The TennCare Diaries

[Thanks to Chattanooga writer and Chattanooga State College student, Angela Kelley, for submitting this diary.]

Laura, a 28-year-old married pediatric nurse with two step-children, is the only member of her family without health insurance coverage. Her husband, a real estate consultant for H&H Publishing, has company-provided insurance, but the insurance provider does not offer group insurance plans. As a result, he is not able to include his family. So the way the children are covered gets complicated. The children are covered under the maternal mother’s (i.e. the children's grandmother on their mother's side) health insurance.

They are a middle class family living in an East Ridge neighborhood at the very end of a cul-de-sac, which is an ideal spot for children to play. There's little traffic and lots of space. Children are always outside playing games from Red Light-Green Light to kickball. Yet earning $60,000 per year between both parents but being in debt, the family barely has enough to make ends meet. Laura explained to me that when they entered into marriage, they both brought a lot of bills with them. Now they owe more than $15,000 in credit card bills because they charged everything form mortgage payments to hospital bills.

Laura is on eight prescribed medications for multiple health problems which if not taken would diminish her already low quality of life. She said that she has had Irritable Bowel Syndrome (IBS) for 5 years, Interstitial Cystitis (IS) for 2 years, and Stage-4 Endometriosis for 13 years. She desperately wants to have her own child, but with Endometriosis in its last stage, it is impossible for her to conceive a child without the help of fertility treatments. Fertility treatments cost tens of thousands of dollars and therefore are not affordable to her. Still she is very aware that she will have all of the above diagnoses for the rest of her life and only hopes that they will not become cancerous or cause any other terminal diseases. When I asked her how has her illnesses affected her work being a nurse, she said that she had lost her job at Erlanger due to excessive absences and tardies because she was suffering from one or more of her illnesses. By law, Laura’s illnesses were covered under the Family Medical Leave Act, but her employer only had to hold her job for a specified length of time.

Since working at a hospital is fast paced and she never knows when she is going to have another episode of IBS, she decided to seek employment through home health care. Home health care companies have slower paced work environments and more flexible schedules, so this was an ideal employment alternative for Laura. Now Laura has been employed at Continue Care Home Health Co. for over a year. She said that although she enjoys working for a home health company, there is a negative side to it. Home health companies pay more money than hospitals, but they usually don’t offer health insurance, and Continue Care is one of the ones that doesn't.

I met Laura because Continue Care assigned Laura to take care of my 20-month-old baby girl. Due to my daughter's birth complications, being born 15 weeks premature, she has had multiple health problems which require around-the-clock care. Laura is one of her regular nurses, so I have firsthand knowledge of how Laura's illnesses affect her quality of life.

When Laura experiences an episode of IBS, it hits her suddenly without warning. She doubles over and runs to the bathroom. The first time this happened, I approached the door to make sure she was okay, but all I could hear was her heaving from the vomiting. That particular day her illness kept her in the bathroom for over 2 1/2 hours. When Laura emerged from the bathroom, looking deathly ill, I could smell the sickness in the air. She apologized for spending so much time in the bathroom and said that was one of her worse episodes ever. Normally she has severe stomach cramps and diarrhea, but this time she was vomiting as well.

With all of Laura’s diagnosed illnesses, and the fact that she has no insurance, I had to ask her what she would do in the event of a big medical crisis, and she said that she would seek to declare her self indigent to receive medical treatment. She told me that in the past she felt she was at a dead end in her life, that if she had a medical crisis, she could be sure there would be no medical insurance. Back then, she said she was feeling helpless and hopless until someone told her of a program that offers medical treatment at drastically reduced rate, and that maybe she would qualify for it. This program is what she calls an alternative to having
insurance.

She declared herself indigent and applied for the indigent program that’s located in Erlanger’s Medical Mall on Third Street. Laura said that when she applied for the program, she was deathly ill and had to be examined by a doctor. Tests were performed, x-rays were taken, and she had to undergo surgery. One would think that her bill for the above services would have been a few thousand dollars, but Laura said she only had to pay $300.00 and she was able to make payment arrangements. I had never heard of such a program before and it really piqued my interest so I called Erlanger to find out more. The name of the program is Hamilton County’s Indigent Care Program and is funded by the Hamilton County government. You can receive medical treatment, lab work , x-rays, and prescriptions at reduced rates, but you have to qualify. There are set guidelines listed below that you have to fall under.

1. You have to live in Hamilton County. Since the indigent care program is funded by Hamilton County, only Hamilton County residents are eligible to apply.
2. You cannot have any other medical resources. Those with private insurance or TennCare do not qualify.
3. You must undergo a screening process for a financial interview and your financial resources cannot exceed $4,000 for an individual or $8,000 for a couple. Incomes are based on the Federal
   Poverty Guidelines and the amount you would be charged for services will be based according to your income.
   

For more information you can call Hamilton County’s Indigent program at 778-7532.