After being diagnosed with a medical condition that threatens her life, a Union City woman was forced to spend two critical months searching for a doctor willing to help her.
Peggy Albedhady, 47, learned she had a 6-millimeter brain aneurysm, an abnormal bulging of an artery in her brain, last November. She said that since then, she has been discharged too early from two prominent area hospitals and denied appointments with dozens of doctors.
The reason for so many rejections, she said, is her insurance: Medicaid.
“I don’t have a lot of money. Does that give me the right to die?” – Peggy Albedhady
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“I don’t have a lot of money,” she said last week. “Does that give me the right to die?”
Private doctors can choose not to participate in the Medicaid program. However, all New Jersey hospitals are required by state law to help anyone who seeks treatment in their emergency rooms.
Though Albedhady recently found a neurosurgeon to help her, she still goes to bed every night wondering if she is going to wake up the next morning, she said.
The diagnosis
Albedhady said the problems started in November. “I was very weak and sick for five days,” she said. “I thought it was the flu.”
When she collapsed on the way to the bathroom, her daughter told her it was time to go to the hospital. They went to Hoboken University Medical Center’s emergency room, but there was a very long wait, said Albedhady, so her daughter suggested they go somewhere else. They decided to go to a hospital with a great reputation, so they went to Hackensack University Medical Center.
Albedhady was admitted to the hospital. Tests revealed she had a brain aneurysm, as well as Hepatitis A and B. She was scheduled for further testing, but five days later, she said, she was abruptly discharged without the tests or an explanation.
“[They] discharged me like I can’t describe it,” said Albedhady. “Like you got tired of your animal, you got tired of your pet, and you just throw it out in the street.”
A hospital representative, Mary Blaney, released a statement saying: “Hackensack University Medical Center provides care to all patients regardless of [their] ability to pay.” She declined to comment any further on the case.
Albedhady added, “They told me nothing of the dangers of the brain aneurysm or the liver problems.”
Albedhady was told to follow up with two doctors who worked at the hospital but also have private offices, she said.
But when she called both, she was told that they do not accept Medicaid.
That was when her extensive search for help began.
The search
“They had me keep calling doctors, calling doctors, calling doctors,” said Albedhady. “I thought I was going to die.”
She called more than 50 doctors in the area, she said. Many did not accept Medicaid, and the ones that did accept it were backed up for months.
Albedhady said that one doctor was surprised she had not found help yet, and he even promised to make a few phone calls on her behalf. When Albedhady called back for a reference, the receptionist told her that the doctor was a very busy man and that she should find a neurosurgeon on her own.
A few days later, a woman answering the phone at a different doctor’s office told Albedhady, “Good luck” finding help.
In late December, Albedhady began experiencing severe headaches and sharp pain in her face and neck, she said, so she went for help at Englewood Hospital and Medical Center.
After a few hours, her attending physician determined that it was a sinus infection, she said. Tests also revealed her brain aneurysm, which she had already told the doctor about, but he told her that because it was a preexisting problem, he could not treat it.
She said the doctor also told her that if the aneurysm was bleeding at that moment, then that would be a different story.
“Again, I am being released to die,” said Albedhady.
When contacted last week, a representative from Englewood, Sandra Sgambati, said in an e-mail that the hospital “is committed to serving patients in need of medical care” and “is a participating provider with Medicaid, and therefore, is eligible to treat all such enrollees, subject to contractual relationships, as further described below.” She then described how Medicaid worked and noted that traditional Medicaid is state-run, but there is also a type that is only accepted countywide.
When told the details of Albedhady’s case, including the matter of the preexisting condition, she said she could not comment on the specific case.
The rules
All hospitals in New Jersey participate in Medicaid, according to Ann Clemency Kohler, the executive director of the National Association of State Medicaid Directors.
She added, “If there was a hospital that did not participate in Medicaid, they would still have to treat people who came into the emergency room.”
Many hospitals have closed in the last few years because of financial reasons, some of them partly due to the difficulty of getting reimbursement for underinsured and uninsured patients.
Kohler said last week that treatment should not be dependent on whether the condition is preexisting.
“Medicaid does not use preexisting conditions,” said Kohler. “It is irrelevant. [The patient] should be treated, and the hospital should bill Medicaid.”
Suzanne Esterman, a spokesperson for the New Jersey Department of Human Services, which regulates the state’s Medicaid program, said last week that it is not common for New Jersey Medicaid patients to be turned away from receiving treatment from private doctors because of their healthcare coverage.
However, according to a recent article published in The Wall Street Journal, studies have shown that a significant number of physicians are reluctant to participate in the Medicaid program because of low reimbursement rates and a slow payback process.
“Many doctors do not participate in Medicaid because of the rates,” said Kohler. But, she said, doctors are paid back quickly if the claim forms are filled out properly. She added that the Medicaid claim forms are similar to those for private insurance companies.
Caregiver to granddaughter
Albedhady said that Medicaid personnel did not give her any trouble. “It was the doctors’ offices that gave me a hard time, but they blamed the insurance,” she said.
Albedhady is a trained medical assistant and the primary caregiver to her 3-year-old granddaughter.
“All I want to be is whole again so I can take care of my family.” – Peggy Albedhady
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About a week ago, a doctor at the JFK Medical Center in Edison, N.J., in Middlesex County, agreed to help Albedhady. She had received his information from an office manager at a diagnostic center she had visited during her search. The manager knew that the doctor was helping another person in a similar situation and thought he might be willing to do the same for Albedhady.
“He explained everything that everybody [else] should have explained,” she said last week.
She added that she has been working on getting healthy enough to have brain surgery that could save her life.
“He was concerned about the liver because with a surgery like this, everything has to be okay,” she said.
This week, her doctor will help her decide whether she should have the surgery immediately or wait and keep a close watch on the size of the aneurysm.
What to do
Hudson County has a government-funded health center specifically for low-income residents like Albedhady: The North Hudson Community Action Corporation, with branches in Union City, West New York, and several other towns. While the center does not always have a specialist on staff, its personnel can make referrals.
When asked why she didn’t use NHCAC, Albedhady said she called them, but when the receptionist asked her what a brain aneurysm was, she got frustrated and hung up.
Albedhady said that people in Hudson County need more options for getting health care for serious illnesses. She added that Medicaid patients should demand treatment.
“By all means, do not sit back and wait to get help,” she said. “Unfortunately, you got to get out there and find help yourself, or you could just count on dying.”
From her struggle, said Albedhady, she hopes there will be increased awareness about the issues surrounding health care.
“Sometimes it takes one person to start hollering, to open the eyes of others,” she said. “Something has to change.”
A hundred thousand more New Jerseyans are on Medicaid now than a year ago, but a state spokesperson said it is not necessarily due to the economy.
“We always see an increase in numbers,” said Suzanne Esterman of the Department of Health and Human Services. “I am not able to say there has been a huge jump from month to month, but our enrollment is always growing, as more people find out about it, as more people realize they are eligible. There are a variety of reasons.”
Esterman said that last January, one million New Jerseyans were covered by Medicaid. This past January, she said, the program was covering 1.1 million individuals.
She said more and more people enroll after they learn about the state’s programs for low-income people and families.
“People who have lost their jobs often will lose their health coverage, too,” said Esterman. “Some of those people are coming to the safety net that the state provides to get health care coverage through Medicaid or New Jersey Family Care, which is a subset of Medicaid.”
Several states across the nation have made cuts to their Medicaid programs to ease their financial burdens during tough economic times, according to a recent article in The Wall Street Journal. However, Esterman said New Jersey has not made major cuts this year. – AS
Amanda Staab can be contacted at astaab@hudsonreporter.com.