No time to waste: UChicago nurses seek solutions for the uninsured

February 17, 2023


Matthew McGehee

Health care workers fight for solutions to provide care for uninsured people.  

UChicago Medicine nurse Sonia Jama recalls a time when she had a patient with a deadly brain tumor in need of immediate treatment. She directed the patient to a navigation service to seek a solution. However, the care process was delayed due to limitations with his insurance. This is not a unique experience for Ms. Jama. 

A 2022 study concluded that 8% of Americans are uninsured. Consequently, certain health care services are restricted for some. The approval process for such services can take a while, and someone with a deadly, aggressive condition simply cannot wait for care.

Health care workers work with limited care solutions for uninsured people, regardless of the severity of their condition, balancing morals and obligations with hospital policy.

Ms. Jama and Vanessa Contreras, both neuro-oncology nurse navigators at UChicago Medicine, frequently encounter uninsured patients. Ms. Contreras checks to see if the health care provider is appropriate for the uninsured patient, and Ms. Jamas manages the treatment if approved. 

 Ms. Jamas said though UChicago Medicine accepts charity cases for uninsured patients, the process that follows is long and often delays care.

“The time it takes to approve some of these charity cases is probably one of the biggest obstacles we face,” she said. “We have to jump through many hoops for the uninsured, and I can’t tell you how much time we spend just getting the authorizations for imaging or treatments.”

Ms. Contreras helps ensure the patients get the treatment they need promptly. One of the more common solutions is an out-of-network exception form, also referred to as a “grant,” which allows the uninsured patient six months of coverage. Such forms are only short-term solutions to a more significant problem.

“After that six months are up, we have to file another form. And then we have to keep doing that over and over,” Ms. Conteras said. “But the stipulation is that you’re still actively searching for a physician when the grant is approved. So it’s really like a Band-Aid on a wound.”

Communication with patients is another obstacle Ms. Contreras faces in her work. She said some uninsured patients don’t always follow up and, consequently, cannot come back to receive help.

“We can push them, we can do whatever we can for them, but ultimately it’s up to the patient to follow through,” she said. 

Some outcomes of situations involving uninsured patients can depend upon their medical provider. 

“Some providers are very generous,” Ms. Jama said, “others not. Some providers have offered to waive the fee to see a patient, which is very generous.” 

Even generous providers have limitations to the services they can provide by hospital policy. 

“The generous provider could, for example, order an MRI for an uninsured patient. But then we’re like, ‘Well, wait a minute, the patient hasn’t been seen in two years. What’s the liability?’ Because the doctor’s gonna order this scan, so then he’s responsible. A lot of times, we have to talk with risk management to make sure that it’s OK. There is a limit, and we have to follow policy.”

Ms. Jama and Ms. Contreras said they feel a moral obligation to help uninsured patients and do their best to work around the limitations. 

Similarly, Margaret Clifford, a personal care assistant at Christ Advocate Medical Center, said she feels a strong moral obligation to help all kinds of patients.

“As a health care worker, how can you not help someone? It doesn’t matter their circumstances,” she said, “they need help. It’s our responsibility.”

Ms. Jama said she thinks most of the struggle reflects the American health care system, not UChicago Medicine. She is appreciative of the resources available at the university.  

Ms. Jama said, “I’m very fortunate to work at a facility that cares about the community.”

For around 60% of patients, especially those with time-restricting conditions, Ms. Contreras fills out an out-of-network function form where the patient will be sent elsewhere using a navigation service.

Equal Hope, a navigation service, primarily started as an organization to improve health care for women with breast cancer. The service connects individuals at a community level, and helps them find their way into the health care system. A lot of times, health care facilities refer uninsured patients to Equal Hope. 

Co-Executive Director Paris Thomas said, “There’s a lot of hospitals, primary care doctors, who refer patients to us if they can’t help them, or if they’re uninsured, because we will find and figure out how we can help them.”

Equal Hope has reached over 300,000 individuals and navigated close to 8,000 individuals into some preventative health care service. 

Ms. Thomas said the biggest problem with America’s health care system is the many health inequities and disparities “plaguing” marginalized communities.

“I think in health care, there’s a lot we can say that is amazing,” she said. “We save lives, we do amazing work. But at the same time, when technology advances in health care, there’s a group of people who are always left behind and those who happen to be underrepresented populations, which creates health inequities.”   

Health care workers like Ms. Jama and Ms. Contreras, organizations like Equal Hope, and generous providers fight the inequities of the American health care system daily to provide care for the uninsured and marginalized populations.

“A hospital is a business. They are run like a business and I get it,” Ms. Jamas said, “but we must remember, even when it is hard, that we’re also in the business of helping people.”

Q&A: Education in health care

Chicagoland Health Care Workforce Collaborative: April Harrington, Project Manager

What does the CHWC do and what is the organization’s mission?

 “The mission is to create a more inclusive health care workforce through three strategic pillars. One is to target local and targeted populations. We want to provide career pathways to underemployed and unemployed populations. Our second pillar is to create a stronger partnership with our training providers, so more of a dialogue between employers and our community college system or high school system so that we are all thinking creatively about changing the pipeline and the models that we have used for years and decades to train people in this pipeline. The third is focused on retention and career pathways, so we want to make sure that we’re not just bringing people into entry level frontline positions in the health care system, but that we’re providing opportunities to advance and for people to move up a career ladder, so that they can go from, an hourly job, or just a salary, to a family sustaining wage.”


What does inclusivity in the health care workforce look like?

“A lot of employers, whether they’re in health care or not ask the question, ‘How are we hiring people of color?,’ ‘How are we hiring people from these specific groups who have been marginalized, for example, people with justice involvement with disabilities?’ And that’s good, and that’s great, but not as many people are advancing into leadership roles, that are advancing into roles that offer quality wages that allow them to sustain families and so that they can take that back to their communities and their children. So I would say that true inclusivity would mean that the leadership rates also resemble the diversity of the city.”


What does a solution look like?

“I think that our education system really needs to look at itself as well and think about how they are contributing to the labor shortage in health care. There are these sort of these unnecessary barriers to enrollment, licensure to certification. Employers need to embrace more alternative models. Nursing assistants and medical assistants, for example, deserve far more than what they’re currently paid. Part of the problem with what they’re paid leads to the way that we pay for health care in general in this country.”

There needs to be a change in mindset from societal and global, of the real value of frontline health care work that not only translates to monetary rewards, but as we serve the people in these positions, as well as it’s not just about money, it’s about respect. It’s about being seen, the difficult thing we’re doing, and having people appreciate that.”

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