The nurse navigator helps patients get the care they need

SAN ANTONIO — Maria Lee, an independent insurance broker and Medicare advisor, is used to saving her clients money on monthly premiums, but one day at the office she saved a woman’s leg.

She remembers seeing a new client in the small office building she rents on the south side of San Antonio.

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The woman told him she was struggling to pay her $45 twice-weekly copayment for a slow-healing cut, a situation that had worsened with her husband’s stage 4 cancer diagnosis. Their combined monthly income was less than $2,000.

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Then the woman lifted her trouser leg to reveal an oozing wound. Lee, 47, who was a family practice nurse before becoming a healthcare navigator, knew the woman was at risk of losing the limb.

“I literally wanted to walk her across the street to the clinic,” Lee said, referring to the San Antonio Vascular and Endovascular Clinic, “because if it gets into her bloodstream, it can become an amputation”.

About this story

Laura Garcia reported on health disparities for the Express-News as the USC Annenberg Center for Health Journalism’s 2021 National Fellow and recipient of its Dennis A. Hunt Fund for Health Journalism. Learn more at

Lee called the clinic, known as SAVE, to see if vascular surgeon Dr. Lyssa Ochoa could see her client immediately. Luckily for the woman, Lee already had a partnership with Ochoa — the CEO and founder of the SAVE clinic and one of the few vascular medicine specialists on the medically underserved south side of town.

As Lee worked to transition the woman to a more affordable health plan, the SAVE clinic was able to save her leg.

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Lee and Ochoa are part of an informal network of healthcare navigators in San Antonio who speak Spanish and understand the cultural complexities and socioeconomic barriers that prevent many residents from getting the care they need.

The idea, they say, is to prevent patients from falling through the cracks of the country’s profit-driven healthcare system – cracks that may be wider and more dangerous for many people on the south side. , especially Latinos.

An opaque system

Over the past few years, Lee has become adept at finding ways to help people.

Mastering the nuances of the healthcare system is not easy, even for those working in industry. Agreements between private insurers, pharmaceutical companies and medical providers are constantly changing.

Each health coverage option that Lee talks to her clients about has its own eligibility requirements and limitations, so she starts by getting to know them.

If her clients are 65 or older or have a disability, she helps them apply for health insurance and makes sure their doctors and nearby medical facilities are networked.

For younger clients who don’t have access to employer-sponsored plans, she checks to see if they qualify for a subsidized health plan through the Affordable Care Act. If they are approved for a plan on, she helps them find an independent doctor who accepts ACA insurance.

But when those plans aren’t an option, she finds out if they’re eligible for local safety net programs through CommuniCare or CentroMed, a federally-licensed health center that offers medical, dental, midwifery, and health care. affordable behaviors.

Lee also directs South Side residents to nearby Wesley Health and Wellness Center or Dixon Health and Wellness Center, operated by the nonprofit Methodist Healthcare Ministries of South Texas Inc.

But if they live in Bexar County and may need hospitalization, she directs them to CareLink, a financial assistance program that allows people to access college health through the Bexar County Hospital District. funded by the state. This program requires proof of residency and household income.

After Lee left medical school, she trained as a Certified Candidacy Counselor with CentroMed during the initial Obamacare enrollment period and eventually earned a master’s degree in healthcare administration.

She later became a licensed insurance broker to help people weigh their options and learn how to navigate the health care system.

Lee kept clients waiting weeks for reminders and months for medical appointments, and some told him they were considering cashing in their 401(k) plans earlier to stay afloat.

She saw people taken advantage of by predators: those selling so-called “skinny” insurance plans that don’t cover regular medical care or brokers selling expensive plans bundled with life insurance, dental coverage and sight coverage.

Because she’s independent, she doesn’t have to direct clients to certain plans, and she doesn’t charge for her sessions.

She said some customers bring their teens to help them understand the details of their health coverage, such as co-pays, deductibles and in-network hospitals. She tells them about discounts and ways to save on prescriptions.

Sometimes she learns that teenagers want to go to college, so she helps them apply for financial aid.

Her regular customers often show their gratitude during the holidays, she said, with baked goods, freshly picked chilies and homemade tamales.

“Bad for your insides”

For many people, especially those living on the South Side, access to health care can be financially crippling, said Dr. Carlos Roberto Jaén, chair of the Department of Family and Community Medicine at the Long School of Medicine in the city. UT Health San Antonio.

Depending on the rates that insurers negotiate with medical providers, consumers can easily get into debt. The process isn’t transparent: The cost of a routine blood test in San Antonio ranges from $57 to $443, according to a Health Care Cost Institute report using 2017 data.

Jaén, a family physician, treats some of the city’s poorest and sickest patients at the state-funded Family Health Center, located downtown on University Health’s Robert B. Green campus.

A study by Jaén and four other researchers found that providing free transport to medical appointments for economically disadvantaged patients led to fewer no-shows and cancellations, saving the county health center more than $15,000 per month.

Offering rides also helped patients avoid unnecessary emergency room visits or hospital stays, which the study found can cost 141 times more than a non-emergency medical appointment.

Yet health disparities cannot be solved simply by paying for Uber rides or building more clinics.

Research shows that persistent difficulties can have a deleterious effect on mental and physical health, eventually increasing the risk of developing chronic diseases such as type 2 diabetes and heart disease.

“We know that constant stress is bad on the inside,” he said. “It raises all the stress hormones that raise your blood pressure, raise your blood sugar, and tend to make your body more apple-shaped due to the way your body deposits fat. These things over the course of a lives have an impact.

“Just completely unaffordable”

When Lee was a nurse, she would often see the same diabetic patients come into the clinic and not seem to get better. She asked them if they took their medications and learned that many never went to the pharmacy to get their prescriptions filled. It was too expensive.

“They came back to us in two or three weeks in exactly the same way, if not worse, because we forget that apart from this visit which could have cost them a share of $25 or $40, they do not have access to the rest,” she says. “What normally should have been healed in a month sometimes took three months.”

Lee saw such heartbreaking scenarios every day at work, but she didn’t fully understand them until her mother was diagnosed with type 2 diabetes at age 40.

Lee’s mother, Maria Jimenez, worked 12-hour days at a restaurant, while her father worked building swimming pools. He often worked at night in the same restaurant. Neither had health insurance through their employer. This was before the Affordable Care Act, which provides subsidies to offset monthly insurance premiums.

Her mother was prescribed an oral medication called Actos to control her blood sugar. Without intervention, she was at risk of serious complications, including stroke and loss of vision.

She remembers driving to her mother’s house and shaving off pieces of an aloe vera plant, applying them to a wound on her mother’s leg and praying for it to heal. They were bandaging him because his mother had to go to work, and there was always the fear that she would catch an infection and lose the limb.

For a time, Lee was able to get the brand name drug through pharmacy assistance programs or get samples by calling people she knew, but when those resources ran out, the family had to pay up to $250. $ per month.

“It was just unaffordable,” Lee said.

Lee had just had his first child and his parents were sending money to their parents in Mexico. So, with the pills financially out of reach and Lee’s mother needing to lower his blood sugar, a doctor prescribed him insulin.

Lee’s eyes filled with tears as she spoke about her mother’s fear of injecting insulin.

“I had to help her inject at night and show her over and over again,” Lee said. “At least I had a car and I was clinically trained, but I was like, ‘Mom, you have to take this. I know you don’t want to.’

Lee’s mother repeatedly asked why she couldn’t continue taking the pills.

“I would say, ‘Mom, we can’t afford the pills.’ …So insulin became a normal way of life for her. Poking her fingers two, three times a day has become a normal way of life for her,” she said. “There was no other option.”

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