Insurance Assistance at Birmingham Free Clinic

The phrase “money isn’t everything” is usually evoked to deter greed and encourage more wholesome intentions. Its use and phrases like it, serve as a mantra for living a more fulfilling life. However, in the context of US healthcare and insurance coverage, money can and often is everything.

Navigating the ever-rising healthcare costs and ever-changing insurance policy can be a seemingly insurmountable task for many low-income and uninsured individuals. In lieu of this complexity, some may choose to forego routine medical care until a problem they are experiencing becomes emergent and dire. In these cases, ambulance calls and visits to the emergency department rack up bills that can be in the thousands. If left unpaid, healthcare systems will turn these bills over to collection agencies that will seek out individuals putting them at risk for serious personal and financial loss.

Facing this reality head-on is frightening. Lack of access to healthcare and the stress associated with facing an unpayable bill can have negative consequences on a person’s overall health and wellbeing.

Providing assistance to patients in these and similar situations is one of the many missions of the Birmingham Free Clinic. As Birmingham’s National Health Corps members, my colleague, Ingie, and I, have attended numerous trainings on insurance navigation to help our patients work through these tough situations. We work in collaboration with members from Apprise, a federally-funded program, and the local YWCA to offer insurance navigation counseling on-site at Birmingham. We work with patients one-on-one to either apply for Medical Assistance (e.g. Medicare, Medicaid) or to retroactively seek assistance with paying an existing medical bill.

To tackle an existing bill or an emergent condition, we will either help patients apply for Emergency Medical Assistance (EMA) or Financial Assistance (FA) programs (e.g. UPMC or AHN FAs). EMA is a state-funded program and as such is unique to each state’s legislation. In Pennsylvania, EMA covers an emergent medical condition (EMC) that without immediate medical attention would result in a severe bodily impairment or death. EMA provides coverage for the entire course of treatment for of the EMC as outlined by a physician in the application. In other words, EMA coverage would extend beyond an urgent trip to the Emergency department, and it would cover all necessary lab work, imaging, and treatments to resolve the EMC.

Financial Assistance programs are similar but are not limited to emergent conditions. Instead, they can extend coverage to any existing bills for which an individual demonstrates a lack of insurance, ineligibility for government assistance, or financial need. Many hospital systems have online applications for their FA programs. These applications generally require demographic information and income documentation to determine eligibility.

Although both programs can serve great benefit to patients, they often take weeks to process and require follow-ups or updates to have the applications processed. It is for this reason that we do our best at Birmingham to work with our patients from the moment we start their application to the day they receive coverage. By providing access and assistance with these programs, we hope to improve the health and wellbeing of the Pittsburgh community.

This post was written by NPHC member Chandler Jonathan Mitchell

Chandler serves at Birmingham Free Clinic as a Patient Navigator.