Posts Tagged ‘out-of-network’

Krissy Williams, Pratt Institute

I am a junior at Pratt Institute with a major in Creative Writing and a minor in Psychology. After college, I hope to pursue a job in creative writing.   

My family and I qualify for Medicaid although we’ve had to switch to metro-plus because Medicaid wasn’t as accessible for our needs. Due to the limitations under Medicaid, I really struggled with being able to access certain doctors and therapy because a lot of therapists didn’t take my insurance. It took me months to find the care I needed. In one instance this caused me to go into debt, because I went into a therapy office thinking that they covered me. However, days after the session they informed me that it was not fully covered by my insurance and gave me a bill that I couldn’t pay off for months. I’ve also noticed the more advanced therapy treatments I need like EMDR are inaccessible to me because it is only for people who have the funds to pay out of pocket. My family and I also struggled with getting our prescriptions filled under Medicaid as many pharmacies, for example Walgreens didn’t accept our insurance.

I think we shouldn’t have to be upper class or rich to have good care. Lower-income individuals are always at the short end of the stick when it comes to these things. Therapists don’t take insurance because the health care system doesn’t pay them enough. In return this causes therapists to overcharge and only cater to upper-class people which leaves us with nothing. This is not fair to those who have chronic illnesses who cant afford to pay for treatment. It’s ridiculous we have to pay to get the help we need to live.

Valerie Guerrero, SUNY Cortland 

I am a SUNY Cortland student in my fourth year. I am a dual major in Spanish and Sociology with a concentration in Criminology. I was born in the Dominican Republic where I lived until I was 12 when my mother decided it would be better for us in the United States. I currently live in the Bronx when I am not away at school. I have been at SUNY Cortland for my entire college career. I chose to go here because my high school volleyball coach attended SUNY Cortland and they promoted this college all throughout high school. Along with that, I wanted to go away to school, and Cortland provided the best EOP program for myself and my family.

In my family, insurance is through my mother through the government. There have been many times when a member of my family needed a prescription, but insurance wouldn’t cover it, so we simply just went without it. When I was in high school, there was a point when I didn’t have insurance, and we weren’t able to get our annual physicals; the school almost kicked us out. At this time, I didn’t have insurance because my mother was switching to a different insurance company due to my sister going upstate for school at it being too far for the insurance to cover. 

Recently, I went through a tough situation with medication from my insurance company. An uncommonly known fact of birth control prescriptions within the United States is that to refill a prescription of birth control pills a patient needs to attend an annual appointment with their OBGYN. When it was time for me to attend my appointment, I was in the Dominican Republic, and instead, I made an appointment with a doctor there. I was not aware that the United States doctor would not accept this visit and still wouldn’t prescribe my pills. If I were to go off these pills, since they’re hormonal, it would affect my body in multiple ways even if it were only for a few days. So, prior to running out of pills, I decided to go to the closest planned parenthood to me. Because of the type of insurance that I had, I was worried that I would have to pay completely out of pocket. Before insurance, the visit, tests, and my prescription would cost over $100 on top of the $105 I had already spent on transportation to and from the facility but luckily it was covered. If my doctor and insurance could have made an exception one time, I would have been able to avoid all of this. 

I feel that we need to make a universal, single-payer form of health care for so many reasons. With a universal form of healthcare, my mom wouldn’t have had to change my insurance because my sister went away to school, my family could have always gotten the prescriptions they needed at a decent cost, and I would have never had to go to planned parenthood which some insurance companies do not cover. If I am working and paying taxes in this country, I believe insurance shouldn’t be something I need to be concerned with.

Nicole Masaki, Canisius College

I attended college out of state (primary residence was California, but went to college in New York), thanks largely to the scholarships I received from a private college. While in college, I was on my mother’s health insurance plan she had through her job. Despite her working for a municipal government and in a unionized role, we still could not afford more than the lowest cost plan. And while I was in high school, it was great for local care especially because I do not have major health concerns. 

But when I went to New York for college, I quickly learned that the health insurance plan I thought worked for me, only worked because of where I was located. While in college, I did not have access to a primary care doctor or preventative healthcare. During the fall semester of my junior year, I woke up one morning and my shoulder was stiff and sore: it even hurt to put on my jacket or backpack. Several days went by and one night I suddenly got very dizzy and my whole arm went numb. With both sides of my family having heart conditions, I knew this wasn’t the time to worry about coverage: I needed to go to the emergency room. We called our campus’ Public Safety and they drove us to the emergency room that was only a few blocks away from campus. 

When I checked in, they of course asked for insurance. So I handed them my one and only insurance card. In California this was all I had ever needed. But the staff working asked where my second card was, she was only familiar with New York health insurances. 

Shortly after I was seen, I explained to the ER nurse what I had been experiencing the last few days and the reason I came in today–family history. I was hooked up to a heart monitor, a nurse pricked my finger to check my blood sugar levels and I was taken in for an x-ray. Thankfully I was not seriously ill: only a pinched nerve. I was asked if I wanted a prescription for a higher dosage of ibuprofen than what I could get over the counter. I declined, I was back to worrying about the cost. I went home and did my best to rest, well the best that a full time college student could rest. 

Two weeks later my mother called me. She asked why I hadn’t given the hospital my insurance– She had just received a bill for the full cost of my hospital visit. After calling our insurance company, they informed us it was not “medically necessary” for me to go to the emergency room. Of course they didn’t take into account that at midnight the only health care open was the emergency rooms, and I would not have known it wasn’t medically necessary unless I went to the emergency room. After months of fighting both our insurance provider and the local hospital, we managed to get our bill down to the $500 maximum for emergency visits. 

