Navigating the Healthcare Coverage Market by Shuyi Chen

The United States has one of the most complicated and expensive health care systems in the world. This is easy to observe in health insurance programs. From the various types of insurance programs like Medicaid, Medicare, Marketplace and CHIP, to the unfamiliar jargon of co-insurance, deductible, monthly premium, and advance premium tax credit, it is understandable that people get lost navigating coverage options. In addition, language barriers, immigration status, and social capital all make it more difficult for certain patients to access health insurance and healthcare.

I have always believed that health insurance is the first step to access quality health care. This is also one of the reasons why I decided to join National Health Corps as an Insurance Specialist at Philadelphia Department of Public Health’s Health Center 2. Through my four-month service here I have screened more than 300 patients for insurance eligibility and helped approximately 100 patients obtain health coverage through either Medicaid or the Affordable Care Act. With insurance, patients can get help pay for medical services they receive and it also gives them a sense of security when they have health needs at any time. Health insurance also reduces patients’ burden when they need to make a decision between going to the doctor or paying for food and transportation.

Among the many patients I encountered, one patient sticks in my mind the most. The patient  recently moved from her home country to the United States to join her daughter. However, two months before the open enrollment period of the Marketplace, which would normally be her only chance to get health coverage, she came to Health Center 2 with a complaint of sudden blindness in her right eye. The ophthalmologist she went to told her that she needed eye surgery, and if left untreated, it would result in irreversible blindness. I remember this patient the most because this was my very first day seeing patients on my own as a NHC insurance specialist. I was a bit nervous, but also truly excited to get started, and most importantly felt a sense of responsibility for my patient’s health. I knew that if I didn’t try my very best to apply for insurance for her, there would be no way she could afford the surgery fee and she would go blind. Due to her immigration status, the only option she had was Emergency Medical Assistance (EMA), which is also the trickiest insurance to get approved from the county assistance office. I  also learned from some past cases that blindness was not considered a life threatening disease and thus not likely to be approved by EMA.

Regardless of this, I still wanted to give it a try. After much back and forth between me, other staff at Health Center 2, and the county assistance office, the patient’s  EMA case was finally approved. I remember calling the patient’s daughter to tell her that her mother could get the surgery and she was screaming over the phone, “thank you Shuyi, I know you worked really hard on this case!’’ In the end, I felt truly glad--both for the family and for my successful first attempt as a NHC member. I also realized that while the U.S. healthcare system is complicated to navigate at times, if everyone in the healthcare system is an effective team member and works closely with each other, we can yield better health outcomes for patients.

Throughout my service term, many patients were able to receive the health benefits they deserved. However, there are many more patients who do not qualify for any government insurance programs or are simply unaware of these programs. If we want to make our nation a healthier and more secure state, there is much more we can do to achieve this goal.