By Keegan Hamilton
By Albert Samaha
By Village Voice staff
By Tessa Stuart
By Albert Samaha
By Steve Weinstein
By Devon Maloney
By Tessa Stuart
Bad news: More than 1.8 million New York City residents (nearly one in four) do not have health insurance, according to a 2003 United Hospital Fund report. And nearly one in three adult New Yorkers were unable to get necessary health care when they needed it last year, says the Department of Health. With the least expensive private insurance premiums edging toward $400 per month, the price of a standard doctor's office visit well above $100, and the proliferation of the full-time freelance job, many New Yorkers are taking a wait-and-see approach to sickness: Wait until you're at death's door and then see the bills skyrocket after a pricey visit to the emergency room.
The expense of modern medicine hits one group especially hard: those who earn too much to qualify for Medicaid (or whose off-the-books wages are unverifiable) but don't get insurance through their jobs. This squeezed economic stratum includes waiters, messengers, baristas, salespeople, artists, and freelancers, to name a few, most of whom rarely see a doctor.
But it doesn't have to be that way: Even without insurance, you have cheaper choices for a case of strep than a $300 emergency room visit. Many clinics will render services regardless of a patient's ability to pay, or will use an income-dependent sliding scale to determine an affordable fee. To qualify for sliding scale, you'll typically need to show proof of your income using W2s, paycheck stubs, or, if you have neither, a letter from your employer verifying your pay. If you're near the bottom of the scale, you'll probably get treated for a fraction of the full price. But beware of sticker shock: Sliding scales sometimes do not apply to prescriptions or lab tests, which could set you back hundreds of dollars. It's best to ask before submitting to a test or filling a prescription.
If you do have proof of income, you may qualify for state-supported insurance. An estimated 40 percent of the uninsured in New York State are eligible for reduced-cost coverage through programs like Healthy NY (ins.state.ny.us/healthny.htm, 866-HEALTHY-NY)monthly premiums run as low as $161, and the income threshold for a single person is about $22,000 per yearor free coverage through Family Health Plus or Medicaid. Checking out all your options could pay off.
The spectrum of services at RYAN-NENA COMMUNITY HEALTH CENTER (279 East 3rd Street , 212-477-8500, ryancenter.org) comprises general medicine, dental care, vision exams, counseling, and lab work, and they even have an allergist and a heart specialist on staffall priced on a sliding fee scale. They can also help you qualify for insurance. The William F. Ryan Community Health Center also maintains clinics on the Upper West Side (110 West 97th Street, 212-749-1820) and Chelsea (645 Tenth Avenue, 212-265-4500).
Focused on the issues of the gay community but welcoming patients of any sexuality, the MICHAEL CALLEN-AUDRE LORDE COMMUNITY HEALTH CENTER(356 West 18th Street, 212-271-7200, callen-lorde.org) offers dental, mental health, gynecology, and general medical services in a state-of-the-art Chelsea facility. Its community outreach programs include HIV-oriented adult support groups and special medical services for the 13- to 24-year-old set. Sliding scale. Call for appointment.
Every Saturday from 9 a.m. to noon, volunteer doctors and NYU med students offer consultations, physicals, lab services, radiology, and pharmaceuticals to the indigent and uninsured at the NEW YORK CITY FREE CLINIC(16 East 16th Street, third floor, 917-544-0735, 212-263-1001, endeavor.med.nyu.edu/freeclinic/index.html). Free. Call for appointment 4 to 6 p.m. on weekdays (Tuesday 6:30 to 8:30 p.m.), Saturday from 9 a.m. to noon.
Eastern medicine can help soothe arthritis, asthma, toothaches, depression, migraines, and more. At the PACIFIC COLLEGE OF ORIENTAL MEDICINE'S CLINIC (915 Broadway, third floor, 212-982-4600, pacificcollege.edu/clinic/newyork/serv_fees.html), acupuncture interns, supervised by licensed professionals, can rebalance your chi for the reasonable price of $30 per session and/or prescribe some curative Chinese herbs from the in-house pharmacy. Appointment or walk-in.
The NYC DEPARTMENT OF HEALTH & MENTAL HYGIENE currently operates four STD clinics in Manhattanthree of them uptown (2238 Fifth Avenue, 212-690-1760; 158 East 115th Street, 212-360-5962; and 160 West 100th Street, 212-865-7757) and one in Chelseathat provide anonymous, free HIV and STD testing, treatment, and counseling. The Chelsea clinic (303 Ninth Avenue, second floor, 212-239-1721, nyc.gov/html/doh/html/std/stdfree.html), in a nondescript brick building, offers the sort of institutional reception you might expect from a government agency, but anonymous and institutional care sometimes has its advantages. Call for information about the clinics' hours.
Forget the dentist; it's hard enough to see a doctor when you don't have any money. Even people who do have health insurance often don't have dental plans. But 90 bucks at the NYU COLLEGE OF DENTISTRY'S CLINIC(345 East 24th Street, 212-998-9800, nyu.edu/dental/patientinfo/clinic_info.html) can get you an initial checkup, a full series of X-rays, and an oral-cancer screening. Call for appointment. Reduced-cost services available.
Not all private physicians support the insurance-company-centric status quo. One such doctor, long celebrated on the Lower East Side as an ally to musicians, artists, and the uninsured, "DR. DAVE" ORES (15 Clinton Street, 646-435-0009, davidjoresmd.com) operates out of a storefront. Although his rates are posted in the examination room, he often concludes visits with working-class locals by asking them to pay as much as they can afford. Call for appointment.
Psychotherapy is notoriously expensive, with some shrinks charging hundreds of dollars an hour to unravel the mysteries of your ego, superego, and id. But psychoanalytic training institutes typically charge much less than that. Sessions at the THEODORE REIK CLINICAL CENTER FOR PSYCHOTHERAPY (150 West 13th Street, 212-924-7440) may cost you as little as $25, depending on your income. Sliding scale. Call to set up intake appointment.
A final word of advice: Do your homework while you're healthy. Make a plan. Nothing can exacerbate an illness like financial stress. The ER must treat you, no matter the cost. But there are many places that want to help you get better without making you feel worse in the wallet.