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Uninsured struggle to get specialized care

October 21, 2009|By HEATHER KEELS

Free clinic patients uninsured for variety of reasons

Health insurance options

WASHINGTON COUNTY -- Just before Kevin Coble's mother died, she made her son promise her one thing.

"I had a knot on my neck," said Coble, 28, of Hagerstown. "She made me promise that I'd go get it checked."

That will have been two years ago in February, and following through on his promise has proved harder than Coble expected.

Coble, who works in construction or mows grass when work is available, does not have health insurance, and his income leaves nothing left over for medical bills, so he turned to the Walnut Street Community Health Center, which offers a sliding fee scale based on income.

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There, Dr. Johnson Koilpillai, the center's medical director, was concerned by the 4-centimeter mass on Coble's neck, which has gotten bigger in recent months.

"It could be a benign cyst that's getting bigger, it could be cancer; no one really knows," Koilpillai said.

Koilpillai told Coble he needed to see a throat specialist, but so far, Coble hasn't been able to afford to do so.

Just to get in the door for an initial visit will cost $100 to $200, money Coble said he can't afford to spend when he's supporting his girlfriend and her three children. And paying for surgery or treatment is even farther out of reach.

Coble's predicament is a common one for patients without health insurance, according to officials from area clinics that serve uninsured and low-income patients.

Uninsured patients can get many of their health needs taken care of for free at the Community Free Clinic in Hagerstown, or for as little as $10 a visit at the Walnut Street Community Health Center in Hagerstown or Tri-State Community Health Center in Hancock, which offer sliding fee scales based on income with help from federal grants.

But when patients need specialized care not offered at the clinics, they sometimes are left struggling to pay the full bill out of pocket, clinic directors said.

Sometimes, clinics are able to work out agreements with specialists for payment plans or pro bono services for uninsured patients, clinic directors said.

The Community Free Clinic has a network of about 80 providers who sometimes will donate their services to patients on referral after the clinic does all of the preparation, such as blood work, Community Free Clinic Executive Director Robin Roberson said.

Not all uninsured patients are so lucky.

One particularly limited area is dental services, especially preventative care, Roberson said. The free clinic works with one dentist who will see a limited number of free patients, but the clinic reserves those spots for patients with the most severe dental problems, she said.

At the Tri-State Community Health Center, affordable dental and mental health services are among the specialized services that providers have the most trouble finding for patients, said Kris Weaver, director of nursing.

Koilpillai said the high cost of paying for specialized care out of pocket can have serious repercussions for uninsured patients.

For example, one uninsured Walnut Street patient, a 45-year-old woman, suffers from a nerve problem called trigeminal neuralgia that causes her severe pain, Koilpillai said.

Koilpillai said he has tried several medications for the patient without success and she really needs to see a neurologist, who could administer injections to try to kill the nerve.

Even when the woman had a job, it didn't provide insurance, but her pain has made her unable to work and she has lost her income, too, Koilpillai said.

The center tried to help the woman get Medicaid, but she was denied because her condition is not considered disabling or chronic, he said.

"Which, for the most part is true, if you get proper treatment," Koilpillai said. "But if you don't have access to a specialist, it can be a long-term problem. It's kind of a bad system in that estimation."

Even for patients who eventually get Medicaid, the approval process can take several months through a few years, he said.

Meanwhile, patients delay treatment while their conditions worsen and sometimes trigger other health problems, Koilpillai said. For example, the woman with the nerve problem has fallen into a depression, he said.

Hagerstown resident Stacey Harbaugh, an uninsured Walnut Street patient who suffered a torn rotator cuff in her shoulder, said the situation is something of a catch-22.

Without health insurance, an orthopedic specialist will not even examine Harbaugh for less than $300, she said. At the same time, the torn rotator cuff injury has prevented her from working at either of her part-time jobs, and her husband's disability income leaves nothing left over for the costly doctor's visit.

"Right now, I'm just in limbo; arm in a sling, on pain medicine," Harbaugh said in early September.

Koilpillai said reforms that expand eligibility for Medicaid or make insurance plans affordable for those whose employers don't provide it would make a real difference for those and many of his other uninsured patients.

"These conditions would still exist, but I think it would definitely improve access and reduce what we call 'morbidity' -- the suffering," he said.

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