Guiding Principles in Conflict with Survival Instinct
Part 1 of 2 What would you do if, for 4 months, you had been trying, to no avail, to receive treatment for an excruciatingly painful infection in your jaw? The reason you have received no treatment was because your HMO dental insurance was unaccepted by all but one dentist in your area who required you to sign an $11,000 loan contract with a super high interest rate and $400 monthly payments before providing services, you have transportation barriers; you are on a small, fixed income and are unable to pay for treatment out-of-pocket; and, your debt-to-income ratio prevents you from qualifying for the usual credit programs. In addition to these barriers, you have found that, despite your condition originating as a dental issue, it has escalated to a medical issue as verified by your medical insurance carrier; however, no MD will treat this condition for the same reason as the dentists—they refuse to accept your medical insurance.
Being in this predicament myself, the best solution I could come up with was to drop the HMO dental insurance that was unaccepted by dentists and sign up for a PPO insurance that would be. Unfortunately, this PPO dental insurance is through my Medicare Advantage medical insurance as a supplemental coverage and only one dentist in my area is accepting this one, as well.
At first, I was overjoyed that this dental clinic would accept my insurance and I took the soonest possible appointment. Sadly, when I looked at my benefits documentation, I found that the sales representative had misread the outline of the coverage. She told me the coverage was 70%. I found out it is the copay that is 70%.
I am looking at an exam, x-rays, cleaning, scaling, root planing, and oral surgery with three extractions including general anesthesia preceded and followed by antibiotics and prescription pain medication. My estimated 70% share is $4033, before tax, with a $2000 deductible required to be paid before the insurance will pay the dentist. So, the dentist requires that I pay my entire copay upfront before they will provide services. Add to this figure the prescription copay for the antibiotics and pain medication as well as the $86, before tip, round trip ride-share fare. Even if I had a vehicle (a seizure disorder prohibits), the transportation would still be required because of the fact that a person undergoing general anesthesia is prohibited from driving within 24-hours of regaining consciousness.
It is important to note, Ride-share from my semi-rural location is hit and miss with reliability. Most drivers, upon seeing that the pickup is outside the metro area and only around 16 minutes in travel time, will decline the fare.
I am unable to rely on friends and family. The last time I asked my son for a medical ride he told me, “If you can’t take care of yourself, maybe, you belong in a nursing home. Don’t bother me.” Friends tell me either they work and are unable to take time off during business hours for a non-relative or that they have their own problems to deal with. I know these are excuses; because, I have told the working friends that I am willing to catch a ride to the clinic on their way to work and wait until the friend gets off work for a ride home and just bring a book to occupy myself while I wait for the clinic to open, spend all day there, and wait for the friend after the clinic closes. I also offer gas money and dinner. Their answer stays the same. My offer goes to the friends who say they have their own problems. Their answer stays the same and they only contact me, never to inquire about my condition, but because they want something from me.
So, there are community agencies I’ve reached out to for medical transportation—37 of them as well as the local Catholic Charities and Jewish Community Services. The community agencies have all turned me away; because, they either require I qualify for Medicaid or tell me I am out of the service area at my semi-rural address. I am ineligible for any Medicaid program; because, my gross income is $200 over the limit. The Catholic Charities representative told me COVID has tapped out their resources and they are unable to help me. Jewish Community Services has failed to return any of my messages. I have inquired with 211 and there is no transportation services they offer near me.
There used to be two transportation services available to me before COVID. There was a public transit bus; which, used to pick up the tenants in my area twice a month and take us to Walmart. From Walmart, we could access the public transit metro lines. This flex ride service was discontinued when one of the regular passengers, the man who advocated to get the program started, passed away. We were told by the transit system that the ridership was too low—because one passenger died!