The Logistical Challenges of Getting Care
Valdosta serves as case-study into the logistical hurdles rural patients face. Lacking nearby hospitals or affordable transportation, the infrastructure just isn’t there to support patients in getting to specialists. Dr. Loeffler describes how she used to have more options for patient referrals, but in the past few years has found it more difficult due to limited availability of specialists.
One of the greatest impediments to getting kids to the pediatrician, of course, is insurance coverage. “If you lose your Medicaid status at any point in time, it could take 3 months to get it back,” says Loeffler. “So guess what else stops? Your medicine and your care.”
“Insurance companies and Medicaid consume the majority of a provider’s day. Payment is less than desirable. We are required to do more for kids in each visit, but we are not being reimbursed.” She offers the example of one payor that offers some Medicaid coverage in Georgia. “This insurance company, for whatever reason, has no contract with our hospital right now,” says Loeffler. “So, say your child needs a simple x-ray. It can take up to 6 months to get approved. Or I can send you 20-40 miles, where I don’t have privileges, and get it done the same day. But then, of course, that family has to drive these distances.” This payor, incidentally, is a subsidiary of the private insurance giant, Anthem.
While Dr. Loeffler tries to provide as many services as possible in her office, her patients who need surgeries or other specialized care must be referred to hospitals hours away. “Getting a ride to our main referral area is often difficult. It’s about five hours away, and then if you’re turned away when you get there, it doesn’t seem worth it to families to go back.” The process can be long and arduous, and families often worry that, even if they make it to the appointment, they won’t get the care they need on the same day. Dr. Loeffler also explains that, “Medicaid’s public transportation system is less than desirable. They won’t take anybody less than the parent and the patient. They often don’t have car seats or availability for wheelchairs, yet they say there are no problems with the system.” The necessity of driving, in a rural area with little to no public transportation, is daunting to many families.
“There’s no rhyme or reason to how Medicaid is divvying up patients,” Dr. Loeffler says. “Patients that I’ve been seeing for years all of a sudden get assigned another provider. What happened? They don’t live in my ‘service area’ anymore. The rules have changed constantly and there is no consistent formulary.” This constant fluctuation takes its toll on families, who will often forego seeing a provider to avoid the painful and often thankless work of securing coverage.