With so much attention focusing on health care reform it seems easy to get lost in the big picture. Some may forget there are millions of people who right now, are not seeking nor receiving needed medical attention due to lack of insurance. The uninsured many times are refused adequate testing which could offer early detection of a disease. Other times, the high cost of medications can force someone to choose between buying groceries or having prescriptions filled. In other cases, some uninsured people due to their location are forced to either seek emergency medical attention at a hospital or die. Here is one such story which happened only a few months ago.
My then boyfriend now husband Tony had a small but open follicle type hole just below his navel. For years it was not a concern other than occasional pus. It never grew nor was it painful. One day he approached me and asked me to tell him if it seemed bigger. After looking and gently pressing on it, I concluded that it had definitely increased in size.
Not being one to run to the doctor for every little bump and sniffle, he opted to wait to see if it would show signs of healing on it’s own. Perhaps it was just a large boil. The fact that he was self employed and did not have health insurance was also a contributing factor to his waiting. He decided that if it continued to get worse, he would make an appointment at the $20 clinic in town.
The next day however, Tony mentioned it was becoming tender and again asked my opinion. When I touched it, I noticed it felt hot and a foul odor had developed. Over the next few days, it became so painful, he couldn’t button or zip his pants. It had grown to the size of a golf ball. It was Friday evening. At this point it was growing so quickly, we both knew it would be unwise to wait until Monday to have a doctor look at it.
That evening we went to the emergency room. This was and still is the only emergency room in our small town. The next closest emergency room is an hour and a half drive away. While Tony was the only patient in the tiny reception area, they treated both of us kindly. Like family. He felt a little embarrassed at coming to an emergency room for a bump. But we thought maybe they would give him a prescription for antibiotics and send him home, hence the reluctance to make the drive to the larger hospital so late in the day.
What the doctor found was an abscess. He said it was very close to rupturing and the infection could spread throughout Tony’s body. If left untreated would kill him. We were shocked. How could something so urgent happen so quickly? The physician urged Tony to have it treated immediately and not to attempt to make the trip down the mountain. We figured we were in a hospital already and the staff seemed very competent. Besides, the thought of two emergency room bills did not appeal to us at all. Tony of course agreed.
While waiting for them to prepare to treat him, the nurse asked him if he had medical insurance. When he said he didn’t, she was very accommodating and explained that ACHSS was available to low income uninsured people just like him. We both sighed in relief.
The doctor proceeded to lance the abscess in the emergency room without a nurse present. Instead, he asked me to hold the draping in place while he lanced, cleansed and packed the wound. I did not wear sterile gloves or anything. Tony and I both thought this was unusual protocol, but otherwise did not question this. The doctor told Tony that since he did not have medical insurance and no primary physician, that he was to just come into the emergency room every day to have the packing checked and changed. He was to do this every day until the wound healed. We were sent home with discharge papers, a couple of prescriptions and an application for ACHSS. We went back every day as instructed. The wound healed beautifully.
The Monday following the emergency room visit, Tony turned in the paperwork as instructed to a lady who specialized in processing ACHSS applications. The lady assured him that the bill would be taken care of due to his being low income. However a couple of weeks later, he received a letter stating he was denied coverage due to his income. Tony grossed $800 per month. Because my husband’s business is online, he frequently ships products to his customers. ACHSS does not allow for the cost of shipping as a business expenditure. This more than quadrupled my husband’s apparent income making him ineligible for coverage. He promptly received a bill for all procedures. Tony just as promptly went to the lady who assured him he would be covered and asked for an explanation. She appeared perplexed and assured Tony she would speak to her manager. Her manager said there was nothing that could be done other than an appeal. Tony said he wanted to appeal the decision and followed all instructions given to him for filing such an action. He provided detailed financial records proving his income. She said she would take care of it. However after months, we still have not heard anything regarding the appeal. The manager has refused to answer any phone calls despite numerous messages. And she somehow “happens” to be out every time he visits her office, regardless of what time of day he goes. At this point, the bill has been sent to collections and has affected Tony’s credit.
We still have yet to receive answers and aren’t even sure if the manager even filed Tony’s appeal. We have been told that ACHSS has 45 days to reassess the decision and to notify my husband. Being unable to get in contact with anyone, we have given up hope.
He has since had to seek medical treatment for other issues with the $20 clinic in town.