Health Care for Broke People: Where to get Cheap Medical Care in New York City without Insurance

Vol. 1 Issue 36

If you are a non-citizen living in New York City chances are you don’t have very good health insurance, still, it is possible to find treatment whether you’re here lawfully or unlawfully. You do not have to writhe away in pain and sickness. It takes a lot of work to find these places but I’ve done most of that work already. Hopefully my legwork will connect at least a few people in need with the appropriate help.

#1- Proving your Broke- The most important thing to getting any form of decent care is to prove that you have no money and no income, so even if you are working for minimum wage part-time, like I was, they will consider you not broke (even if you are). Medical Case Managers will want to see a bank statement proving that you have no income. If you want to get treatment for a reasonable fee, this is essential.

If your main bank account shows your glorious monthly income of $400 they will declare you “not broke,” so the best way around this is to have a separate bank account with very little money, into which you never receive deposits from a job. Use this back account a few times a month for small purchases to maintain it. It must look like it is your active account otherwise there will be a barrage of questions and you will have explain how you live on an account that hasn’t been used in months. Once you have this nearly empty ($100-4000), legit-looking account almost any questions regarding how you pay you bills, rent, or buy food can be answered by saying you use credit, savings, or by borrowing money from others. Just to be clear, you should try to prove your broke if your actually broke. If it seems like a major chore to set up this bank account, well, that’s because it is, but once the account is setup all you have to do is maintain it. This way you will always have the proof you need to qualify as being broke. If you have money and are just looking for a deal, do not try to use this method. That would be fraud.

If you are in NYC unlawfully you cannot get a bank account thanks to the Patriot Act. This is an atrocity of a law that inconveniences many people. It creates the need to get false identities with fake IDs, and/or jobs that pay only cash which are usually exploitive. Obviously the plight of the unlawful citizen goes way beyond just being denied a bank account, but a bank account is very important to a leading a structured, secure life. If you cannot get a bank account then obviously none of my bank account info applies to you. I guess you would have to claim you don’t use banks, or be honest and tell the Case Manger your reasons for being in the US, and how you are surviving. All ERs in New York except undocumented individuals but I have no knowledge of how far up the medical ladder they are allowed to go.

If you have managed to unlawfully open an account through your own ingenuity this is illegaal (and bad mmmkay), but good for you. In theory you could always just open a second account at your same bank and maintain that as you “broke account”...In theory.

#2- Where To Go in an Emergency- If you get sick or injured any emergency room will take you and treat you. Some will give you a discount and reduce their fee to almost nothing. Public Hospitals- Any of the public hospital will take you, and if you prove that you’re broke they’ll reduce all visits to $10 after the fact. I’ve been to the ER at Bellevue and Harlem Hospitals and both of the ERs treated me and charged me $10 after. Going to an ER is the best way to get referred into a clinic at a public hospital if you have a condition that requires further care. Harlem hospital had the longest ER wait time, but had the most considerate doctors.

Private Hospitals- Because they are private and expensive you’d think they’d be better but I found both Columbia Presbyterian and Brooklyn Hospital’s ERs to be worse that the public ones. The waits were just as long (3-5 hours for a non-life threatening emergency) and the doctors were no better.  I waited 5 hours, saw a Dr. Breen and all she gave me was OTC pills; I waited 5 hours for Naproxen! After I proved that I was broke they dropped the fee to $10, but at the private hospitals they double bill- once for the doctor, once for the hospital. It’s literally twice the price, and only the hospital will lower their fee. So you either need to pay the doctor’s fee of $350 for a single ER, visit or ignore the bill.

#3- Non- Emergency Care- Hospital Clinics/Specialists- If you want to see any kind of specialist for a serious or ongoing condition you will likely need to get referred to them either through the ER, or through another outside medical clinic (most hospital clinics do not accept outside referrals. Make sure to check before you waste time getting one). Public hospitals have most specialists but the wait times to get appointments are long, like 3 months long.

