Health rights defenders

Nine Health Consumer Centers in California help people get the health care they need

五月/六月 2005 期刊
編輯 Jean Tepperman

When Maria Elena Gomez’s son Victor was 13, he started feeling “extreme pain” in his abdomen and experiencing bladder problems. Doctors found a kidney tumor and operated to remove it. Since Victor was enrolled in Medi-Cal and California Children’s Services (CCS), a program for kids with special medical needs, Gomez was surprised and upset when she received a letter from a collection agency demanding payment for the surgery.

So Victor’s doctor referred her to the Los Angeles Health Consumer Center (HCC). The staff there educated her on how to submit the bill and helped her get payment from CCS for the surgery—and follow-up visits. Victor still can’t play rough sports, says Gomez, but he has been more active than before the surgery—and pain free!

Health Consumer Alliance

The Health Consumer Center that helped get Victor his operation is one of nine that make up California’s Health Consumer Alliance (HCA), founded in 1999, to “help low-income people obtain essential health care.” The centers, based in Legal Services offices:

educate people about their health care rights
go to bat for people who are having a hard time getting care or insurance
identify and work on fixing problems in the health care system.

HCA is a coalition of 11 organizations led by the National Health Law Program with major funding from the California Endowment.

Getting insurance

Signing up: Almost 1 million children in California lack insurance, but many are eligible for public programs, says HCA Director Lorraine Jones. “Some start (enrolling), then never hear back or don’t know how to proceed. We help track down what happens to their application,” or just provide information about what they’re eligible for.

Working out problems: Barbara Frankel, director of the L.A. center, tells the story of a child who lost Medi-Cal coverage when his mother left the state. His grandmother, who was caring for him, couldn’t re-enroll him in Medi-Cal because she didn’t have his birth certificate. “We have a relationship with the (local Medi-Cal office),” says Frankel. “We convinced them to extract the information from the mother’s case, got the child a Medi-Cal card, and in the process got the grandmother on Medi-Cal.”

Including all children: Finding solutions for children not eligible for Medi-Cal or Healthy Families is tougher, but the Health Consumer Centers can sometimes connect them to low-cost private insurance programs or public health centers. And 10 counties now have Children’s Health Initiatives (CHIs), committed to providing health care for all children.

Connecting to help

Outreach is central to the work of Health Consumer Centers, says Teresa Alvarado, director of the Fresno Center. “We’re at community events, health fairs, community organizations, parent centers at elementary schools.”

“We found we had to use different outreach for different ethnic groups,” says Frankel. Not many Asian families were calling the center, so the HCC stationed staffers in Asian community organizations, to do in-person outreach. For Spanish speakers, they found, “the best way to reach people was radio.”

Every Health Consumer Center has staff members who speak several languages and materials available in many more.

Keeping insurance

Health Consumer Centers also help keep families from “falling off” insurance, says Frankel. Programs sometimes cut families off because of computer problems or technical details in their annual income reports.

Antonia Leonetti of Burbank says her children were on Healthy Families for years, until they were cut off last spring. “They said they never got the paperwork,” Leonetti says, although “I kept faxing it and re-faxing it.”

If families are still eligible, “we help them get reinstated,” says Elizabeth Landsberg, director of the Sacramento center. “Many times it would just take a phone call, but sometimes we have to file for a ‘fair hearing’—and go with them to the hearing.”

Getting care

“You’re not going to have good outcomes because you have a card in your pocket,” says Teresa Alvarado, director of the Health Consumer Center in Fresno. “You have to access the services.”

When Kaiser started covering some kids not eligible for public insurance, Alvarado showed the parents which bus to take and went with them to the Kaiser orientation. “We encouraged every family to take a card, then took them to the reception area to make appointments for the kids. We told them, ‘we’re here to facilitate.’”

When insurers, public or private, refuse to pay for a particular service, says Landsberg, “we’ll help (families) file appeals, go with them to hearings, even sue if necessary.”

Medical debt

Many people seek the help of Health Consumer Centers because they face medical bills they can’t pay. HCA research, says Frankel, “found a very good percentage of people in medical debt actually had coverage or were eligible for Medi-Cal or Healthy Families.” In those cases, HCCs may be able to persuade the insurance program to pay.

The L.A. center is now working to get Healthy Families to pay $28,000 in hospital and doctor bills for Ryan Ramage, Jr., of Covina, an 11-year-old who broke his arm skateboarding. His mother, Rachelle Ramage, says when the accident occurred, the family had been enrolled in Healthy Families for three years. They discovered that Healthy Families had cancelled their coverage because of technical details in the way they documented their income.

Changing the system

“When we encounter 10 people with the same problem,” says Alvarado, “we know we’re only seeing a fraction of people with this problem.” HCA staff “get together and talk about what we’re seeing,” document problems, then advocate for solutions.

“Our first major report was about Denti-Cal,” Landsberg says. The centers were getting many complaints about the quality of care and difficulty getting appointments. HCA wrote a report describing the problems and are now working with the Department of Health Services to find solutions.

HCA’s latest report, Sick and in Debt, documents “improper practices that cause medical debt for low-income Californians” and recommends steps for correcting them. “If everybody had insurance,” comments Frankel, “this wouldn’t be an issue!”