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    Some of you may have read my diary of September 2nd in which I detailed an ongoing health crisis and my efforts as an uninsured American to receive proper medical attention.
     The Cliff Note version is that on August 22nd I experienced a sudden bilateral loss of strength in my arms and legs.  This was accompanied by intense pain down all four limbs, and eventually my neck.  Fine motor skills have been seriously compromised, with tasks such as operating the computer mouse impacted.  Balance and walking has been affected as well.
     The problem, whatever its cause, has only worsened in the time since, with tasks such as holding a fork and extracting money from my wallet becoming real challenges.  
     Three days after its onset I went to a local hospital's emergency room, only to be quickly discharged since my breathing is not affected and my life was not in imminent danger according to the ER's doctor, who advised me that I needed to see a neurologist for tests, as did my own GP (who I pay for out of pocket) when I saw him two days later.
     Below the fold you can read of how in today's America an uninsured individual can struggle for weeks to get needed medical care, eventually come to believe he is only a week away from undergoing a series of important tests, to learning he is in fact months away from these tests and any hope of a diagnosis.  And of how the Affordable Care Act, or "Obamacare" will change this.

    I do not currently qualify for Medicaid in my state, the exclusionary factors being that I do not have any children, and my Corolla, although nearly eight years old, is still worth over $2,000.  I recognize, of course, that a line must be drawn somewhere, and I'd be pretty unhappy if somebody driving a Bentley received Medicaid.  But $2,000 today won't buy you a vehicle reliable enough to get you to your no-benefits service sector job.
     Fortunately my Democratically controlled state will be accepting the Affordable Care Act's Medicaid expansion next year, which will have an enormously positive impact on me, once it goes into effect.
     A member of the DK community pointed me to FQHCs (Federally Qualified Health Centers,) community clinics that receive federal funding and must take all patients, with or without insurance, charging a sliding scale fee.  Unfortunately I found that these clinics provide only basic health services, and none seem to have neurologists on staff.
     A case manager at one FQHC told me that when her clinic's patients need a neurologist they usually go to a large, well-respected Catholic run medical center in Chicago's western suburbs.  "They offer financial assistance," I was told.
     I called the medical center and explained my situation and my two needs:  To see a neurologist and to learn the details of their financial assistance program.  I was transferred to the facility's scheduling line where, after a half hour on hold, a scheduler said that I needed to contact the financial services department before making an appointment.
     I called the medical center's financial services office where a recorded voice instructed me to leave a message which would be replied to within two business days.
     The following day someone from financial services called me.  A woman who, when I could draw her attention away from the bagel she was eating or whatever it was that she clearly was focused on, told me that contrary to what I'd been told the day before, I needed to first schedule an appointment.
     She said that after I saw the neurologist I would need to pay $100 out of pocket, at which point I could, as she put it, "apply for assistance."  I told her that I strongly suspected the neurologist would want some tests run, perhaps some of them done then and there, and asked her how the billing for that would be handled.  "I have no idea," was her response, which I was to discover was perhaps the only accurate bit of information her department ever relayed to me.
     I once again called the appointment line, to be told the earliest appointment available was six weeks away.  Fortunately a kindly nurse in the neurology department found a slot for me just five days hence.
     Upon arriving for my appointment I learned that I had to pay not after seeing the doctor, as the financial services counselor had said, but before. And the amount was not $100, but $210. Fortunately I had enough cash on me.  I was instructed to stop by the financial services office on my way out to apply for assistance.
     I liked the neurologist very much.  Although he was running an hour late by the time he saw me he gave me his full attention and seemed eager to hear all the information I had to give him, in addition to asking many questions himself.  He assured me that "we're not going to let your insurance status get in the way of you receiving the care you need."
     After examining me for nearly an hour, during which he administered a gamut of strength, reflex, and coordination tests, he said that he doubted my problem was neurological in nature, but rather some sort of systemic problem affecting my body's muscles.  It was his opinion that if my nerves are affected it is at their junction with the muscles, such as would be found in Myasthenia Gravis.  He told me that, contrary to my understanding, MG could present without affecting the eyelids first, but that such a presentation is rare.
     He then left the room briefly and returned with an older doctor, whose name tag identified him as an associate professor at the center's medical school.  This other doctor told me that, as a fibromyalgia sufferer (for fifteen years, and I never thought I'd look upon them as the "good old days" but they were compared to this new problem,) I was "already predisposed to this sort of thing," and "we may never be able to give you a diagnosis."  He also offered, without any prompting from me, an assurance that my insurance status was not going to get in the way of me receiving the attention I needed.
     The neurologist ordered some blood work, and, saying "We need to take a look inside you," wrote an order for me to receive an MRI of the brain, one of the brain stem, and another of the neck.  Afterwards a very nice gentleman at the desk in front found an available slot for the MRIs about a week and a half later.
     Although it was now after 6 pm I found that the lab was open and I had blood drawn without any request for any additional out of pocket payment.  The neurologist said that he would call me if any of the results came back markedly abnormal, and since I haven't heard from him in the time since I assume none did.
     On the way out I stopped by the financial services department, only to find that they had closed for the day around the time I was first being seen by the doctor.
     I called the financial services department the next day and once again left a message, stating that I'd soon be back in their building for the MRIs and could stop by their office then, if I needed to speak to someone in person.  
     This past Monday morning someone from the financial services office called me. She asked me a few questions, then said that she'd mail me the assistance application.  I didn't ask her why, since the application could be simply mailed to me, that I was not offered this during my first conversation with her office, which would have given me a two week jump on things.
     The counselor seemed eager to end the conversation there, but it is extremely fortunate for me that I had another question to ask her, because her reply led to her disclosing information to me that, given that this is her job, one would think she would have readily volunteered.
     I asked her if I received and completed the application by next Monday, when the MRIs were scheduled, if I could simply drop it off at her office, which is in the same building, rather than mail it in.
     Her response was "It wouldn't make any difference.  You'll have to make a payment before getting the MRIs anyway."  This was the first that anyone had informed me of this.  Upon further questioning she said that the assistance application would take four to six weeks to process, and that is why I would have to make an out of pocket payment in advance in order to receive the imaging tests.
     I then spent the next several minutes trying to get her to tell me just how much I should be prepared to pay in order to receive the tests.  For the life of me I don't know why she was so reluctant to give me this information.  After repeated attempts she placed me on hold for several minutes in order to get me a figure.
     When she came back on she said "It will be at least $3,600."  Three thousand, six hundred freaking dollars.  Or no MRIs.  I asked her if I somehow managed to come up with "at least $3,600" by next Monday and my application was subsequently approved, if that payment would be refunded.  "No," she said.  "It will go towards any balance you have."  In hindsight I wish I'd pointed out to her that if I could come up with $3,600, I'd probably have health insurance.
     I asked her what my current balance was for the visit to the neurologist and the blood work.  "Six hundred dollars," she said, making the total cost of that visit over $800.  Of course an insurer, if I had one, would tell them they were going to pay $400 and they'd be happy with that.
     Well, I don't have "at least $3,600."  So I rescheduled the MRIs for mid-November, eight weeks from now, in the hope that my assistance application will be approved by then.  I can only hope that my condition won't deteriorate too much further in the interim.
     Now, I have my problems with President Obama.  And I have my problems with the Affordable Care Act (if I were Canadian I'd have had health insurance since I came out of my mother's womb.)  But here is what "Obamacare" will mean for me and millions of other Americans:

