The Partial Observer by Kristian Connolly
Healthcare and COVID, in First-person Rural
COOPERSTOWN—Growing up in the Village of Cooperstown, my first pediatrician was a classmate’s dad. My second pediatrician was the mother of another classmate. When I aged out of pediatrics and needed a primary care physician while in college in Binghamton, I turned to yet another Cooperstown classmate and friend’s parent as my trusted healthcare provider.
As a young athlete, while none of the school or club teams would ever claim to have had team physicians on staff, I knew that an injury to me or one of my teammates during a game was likely to be initially addressed on the scene by a spectator who also happened to be a skilled practitioner and a member of my community.
From the age of 9 up until the age of 22 or so, whenever I needed to see my doctor, or any other doctor, I literally walked the 250 yards from my house to MIBH (pronounced mib-uh), as I will always know it, to see someone I actually knew independently of when they were in their white coat.
I was young, mostly ignorant, and on my parents’ health plan. So I probably didn’t know the half of it. But my experience then formed my impression of what a rural community healthcare experience should look like. And that’s the rural community healthcare experience I’d still hoped to find when my family decided to relocate here earlier this summer. I feel reasonably confident in making the statement that Mary Imogene Bassett was aiming for the institution named in her honor to be that kind of rural community healthcare provider for the Cooperstown community.
It’s certainly the kind of provider I was hearing about on my second official day on the job at this paper, which found me outside of Bassett Medical Center in Cooperstown, listening to both United States Senator Charles E. Schumer and Bassett Healthcare President and CEO Staci Thompson talk about the importance of rural healthcare providers to their communities, and the exemplary service Bassett provides to its community. Generally, to be sure, but especially with relation to COVID. It was millions of dollars in COVID reimbursement funding from the federal government that had everyone gathered that day in the first place.
But this past week, while my family and I dealt with COVID in our household, I came to understand something very different, and personally distressing, as our somewhat unique, or at least not-everyday, situation helped me learn how local and statewide healthcare entities actually exist and interact in providing access to care for citizens in need of healthcare or healthcare-related services.
First, a very brief note about COVID: I live with a great respect for COVID, and a belief that we, as humans, understand so little about COVID that to pretend otherwise is dangerous and ill-advised. In addition to trying to still manage my spatial relationship with individuals and crowds, I carry a mask on me at all times, and wear it often. I wear my mask to help protect me, and I wear my mask to help protect you. I also wear my mask in solidarity with those people who need everyone to take simple steps like this if they have any chance of feeling safe, and cared for, in a COVID world.
And a COVID world is what we all live in now, and we all should be looking to help each other survive in it. And even as my household does those things that few others do, we all still got COVID. Or is it because so few others do the basic things to protect each other that we got COVID, in spite of our own individual efforts?
Does anyone care?
Either way, we moved here without an income, and to ensure we had continuing health coverage, we enrolled in New York State Medicaid. Even now, with an hourly job at the paper, we’ll come off Medicaid sometime in the near future and still qualify for no-cost healthcare due to our income bracket. Through Medicaid, we have a health plan through Excellus Blue Cross/Blue Shield. Our coverage started August 1, and sometime in July we received our plan ID cards.
Except these were just placeholders. We had 30 days to select a primary care provider, otherwise Excellus would choose one for us. A good deal less than 30 days later, we received new cards with our PCPs chosen for us. Last name, first initial only. Each of us had a different PCP, but all with a “607-547” phone number, indicating that these were all PCPs located at Bassett Medical Center in Cooperstown.
Life is busy. We’d only recently unpacked our last boxes, our health plan had just selected our PCPs for us, and we had no acute need to connect with our PCP. And then we all got COVID.
My wife hadn’t been feeling great for a day or two, and on a Friday night, she was ill. On Saturday morning, we went for the supply of free-from-the-government tests we keep at home, and every single one was recently expired and not had their dates renewed. Unusable. And we feel pretty strongly that testing to find out if you have COVID is the right thing to do, and so is testing on the other side to make sure you’re no longer positive before re-engaging in the world. And we had no tests, and one of us was feeling pretty ill.
