This is the time of year when employers look over their choices of health insurance plans and choose the best benefits to offer their employees.  But what if you don’t get health insurance through you or your spouse’s employer?  And what will you do  if you lose your health insurance coverage during the year?  What happens if a new and chronic illness falls upon you or a loved one and your current plan provides insufficient coverage?  How will you get additional coverage?  The task can be daunting, but as R.N. and Care Coordinator Terri Otteni (Pediatric Alliance — Northland Division) tells us, there is help:

There is a terrific resource for our children with special needs or patients that are newly diagnosed with a chronic disease. This organization, “Pennsylvania Health Law Project,” is a non-profit group that helps children with severe disabilities, behavior disorders, or autism spectrum disorders obtain access to medical assistance and pharmacy assistance programs.

 

From the PHLP website:

PHLP is a nationally recognized expert and consultant on access to health care for low-income consumers, the elderly, and persons with disabilities. For more than two decades, PHLP has engaged in direct advocacy on behalf of individual consumers while working on the kinds of health policy changes that promise the most to the Pennsylvanians in greatest need.

 

If you have no health insurance, or you lose your insurance, then you are a “Pennsylvanian in greatest need.”  Terri explains how she was able to help a family get medical assistance as a secondary insurance for their child with a newly-diagnosed chronic medical condition:

The PHLP provides a step-by-step guide, written for parents, on the ins and outs of getting medical assistance for chronic conditions. I know it seems like that isn’t a problem for most of our patients, but for some folks who have no experience with this sort of problem, it can be a very confusing process. One of our doctors just had a teenage patient whose parents were drowning in medical bills from a newly-diagnosed chronic problem, but could not wade through how to get medical assistance as a secondary insurance. I am excited to have this as a resource for the family!

 

If it wasn’t for Terri’s role as a Care Coordinator for our Patient Centered Medical Home (PCMH) project, this family may have fallen through the cracks:

This case was really heartbreaking to me. The only way I found out they were having a problem was by one of the simple questions we are asking in a pre-visit survey: “Are there any barriers to medical care for your child like insurance issues, financial problems, or transportation concerns?” It was as though the dam was opened when I asked this mom, spilling out a torrent of frustration and emotion, telling me about their struggles financially since their teenager has been diagnosed with a series of inter-related chronic problems. These are hard working, middle class folks who were erroneously told they didn’t qualify for any sort of assistance because they made a little more income than the government standard for poverty.

 

As we move forward in our efforts to become your family’s medical home, we hope Terri and the rest of our Care Coordinators can make a positive difference in your lives too!