork to complete, to be returned to them when I came in for the first appointment. Or so I thought. Apparently, I was mistaken. I received two telephone calls from the facility the day before my scheduled appointment. The first was to schedule two other appointments around the time for the first. The second call was from another department to verify that I was aware, up front, of the costs that I would be responsible for from these three appointments.

See, Medicare only covers eighty percent of covered services. The patient is responsible for the remaining twenty percent. In my case for the Physical Therapy evaluation, the cost for me was $15.90. The evaluation with the Occupational Therapist (for my hands) would cost me $15.43. Lastly, the evaluation with the Speech Therapist (for ongoing swallowing issues) would cost me $38.68 out of pocket. You may look at these numbers and think to yourself that those numbers aren’t that bad. While you may be right in one aspect, there are aspects you may not be thinking of.

Let’s see if I can shed some light on this for you. First and foremost, the total for one day of three appointments for comprehensive evaluations by each department listed would be $70.01. Mind you I do believe that the therapists in question, especially at this particular facility, are well worth the money. The value of their care is not the topic, rather the ability to access the care is the question. Now, so that you understand what happens next, you must realize that while it may not seem like a lot at first, once you start doing the math, you will see how quickly the numbers and totals begin to add up.

The first thing they informed me was that they had not received my charity care application yet. The discussion went on to address the fact that I was under the impression I was able to bring it with me on the first day. She went on to explain that while I could certainly do that, I would be held responsible for the balance owed for the initial evals, as the charity care application is not retroactive at all. She continued to explain that it could take up to two weeks to get the application approved, though occasionally as little as a couple of days. So now I’m faced with a dilemma, I think out loud. Do I make arrangements to pay the fees for the evaluations so that I can start therapy, or cancel them and await a decision on the charity care application. Her response was rather surprising, as she essentially indicated that while she didn’t know what to tell me, she required an answer immediately seeing how the appointments were for the following morning, and I had been scheduled for a visit in each of three different departments.

“Okay,” I said. “How about each appointment after that?”

“Well that could be even more depending on the billing code the therapist puts in”, she, oh so helpfully, explains. She went on to further explain that it doesn’t cover any specific treatment modalities, which are often in addition to the appointment cost.

“Well then, I guess you should just cancel them all until I get a response from the charity care application.” I said. “I don’t want to but I don’t have, nor can I afford $70 a day for therapy appointments”.

Realistically I could easily be looking at well over two hundred dollars a week just for the therapy time, excluding any specific treatment devices and the like. I had to budget how to afford two to four dollars a day to take the bus to get there seeing how I can’t afford to get my car running at the moment so that I can get back and forth to my appointments. That alone could cost up to $12 a week in bus fares. Let’s be conservative and say therapies wouldn’t exceed the $70 per day, that is $210 per week, plus transportation costs puts us at $222 per week, before any extraneous costs such as incidental / disposable supplies, or specialized treatment equipment. That is approximately $943.50 per month based on an average 4.25 week month.

Now, looking back, the seventy dollar triple visit may not seem so bad. Until you do the math, and find out you would be looking at a minimum of roughly nine hundred and fifty dollars a month that is above and beyond what your insurance covers. Keeping in mind there are many, many prescriptions I cannot afford that are significantly cheaper than even the triple visit cost, you will easily see that there is no feasible way that I could afford an extra $950 per month.

Could you?

In closing, I would like to briefly share a story from a friend. She relayed to me how, when suddenly ill one day, she was literally on the computer researching her symptoms trying to determine the nature of her illness without having to go to the Emergency Room. Eventually, she wound up going to the ER, as she had no other choice. But the fact that she, and many others, have had to weigh their health against being able to get groceries, pay rent, and the like due to the high cost of ER visits, and in some cases extremely high co-pays to be seen in the ER. For her, I believe she said her co-pay just to be seen was three hundred and fifty dollars. I don’t know about you, but I don’t have an extra $350 just lying around to pay the co-pay, just to find out if my symptoms are life-threatening or not. If I were forced to do this, I would not be able to. This is one reason that when I do wind up having to make the decision to go to an emergency department, I wait until I know without a doubt I will be admitted. Not necessarily the smartest thing to do, but I know lots of people who are forced to do the same thing. What would you do?

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