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Queens Chronicle

Doctor’s bill: pay what you can

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Posted: Thursday, October 1, 2009 12:00 am

Korin Kormick of Woodside has what she called “a perplexing illness” — and no health insurance.

Kormick moved to the city recently, was unemployed for several months and now has a job that doesn’t offer medical benefits, so going to a normal medical facility didn’t seem possible. Doing some Internet research, she came across the Community Healthcare Network, a nonprofit which promises to treat anyone, regardless of whether or not they can pay.

“I really appreciate that they’re willing to work with my financial situation,” Kormick said, adding that she is pleased with the care she’s received so far.

CHN opened a facility in Long Island City earlier this year, and while the new center isn’t set up to deal with complex problems such as cancer, its staff sees about 350 patients a week for issues ranging from HIV to back-to-school shots.

The uninsured are billed on a sliding scale, based on their income. Most are expected to pay at least $40 per visit, but Anibal Negron, director of the L.I.C. center, said, “If the patient says, ‘I don’t have any money,’ we’ll still see the patient.”

That doesn’t mean anyone can just get a free doctor’s appointment. Uninsured patients are required to submit pay stubs, and those who are unemployed must present documentation showing who is supporting them, in order to qualify for free or reduced-price appointments. Those who do have insurance or Medicaid are billed the same way they would be at other medical institutions.

CHN has been around for about 30 years and operates nine centers in the city, including the new one in L.I.C. and another in Jamaica. The L.I.C. facility, which opened April 15, offers adult medicine, pediatrics, family planning services and free HIV and pregnancy testing. There’s a social worker on staff, and Negron said the center will soon start conducting workshops to educate high school students about sexually transmitted diseases and contraception.

Most patients who come to the L.I.C. center are immigrants, Negron said, but although almost 18 percent of Queens residents are uninsured, the center’s clientele typically have coverage of some sort — often through Medicaid. At some of the city’s other centers, though, many patients aren’t covered. For example, about 20 percent of those who use the Bronx facility are uninsured.

Given the financial woes that Queens hospitals face, it might seem implausible that an institution which offers free or low-cost healthcare could stay afloat. But CHN isn’t faring badly. The secret? Government funding.

Like 23 other health centers in Queens, CHN receives federal grant money from the Health Resources and Services Administration, an agency within the Department of Health and Human Services which is tasked with “improving access to healthcare services for people who are uninsured, isolated or medically vulnerable.”

Thousands of community-based clinics nationwide receive HRSA funding, and the agency estimates that one out of every 18 people living in the U.S. relies on such centers for primary care.

More than 60 percent of the patients are minorities — predominantly African-American and Latino — and almost 40 percent of them are uninsured. Hundreds of thousands are what HRSA refers to as “special populations” — homeless, residents of public housing or migrant workers.

That’s where the controversy comes in. Critics argue that such individuals — some of whom are likely undocumented immigrants — shouldn’t receive care at taxpayers’ expense.

HRSA’s statute, however, obligates the agency “to serve all those who need medical care in the health center’s particular service area,” said spokesman David Bowman.

New patients are screened to determine whether they qualify for Medicaid or other financial assistance programs, according to Bowman. For those that don’t qualify, Uncle Sam picks up most, if not all, of the tab.

HRSA maintains that providing healthcare “homes” — medical facilities that patients visit regularly — for those who can’t pay is cost-effective for the government in the long run because preventive measures reduce the need for more expensive treatments and procedures.

“A healthcare home prevents sickness, manages chronic illness, and reduces the need for avoidable, costlier care such as emergency room visits and hospitalizations,” HRSA says in its annual report.

A study conducted by the National Association of Community Health Centers and the Robert Graham Center in 2007 bolstered that claim, finding that community health centers save the healthcare system as much as $17.6 billion annually.

The study found that overall medical expenses for health center patients are 41 percent lower than for patients who receive most of their care elsewhere. Researchers also said more than $18 billion is wasted each year for non-urgent emergency room visits and concluded that community health centers are a worthwhile investment for the government.

“If Congress invests in community health centers today, an estimated 30 million Americans could have access to their high quality by the year 2015, resulting in healthcare savings of between $22.6 and $40.4 billion annually,” the report says. “If every American made use of primary care, the healthcare system would see $67 billion in savings annually.”

The government appears to be listening. Early this year, $2 billion was invested in community health centers as part of the American Recovery and Reinvestment Act, and in March President Barack Obama pledged $338 million to expand the system.

New York is getting a larger share of the recovery money than any state other than California and Texas, with nearly $19.5 million allotted to help its health centers.

Welcome to the discussion.