The Highs and Lows of Health Insurance

The reality of working in health insurance is that it’s incredibly complicated. Before starting NHC, I knew almost nothing about insurance in the US and was privileged enough to never have to question whether or not I would be insured. But serving this year at Health Center #6 has shown me how extremely difficult it is for people, especially those from low socioeconomic status backgrounds and who are already fighting against barriers in other parts of their life, to access health care. There are so many hidden stipulations that make it so difficult for patients to qualify for insurance and when they finally get it, there’s no guarantee that they’ll have it forever either. 

Take my patient for example, let’s call her Jessica. Jessica came to me back in November to apply through the marketplace for an Affordable Care Act (aka Obamacare) plan. At the time she enrolled, her income put her just over Medicaid limits and because of her age and zip code, her premiums were much higher than we’d hoped (all insurance plans look at gross income and don’t factor rent, bills, or medications into their income assessment). Ultimately she chose to enroll, because she knew she should have insurance and she said she would do everything she could to pay the bills on time. Flash forward to March, when Jessica comes to my office telling me that she wasn’t able to make the payment on her insurance and that she was worried it would be shut off. After speaking with several representatives, I was told that this was true, and that her insurance was going to be cut off because of a late payment. At this point, I was furious because after her insurance would be cut off; there were no other programs she could enroll in until November. That was eight months away.

What was this woman supposed to do without insurance for eight months?

There’s little grace period for patients when it comes to insurance – I’ve had patients denied for making $2 over the income limit. But if there’s anything I’ve learned this year, it’s how to be a patient’s advocate through the difficult application and enrollment process of health insurance. No matter what the outcome is, I think most patients are just happy to see that someone is helping them navigate this convoluted health care system.

But not all cases end negatively, I’ve had incredible successes with insurance this year as well. There’s my patient whose injury literally left him unable to walk. After signing up for Obamacare, he made an appointment with a surgeon, received his surgery a couple weeks later, and just called me last week to let me know he’d be starting physical therapy and walking again soon. Or the undocumented patient who had cancer and needed to begin treatment as soon as possible – her application was approved in 5 days! More than likely, these are the stories you’ll hear me tell (unless you’re my lucky boyfriend who gets to hear all of my health care rants)!

As an Insurance Specialist at Health Center #6, I spend a lot of my days entrenched in the bureaucracy of health care. It’s incredibly easy to get down about the way that our healthcare system works, or rather doesn’t work, for huge subsets of the US population.  And while I really love learning about and seeing how these wider policies are affecting patients, it’s the one-on-one interactions that make me laugh,smile and sometimes cry. This year in NHC has helped me to realize that I hope to someday be the kind of doctor that will always advocate for my patients.
 

This blog post was written by NHC Philadelphia member Michelle Fedorowicz.
Michelle serves as an Insurance Specialist at Philadelphia Department of Public Health-Ambulatory Health Services: Health Center 6.