One Step at a Time

“Hello, it is me... again.” I don’t even have to turn my head. I know exactly who it is. One of my regulars, a petite Greek woman with a heavy accent and a steady smile, peeks her head in. “I got something else in the mail today. Will you look at it?” I motion her to come inside and she pulls out a heap of mail. “I organized them and wrote dates like you told me to. See? January two. They tell me about my premium. That’s what I pay every month.” She looked at me and nodded, excited that she remembered our previous conversation.

Every visit, I learn a little more about her journey. An only child with a recently deceased mother, she chose to immigrate to the United States to care for her ailing, bedridden father. On top of nursing him back to health and securing his finances, she hustles around the city with any and every piece of paperwork ever given to her, looking for a job and securing necessities for herself. On the top of her list, but hardest to check off, was enrolling in health insurance. That’s when she came to me.

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As an Insurance Specialist, one of my duties is to help patients navigate through the complexities of Healthcare.gov, the website-based enrollment process for the Affordable Care Act. Almost immediately, customers are hit with barriers. Many of my patients are not only immigrants who speak limited English, but also elderly and never learned how to operate a computer. How are they to create an online account if they don’t know what an email address is, much less have one? My role is to facilitate the process by assisting them with creating  an account and then transcribing their information into the system. Once their application has been processed, they compare plans and enroll. Easy enough, right?

Wrong. Enrollment is just the beginning of this process. After a patient enrolls, they must pay a monthly premium and/or a yearly deductible. Often, they struggle to fit these pricey, though necessary, payments into their budget. It is then that I look into other resources available to them, including assistance with utility bills, food stamps (SNAP), and other potential solutions to secure day-to-day necessities. This process involves visiting websites, calling organizations, and knowing which questions to ask to determine if a patient is even eligible for these benefits. I find myself on hold for inordinate amounts of time, being transferred from representative to representative, and I can’t help but think how difficult this process would be for those who are unable to understand English well or simply do not have the time to remain on the phone for hours.

Despite these obstacles, so many of my patients continue to come back with new questions, eager to overcome that next barrier. They tell me of the hours they spend in the library researching potential job opportunities and of the classes they’ve signed up for to improve their English. I am inspired by their resilience and determination to become as independent as possible, and even more impressed with the patience many of them exhibit when things don’t go their way. My hope is that in this crucial time for them, I can reciprocate their efforts with the knowledge and skills necessary to answer the questions they bring me. 

Most recently, my Greek friend returned with an unpaid bill. She had just opened her bank account and had questions. Does she use her debit card or a check? What’s a routing number? Excellent, excellent questions, the answers to which I barely learned myself. After some trial and error with  the online payment tool, we completed the payment via telephone using a check. “Well, what if the online doesn’t work next time?” She asks me. “Hmm,” I respond. “One step at a time.” She smiles. “Ah, yes. One step at the time. I like that.”

This blog post was written by NHC Philadelphia member Jillian Millares.
Jillian serves as an Insurance Specialist at Philadelphia Department of Public Health-Ambulatory Health Services Health Center 2.