LD is a 52 year old Caucasian Brazilian woman who was referred for a colonoscopy screening by the Women’s Health Department’s Gyn nurse at the Community Health Center of Cape Cod - CHCCC. The nurse explained to her that in the U.S.A. the guidelines recommend that all persons over 50 years of age should be screened for colon cancer. But LD was reluctant to have the test because of the associated cost. As an underinsured patient, the limited coverage she did have did not cover specialty care, and so she would have to pay for the colonoscopy out of pocket.
Our bi-lingual patient navigator was notified and contacted LD to explain the importance of having this preventive test. She also informed the patient that CHCCC has a program for uninsured and underinsured patients. This program is the Specialty Network for the Uninsured – SNU. Specialists recruited by SNU offer a discount, so patients can pay a reasonable cost and have specialty care and tests through referred by their PCP. The doctor’s fee for a colonoscopy through SNU is $150.00. Although this doesn’t seem to be a big cost, some patients will require general anesthesia for the test, which would bring the cost to up to a $1,000.00, in some cases.
With the help of SNU, LD would only be responsible to pay a small fee for the screening. Additionally, the navigator explained that her contribution would be reimbursed within 4 to 6 weeks through a reimbursement program sponsored by the Massachusetts League of Community Health Centers (MLCHC). With this information, LD decided to have the test. LD was diagnosed with colon cancer in November 2012. The subsequent diagnostic testing she needed was also covered by MLCHC’s colon cancer screening reimbursement program. Just weeks later at the start of December she was offered a reduced price by a SNU surgeon and was able to undergo surgery. While her limited health insurance covered the hospital charges, LD still needed to pay for the anesthesia and pathology—services not covered by her insurance. Fortunately, she was able to once again receive reimbursement for all fees involved through MLCHC.
LD’s insurance paid for the cancer treatment she received at Cape Cod Hospital’s Cancer Center—treatment that was coordinated by her surgeon and oncologist and lasted for 6 months. Suffering a weakened immune system from the chemotherapy, the patient experienced some other health complications that we were able to treat right at the Health Center and that were covered by her health insurance provider. LD is now scheduled to have another colonoscopy through the program in January 2014. This is when she will find out if she is cancer free.
It is not the first time that having a program to help patients pay for screenings makes a life-saving difference. In my 8 years of experience working with uninsured and underinsured patients, it is difficult to convince them to spend money on testing, especially if they are not experiencing any uncomfortable or serious symptoms. When confronted with the decision of spending money on testing instead of, say, paying for their chronic conditions and medications, patients often (and understandably) opt to postpone screenings. I believe that the funding enabling these preventive screenings is money well spent, the screenings themselves wholly beneficial, and the impact on people’s lives immeasurable.
Milene Chioatto, Coordinator // Specialty Network for the Uninsured