So off my daughter and I went, first to Church & Scott. There were no tests available, and when I asked the unmasked pharmacists there about whether New York State Medicaid participants were eligible for no-cost test kits (either through direct coverage at purchase or reimbursement), no one knew the answer. They told us CVS might have some tests, and wished us good luck.
Next was CVS. In front of me in line at the pharmacy was a gentleman who told the pharmacist he was from out of town, and was looking for COVID tests because his wife had COVID. This gentleman was not masked, nor were the CVS pharmacists. The pharmacists directed the gentleman to the front registers of the store, since COVID tests are kept behind the register—like cigarettes and adult magazines. Because when they were kept on the store shelves, “they tended to walk away with people.” Why COVID tests were not kept with the pharmacists themselves was not explained.
Having had the first part of my question answered via being an interested bystander, I then asked the CVS pharmacists about NYS Medicaid and no-cost COVID tests. They also did not know about such a program, except I was advised that there was a NYS Health Department website through which I could order multiple test kits for free. They wished me good luck. I didn’t even need to go and look for that site to know it does not exist. (I did look later just to confirm. No such thing.)
At the front counter at CVS, I stepped to the register, tried to survey my options from a distance, and asked the cashier which of the COVID tests were eligible for Health Savings Account or Flexible Spending Account purchases. The cashier did not have that information.
So I rolled the dice on a couple of two-packs, and swiped my HSA card. Luckily, my receipt indicated that my purchase was FSA/HSA eligible. So instead of having to use our money for the tests, we’re using our…other money. Hmmmm.
Back at home, my wife tested positive. I envisioned this quickly getting very expensive for our house, so still on the hunt for no-cost testing options as, and without the ability to reach anyone at New York State Medicaid or Excellus BCBS because they apparently think both illness and related healthcare questions take nights and weekends off, I found my way to a CDC website which indicated that Walgreens has a pretty good stranglehold on no-cost testing locations.
The closest Walgreens is in Oneonta. Following the website link to Walgreens, I soon was directed to a site that said I could request 2, 4, 6 or 8 at-home tests, enter my insurance info, and Walgreens would “submit a claim to the patient’s insurance to determine if the cost is covered” before the final cost would be determined at pickup—if you still wished to purchase out of pocket, if that were necessary.
This seemed like a solution. So I filled a cart with eight tests. But then I thought it would be a good idea to call down to Walgreens in Oneonta to be sure this was how it worked. When asked, the pharmacist who took the call said, “Yeah, we don’t do that anymore.” When the pharmacist was told the Walgreens website said otherwise, she elaborated, with empathy, “That’s a national website, we don’t control that. We haven’t been doing that process since last year sometime.”
“Do you know if New York State Medicaid covers COVID tests?”
“No, I don’t. Sorry. Good luck.”
Back to square one (or is it negative one by now?).
Not to be deterred, I found a similar promise for potential no-cost at-home tests via the CVS website. After making it through one gate-keeping step, the site asked: “Are you a Medicare or Medicaid member”?
“Yes!”
“The online claim request option is currently not available for Medicare and Medicaid members. Visit your local CVS pharmacy to get your at-home COVID-19 tests. State Medicaid restrictions may apply.”
Uh-huh. You could’ve at least wished me good luck.
After lunch that day, with my wife laid out in bed, my daughter and I tested at the same time. My daughter, who had not been feeling ill at all, tested positive. I, who had been feeling a little off and was sure that once my wife was positive that I would be, too, tested negative.
By mid-day the next day, my daughter was also knocked sideways in her bed. Anticipating a long few days ahead of me as a caregiver, and unable to reach NYS Medicaid and Excellus on the weekend, I worked for most of the day Sunday. That night, while sleeping on my makeshift bed on the living room floor, the fever and chills first welcomed me to the party.
Monday morning, I woke knowing it was my time to suffer. I took a test, and it was positive. But I was still in need of answers (and also, I had a few items to file to meet a deadline for that week’s paper). First I spoke with an Excellus agent who told me our plan didn’t cover pharmacy, because as a Medicaid plan participant, NYS handled the pharmacy part. And COVID testing was considered pharmacy—no matter where CVS chooses to keep the tests.