I would not recommend going to Bellevue for any reason other than an extreme emergency. The waits are long, the staff rude, and the doctors unsympathetic and unhelpful. I wanted to get an MRI, which they do provide to broke people for $150, but before I could get it that I had to go ER and I was then referred to the General Clinic. The General Clinic then made me go through Physical Therapy. This Physical Therapy was a complete waste of time. My therapist was hot though.

After having struggled through the sliding-scale fee public health care system for a few years, I recently shelled out cash for a few appointments with a specialist at NYU, Dr. Wayne Stokes. He is a nice guy and the first doctor I’ve seen that suggested treatments to actually fix the problem. Too bad I had to take my medical records and all his good ideas and go find a more affordable doctor. This NYU practice was charging over 2K for some simple anesthetic injections. I will admit that this private clinic was far nicer than any other clinic I’ve been to, but they were not breaks in the fees whatsoever.  

Some of the private hospitals offer a reduced fee for visits to clinic specialists. Both New York Presbyterian and NYU do not, but Brooklyn does. I am I the process of dealing with Brooklyn Hospital’s Pain Clinic and Neurosurgery department and will have a better review to write after the appointments have taken place. Even thought theses are private hospitals the wait times to get appointments are still long, like 2 months long.

Financial Services-  (718) 250-8080.  

Primary Care Physician/General Practitioners- So if you are not in urgent need of care, and you don’t need any kind of specialist your in luck because there are many places that except non-insured patients for simple things like antibiotics, birth-control, etc. If you are in serious pain do not go to these clinics. They will NOT help with pain management. You will be turned away empty-handed and in pain. You will only have wasted 2-3 hours of your life.

New York Presbyterian has various outpatient clinics around New York. They except un-insured, broke people for $10 a visit. I’ve visited two locations, The Washington Heights Family Center at 181^st st and The Charles Rangel Health Center on 135^th st. -(212) 491-2300- Be prepared to spend at least two, if not three hours per visit. The clinics are tidy, but full of families and pandemonium. I was very unsatisfied with these clinics because I was trying to get help for pain and these doctors were totally unwilling to help. They will try to refer you to outside hospital clinics which are not part of your $10 deal.

The Institute for Family Health on 16^th st in Union Square - (212) 633-0800- offers a similar sliding fee scale and they offer a lot of services e.g. Medical, Mental Health, Acupuncture, and Osteopathic Manipulation. The price for broke people is $15 a visit.  There is a reason the price is so low.

The office is a mismanaged disaster. Certain appointments are hard to book (Osteopathic manipulation is only booked through one person and she does not have a voicemail). Referrals are never made, or in the rare cases that they are, the wait times for outside procedures are months long. The doctors themselves here have ranged from decent to very good in quality. Do not try to get pain meds here. It’s a lost cause.

The Ryan Center on W 97^th st - (212) 740-1820- offers many of the same services, but they also have cheap dental. I recently had a cleaning and a check-up, with X-rays, for $35. The dental waiting list is long so book well in advance. I have never used this facility for medical reasons but I imagine it would be much the same as the two facilities I described previously. One tip to having a smoother transaction here is to arrive very early on your first day and be the first in line. The registration process is excruciatingly slow as there are only two attendants to help long lines of people. Once you’ve registered you do not have to go through the process again for a year. On a bad day expect to wait 1-2 hours for a Case Worker to register you.

#4 Mental Health­- If you need broad information about mental health providers you can call 1800- LIFE NET. The Life Net operators are kind and compassionate but generally unhelpful if your looking for long term placement; however, if you are having a mental crisis and need immediate help, they would be the ones to call.

As far as long-term providers there tons of places around New York were you can have talk therapy twice a week with monthly psychiatric visits, all for cheap. The catch is that the therapists are usually grad students, not doctors, and it is a requirement that you attend their talk therapy. In other words, you cannot just see a psychiatrist.

New York Presbyterian Out-Patient Psychiatry- (212) 305-5977offers therapy and psychiatry for $10 a visit. The condition at this clinic is that you sign-up for a full year at a time with a grad student. These student therapists range in quality from poor to great, but the best thing about this clinic is they have a great psychiatrist, Dr. Garza. He is available to see patients of the clinic once a month for $10.

