State Specific Medical Coverage

Karen Lee Richards Health Guide
  • As many of you know, I haven't had health insurance for several years.  My state (Tennessee) used to offer insurance through their TennCare plan to those of us considered to be uninsurable by other insurance companies.  We had to pay for it, but since it was based on income, it was reasonably priced.  Unfortunately, the plan was poorly managed, which resulted in widespread abuse.  When the state ran low on money for the program, those of us in the “uninsurable” group were dropped and only the people with the lowest incomes were still covered. 

    From that point on, for me all preventive care went out the window.  It's taken everything I could scrape together just to keep up with essential medications and minimal doctor visits to monitor my most critical problems – diabetes and blood pressure.  Although my doctor wanted me to have things like annual mammograms done, I just couldn't afford it.  And to be honest, I figured that if they found anything, I couldn't afford to treat it, so why find out.  Not the best attitude, I'll admit, but that's how I felt.

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    Then a couple of months ago, my doctor's office called to tell me that the Susan G. Komen Foundation had provided a grant for 54 women in this area to get a free mammogram and I was one of the women they were offering it to.  Since my doctor has been so good about working with me on treatment plans and keeping costs down, I wanted to cooperate with her, so I agreed to accept the free mammogram. 

    That was the beginning of an “adventure” that is still ongoing.  And I've found some surprises in the area of health care coverage that I wanted to share with you. 

    My health adventure begins...

    Four weeks ago I had the mammogram.  There were some areas of concern, so they wanted to do an ultrasound.  I was told that if I would go down to the county health department and fill out some paperwork, something called the Breast and Pelvic Program would pay for the ultrasound.  I did that and had the ultrasound.  (While at the health department, I was given a free pneumonia vaccination – something my doctor had been wanting me to get – and offered several other free immunizations as well.)

    After the ultrasound, I was told that there were some calcifications and a 6mm nodule that needed to be biopsied.  At that point, I learned that all of the tests and possible subsequent treatments would be free.  There were programs in place to cover any eventuality.  The same Breast and Pelvic Program would cover my surgeon's visits and stereotactic (needle) biopsies.  If I needed a surgical biopsy, I could get TennCare for 45 days to cover that.  Then if it turned out to be cancer, I would be put on TennCare until I qualified for Medicare. 

    As it turned out, I had two stereotactic biopsies done on the calcifications last Thursday and got good news on the results yesterday – both were clear.  I still have to have a surgical biopsy of the nodule done and have an appointment with the surgeon tomorrow to schedule that.  It will probably the second week in May before that can be done because it takes a little while for the TennCare to take effect.  I'll let you know how that turns out whenever I get the results. 

  • Lesson Learned – Don't Assume

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    I hope I haven't bored you with my story, but I learned something very important that I wanted to share with you – don't automatically assume that because you don't have insurance, you can't get medical care.  I was stunned to find out that I could have all of this medical work done and it wouldn't cost me a cent.  (I'm not sure yet, but I think that during the 45 days I'm on TennCare, I may also be able to get some lab work and and other treatments taken care of that I've needed but haven't been able to afford.) 

    I wish there were a simple guide I could point you to that would tell you where you might find programs to cover whatever treatments you need.  Unfortunately, every state and even every county and city are going to be different.  And there's no guarantee that everything will be covered.  But I've learned that there is much more available than I ever dreamed.  It can be worth doing some digging and asking some questions to find out.  Your local health department is a good place to start. 

    I'd appreciate your good thoughts and prayers as I go through what I hope will be the last leg of this little adventure.

Published On: April 28, 2010