Reaching a Medicaid plan representative at the NYS Department of Health, I asked her my questions about no-cost testing options for those with Medicaid. She said she didn’t know, but would do some looking around for me right there on the spot. Am I the first person in NYS history to have asked this question? A few minutes later, she reported that it looked like such an option might be possible, but the way it worked is that your PCP had to call in the request to a pharmacy before the tests would be provided to the patient. Each patient could obtain two tests per week, or eight per month, this way.
“So the only way to get no-cost over-the-counter COVID tests with Medicaid is first to have a note from my doctor?”
“Yes, unfortunately. Good luck.”
“You don’t know the half of it, but thanks.”
As a reminder, at this point there is no person in my household who is not dealing with a host of unpleasant symptoms from COVID.
After sending off a few items for the week’s paper, it was time to call my Excellus-selected PCP at Bassett Healthcare. I dialed the number. The voice on the other end was very patient as I explained why it was that I called this number.
Then she said: “Well, that doctor is an internist. You’ve called an internal medicine number, and so she is definitely not a PCP. You know, [when the health plans select a PCP] they just pick any old name out of a hat.”
“Of course they do. Can I have you check the doctor on my wife’s card since we’re talking?”
“Sure.”
Name provided.
“Yeah, I don’t think that doctor even works here anymore. But I can give you the number of the Prime Care Clinic.”
“That’d be great, thanks.”
“You’re welcome. Good luck.”
Reaching the Prime Care Clinic at Bassett Medical Center, I spoke with another very kind and reassuring voice who, after I told her my ever-growing story, gently told me that the clinic here in Cooperstown—the only part of the Bassett system that I know—was not taking new patients. If I needed to choose and see a PCP, I could try Cobleskill. Or maybe a couple of different places in Oneonta. I did not move back here with my family for this to be the case.
Still focused on the task at hand, I asked: “Is it your understanding that in order for me to have my PCP make a request to a pharmacy for something like OTC COVID tests that I need to have first seen my PCP in person as a patient?”
“Well, yes, that would be necessary.”
“We all have COVID right now. I don’t even want to see a PCP about my illness, I’m just looking to use my Medicaid benefits for no-cost at-home testing.”
“Yes, I understand. Good luck.”
After passing me the number of the two places in Oneonta, I tried one, pretty much just for the fun of it.
No answer. No one to wish me good luck.
The day I filed this story with my editor, I read that the federal government will again mail a round of free tests. But not until the fall, more than a month from now, and only four tests per household. So for our small household, that wouldn’t be enough to test in and out of positive for each person, if we only needed one test for each step. What about a household of five or more? There are FDA recommendations that say one person should take three tests over a four-day span in certain cases where COVID exposure is known.
At this moment, we do not have a PCP, in spite of our health plan saying we do. Our choice right now is to blindly select a PCP who is, at best, 30-45 minutes away by car, instead of within four miles of our home. We qualify for a host of no- or low-cost healthcare related services and items as Medicaid plan participants. But for us to take care of ourselves and try to provide a basic protection to others in our community by making sure we know that what we’ve got is COVID, and then that we no longer have it, I’ve got to work more than half a day just to pay for those tests—if they’re even in stock when we need them. As of this writing, we’ve been testing positive over a span of 8-10 days, and have totaled six tests used so far, at about $9.00 each, knowing that at least three more are necessary.
This is exemplary healthcare, and how we should be caring for people in an ongoing, always-evolving 54-month public health crisis?
Meanwhile, amid the COVID-induced malaise this past week, Excellus was peppering us with robocalls, in which we were told how our PCPs, as our “main source for healthcare,” were always available to us, night and day. And that Excellus was there for us, too. Well, Monday through Friday, from 8 a.m. to 6 p.m., anyway.
Good luck, indeed.
Kristian Connolly is a resident of Fly Creek and staff writer for Iron String Press Inc.