Both the Institute for Family Health and the Ryan Center have Mental Health services. At the Institute for Family Health it is possible to see only a psychiatrist and not be in therapy. After proving you’re broke each visit is $35.

In Brooklyn there is place call CABS -(718) 388-0390- that offers cheap care, but you must participate in the talk therapy/psychiatry combo. No psychiatry only.

#5 MRI- If you need an MRI it is possible to get them done for between $150-200 at the Ryan center, or through a referral to Bellevue. However once you’re at Bellevue you will have to jump though a ridiculous series hoops. This can take months and even then it’s serious gamble. I decided to pay an extra $325 and get the MRI done myself.  

I got an MRI done with Remake Health http://remakehealth2.3dcartstores.com, (877) 537-6253- for $525 all fees included. Since NYU offered me a cash only discount of $2200, the generous bastards, when I saw this deal I thought it was a scam. It seemed too good to be true, but it is true, and a great deal. It is a legitimate offer and the service is great. If you can spare the extra couple hundred bucks to get this done you will save months of waiting and headaches that you would otherwise surely suffer trying to get this done at a public facility.

Sick and Crazy

Vol. 1 Issue 35

MONDAY- Once again the blog is late. I am without structure in my life at the moment, and without structure, I slack off. I’m sitting in the park at Union Square. It’s like 28/82 degrees. A perfectly nice day, and for the first time in awhile I cannot think of anything to write.

I read Anna Karenina a few weeks ago but I feel like the last thing we need is another review of that. I read a Sylvia Plath novel that was, as expected, depressing. I’m reading Pynchon’s Mason & Dixon now. It got raves reviews when it came out, but I’m finding it less spectacular than I had expected, although I’m only 200 pages in. I’ve learned that you can’t judge a Pynchon novel this early. I read V last summer and it was way easier. I don’t even really remember exactly what it’s about. Malta maybe?

Why am I writing about such boring stuff? Because lately due to pain I’ve been doing nothing, at least nothing interesting.

Reading on its own isn’t exactly a blog-entry-worthy enterprise, unless I was reading very new and hip stuff and writing reviews about it, which I’m not. I thinking about turning this into a film blog as I’m much more hip to contemporary films than books. But I have a few more rants and stories to finish before that will happen.

For today, when I say that I’ve been doing nothing really what I mean is I’ve been spending hours and hours trying to find some place in this freaking country where a foreigner, without insurance, can get any kind of decent medical treatment.

TUESDAY- Doctor’s appointments and rejection have saturated my life. If anything positive is going to come out of this it’s this: I’m putting together a list of all the research I’ve done so that any non-US citizen living in New York without insurance, or just crappy insurance like mine, can find pain clinics or mental health services that are affordable.

WEDNESDAY- Found a place that does cheap dental work for students so I had my first cleaning and check-up in years today. No cavities.

Probably one of the most uninteresting pieces of writing I will ever do (next week),  but if it helps anyone find pain relief in New York City without insurance, it will be a success. I'm posting for the sake of posting again.

The First Rule (of Fight Club)

Vol. 1 Issue 34

Yeah so I missed a week, big deal. So what if statistics somewhere say that the keys to a successful blog are the consistency and predictability of the postings. I know nobody likes to visit sites that are not consistently updated because I am one of these people, but still, I scoff at these statistics. I believe that my blog is so great that dozens of people will continue reading it every month based simply on its content alone! Yeah, that’s right, I said it- dozens! Haha.

Okay, I take it take back. Please don’t leave me. Consistency is all I’ve got and I know it. I do have a decent excuse for missing last week though other than pure laziness or writer’s block- it’s pain. And no, I don’t mean any kind of lofty, abstract pain like the pain of existence, the pain of not-succeeding, the pain of being broke, or the OMG pain of artistic angst, but regular physical pain. Still though, aren’t all these pains still only communicated the same way, through behavior and language?