Medicaid coverage.  Not the best insurance in the world, I know, but a damned sight better than no coverage at all.  Pity the poor red state residents who will be denied this, and eternal damnation to the Republicans who will deny them.

No going hat in hand to a not-for-profit provider, and jumping through hoops, and dealing with grossly incompetent "financial advisors," and waiting two months to receive needed medical care while my assistance application is processed.

No sticking the provider for the costs of my care, should assistance be granted.

No provider then passing the cost on to those who have insurance by boosting their fees, thus boosting insurance premiums.  Yes, I know that there are taxes associated with Obamacare, but how much saner, efficient, and humanitarian it is to provide coverage that way than through our current "system."

No lifetime cap.  I still don't have any idea what my current medical problem is, and as such I've no idea what future costs may be associated with it.  But at least I know that should I one day once again receive insurance coverage through an employer, as I hope, or purchase a policy out of pocket, I won't have to worry about "running out."

No pre-existing condition exemption.  Should I one day be in a position to purchase coverage, no provider can deny it to me.

Community rating. Under the Affordable Care Act, insurers must set my premium based on my age and geographical location.  Whatever malady is occurring in my body now, and whatever malady may have occurred previously or may occur in the future, my premiums cannot be jacked up because of it.

As Joe Biden said, it is a big fucking deal.


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