My first job after college was environmental justice based community organizing in the San Francisco Bay Area. My first question was not how much I would make, room for growth, or company policy–It was healthcare coverage. The cheapest plan available to me was $300 a month. I was expected to spend ¼ of my monthly income on health insurance “just in case”. With rent, high cost of living, and my six month grace period on my student loans coming up, I knew I wouldn’t be able to afford health insurance through my employer. And the Department of Education would not take “sorry I need health insurance” as a valid reason to not pay back my loans. I have never in my life felt so fortunate to be a healthy adult with no chronic health conditions. 

I have personally seen how flawed both the healthcare provided is and the health insurance industry. We need a healthcare system that is easy to understand and works for all people. When individuals are seeking healthcare whether that be preventative, treatment for long or short term conditions, or emergency care they should be able to focus on their health and wellbeing not just what they are able to afford before going broke.

Angela Shin, Hunter College

I am a senior attending Hunter College and thanks to having health insurance, I am able to visit the doctor to get my yearly shots and go to the dentist to get my check ups without having to worry about the cost. I am one of the many people out there that are fortunate enough to have medical insurance to cover the expensive cost of healthcare. But, even with insurance, sometimes people still need to cover the rest of the fees for their surgery or medicine that are expensive. In fact, I once changed my primary doctor and visited a new doctor’s office to get a check up and a blood test. A few weeks later, I received a bill asking me to pay for visiting the doctor. I was confused because from what I know, my health insurance always covered my primary doctor visits. In addition, there are many people in the United States that do not have medical insurance. These people either have to pay for the expensive checkups and medicine out of their own pockets or cannot afford to pay for it at all. I have heard many horror public health stories where people are refusing to take the ambulance or refusing to get treated when they are sick or injured due to hospital bills ranging from thousands to tens of thousands of dollars. People would rather suffer alone and hold in their pain which can be fatal and even lead to death than have a tremendous debt due to the lack of proper health insurance. 

Medicine, like insulin, is highly needed for people with diabetes, and hospital bills from treatments, checkups, and surgeries should not cost so much to the point that people are refusing to go to hospitals. I have a friend who once asked for my dentist because she said the dentist she goes to in Manhattan charged too much for simple checkups. My brother in law says he doesn’t like going to the dentist because the last time he went to take out a few of his teeth, it cost him hundreds of dollars due to the lack of health insurance. As his father has the same issue with insurance, his father hesitates to go to the dentist even when he has severe tooth pain. There are people who are hesitant to go to hospitals when they are sick due to their immigrant status as the lack of health insurance means paying a lot of money for treatment. 

I wish that the higher ups who represent us Americans would care more about their people than money. There are other countries out there that have better healthcare than America, where they value their people more than money. I get it, money is important as it helps the world function. But it is hard enough for people to make a living, especially during this pandemic. There needs to be more affordable and accessible health insurance for all, despite where they come from, their immigrant status, age, gender, employment, and etc.  People’s lives matter more and it should be a priority. After all, what is money if there are no people around? 

Nicole Cordero, Hunter College

I’m a junior at Hunter College majoring in Political Science with a minor in Women and Gender Studies and a minoring in Legal Studies. After graduating college, I plan to attend law school to get my J.D. and become a licensed legal attorney.

There have been a couple of times where my loved ones needed better health care but weren’t able to get it. During my senior year of high school, my father got very sick and was diagnosed with a disease that affected his kidneys, and his body broke down proteins. It was a sporadic disease that not much of the population dealt with, so it took a while to figure out what was happening to him and why. He grew weak, lost and gained extreme weight, and had to fight through unemployment for medical reasons. He mostly got his healthcare through his job. He needed to get more help medically, and it was scary that at this time, in the early phases of his illness, he couldn’t go to the doctor and get the help he needed earlier when his life was at risk. He also had trouble getting the medicine he needed to treat and maintain his illness after being diagnosed. The insurance he got at his new job didn’t completely cover the medicine or his treatments, so he’d have to cover the rest out of pocket. It has always been an issue for my father to get full healthcare coverage and find good health insurance that would help him.

I do have health insurance, and I’m covered mostly through my mom from Medicare. I have HealthFirst, as do my sisters. Aging out of my mom’s health insurance plan is scary, and I’m not looking forward to making that huge transition. I am not struggling with the high cost of medical bills or medical debt, but I know my father is dealing with medical debt from the previous situation. Not having a job or not working while incapable of doing so due to medical reasons was very difficult, and my father had to take out loans to pay for rent and cover medical bills. It was a tough time, but my father is significantly better now and has the medicine to treat his illness.

Kisbel Estevez, SUNY New Paltz

My name is Kisbel Estevez. I am studying Sociology with a concentration in Criminology, and a double minor in Deaf Studies and Communication. I am a senior at SUNY New Paltz. I plan on attending Graduate school in Manhattan. There have been many occasions where myself and/or my family members have needed medical assistance but we’re told our insurance wasn’t accepted so we were turned away. We were forced to deal with it ourselves most of the time. I am covered through my mother’s job, I have Health First Medicaid. I am very much concerned about losing my health benefits; health benefits are not something that comes easy to minorities in America, sad to say. I am struggling with costs of medical bills. Hospital visits can be overwhelming. It can be a back and forth dispute between hospital expenses and my insurance covering it. It is very unreasonable how we are not able to have accessible healthcare for all when many other places around the world are able to achieve this. Universal healthcare is a good idea, because a universal system doesn’t rely solely on government funding. It can provide better coverage for every person. We need to put more efforts into providing a more accessible healthcare system which provides TO ALL.