I’ve been thinking a lot lately about the truth of pain. In Philosophical Investigations I Wittgenstein says, “When I say ‘I am in pain’ I am at any rate justified before myself. - What does this mean?” I think it means that the way that we measure pain, that is just by saying how we feel about it, how much it hurts and crying, is all load of BS. Sure we’re justified to ourselves, but everyone else has to imagine what we feel. We have to display the appropriate behavior to express this feeling that is called pain, particularly when we want relief from the pain in any kind of decent pharmaceutical form. There is no proof of pain as there would be if we were say bleeding, or had a fever. You cannot fake bleeding, ketchup packet and internal bleeding arguments aside please.

Wittgenstein talks about this pain behavior: “I can only believe that someone else is pain, but I know if I am.” So does the notion of pain mean me the same thing to all people? It seems like the notion is too rooted in a linguistic expression. Huh? What am I talking about?

Well, I’ve learned that the only way to convey pain is through pain behavior and this does not work well. As I read through Wittgenstein I have concluded that humans, and humans alone, are able to put forth false pain behavior, as in, humans can act like they are in pain when they are not, thus displaying false pain behavior. This has screwed things up. People have faked pain too many times and now the pain behavior itself is seen as an untruth standing for not-being-in-pain.

It is pretty much universally accepted that animals feel pain right? Does anyone really dispute this? Yet we have no way to categorically know that a dog is in pain but can only tell by its behavior i.e., whining, droopy face, etc. Rover however cannot fake that he is in pain. Rover’s pain behavior is equivalent to his pain.

I go on about this because I’ve learned that purveying your sense of physical pain without any kind of physical proof is an art at which I suck. Pain is supposed to be the body’s reaction to something out-of-order, something amiss, something wrong. At least that’s what I remember from high school health class. So what if nothing is wrong yet we still feel pain? What if it is all psychosomatic? Does that make the pain less real?

Sadly, yes. It does. Whether it’s our innate nature to shrug off anything that lacks empirical evidence, or because too many humans have abused pain behaviors to get drugs, nobody, and by nobody I mean NYC doctors, seems to believe cries of pain without proof.

Examples:

Working Scenario 1. W/Reason For Pain-

Patient: My leg hurts.

Doctor: Why?

P: It’s broken.

D: Here is a cast and some painkillers.

Non-Working Scenario 2. W/O Reason For Pain (dramatization based on actual events)-

P: My leg hurts.

D: Why?

P: I don’t know but I’ve had every possible test imaginable and been through every kind of treatment and it still hurts, a lot. I can’t eat or sleep. I’ve even had to quit my job. Can you give me something for the pain?

D: (In a whisper) Get the hell out of my office you bastard, before I call security.

So how can I get my point across without a bone sticking out of my leg as proof? I know I need to become a better actor and a better liar. At first I thought I could take some acting lessons, but since I’m broke and can’t get out bed I’ve had to come up with a different idea.

Wittgenstein asks, “Could someone understand the word “pain” who had never felt pain?” I would answer this with a ‘no’ and proceed as such. I’d go down to my local hardware store and buy a hammer, or if that particular store stocked them, a baseball bat. When the doctor asked where, and how bad my pain was, I wouldn’t have to rely on pain behaviors like my sad face or crappy negative adjectives. Thanks to my local hardware store, I’d be able to demonstrate to the doctor, on their own bodies, exactly where the pain is and what exactly it feels like.

So now to answer the most important question of all, the one that I know we’ve all been thinking since the my opening sentence: Since this problem has compounded itself to the point where I am pretty much confined to my bed like an invalid, what have I learned?

Two things- One: all that stuff I just talked about leading to the conclusion that doctors suck and have a complete lack of empathy for people in pain that don’t have cancer or a broken bone. Two: a ton about internet protocol, IP addresses, VPNs, encryption, online anonymity, and how much bigger the internet is than I thought. Okay, so I maybe I learned more than two things.

Also learned that if you don’t want to writhe away in pain it is up to you, and only you, to take the management of your pain into your own hands. How to do this is tricky, but possible. The first rule of fight club pretty much stops me from discussing this any further, but if you ever get stuck in bed and have nothing but your wits and an internet connection to solve your pain, and these just aren’t cutting it, perhaps then I can bend this first rule a little. The club has to get new members somehow.