a day in the life of assistance


It’s hard to explain a new field of work to the public: you get a lot of “what is that?” “what do you do?” “is that even a job?”Assisters are a brand new position for most institutions like mine. To add to the confusion, they can be called several things: in person counselors, certified application counselors, navigators. All of these are just super fancy names for the role of guiding the community through the terrain of the Affordable Care Act.

The job is not your typical 9-5: weekend and nights are tacitly mandatory. Unless your organizations have a lot of man power and money–PrimeCare is not in this boat– the job is not just strictly enrollment and education. Assisters are master jugglers, balancing phone calls to answer questions, appointment setting, case follow-up, one on one and family appointments, administrative paper work. If you’re my team, add the difficulty of doing this in 3 languages- English, Spanish, Polish– while having a solidly booked schedule from the moment you walk in, to the moment you leave. It’s more than a day’s work always but definitely all in a day’s work. Tuesday seems like a good day as any to show you our typical full day and the volume and richness of cases we see daily.

7:30am– walk in, immediately notice 16 missed calls on my line from when I left at 545 yesterday to this morning. Decide to complete call backs before the day gets cranking. 3 new callers and 3 new appointments interrupt my phone calls.

8:45am– my 9 am walks in early thankfully and we get going! Marketplace enrollee, only speaks Spanish. We share a cup of coffee, share some thoughts on the cold weather, and enroll her and husband in a health insurance plan for the first time in over two years when they were dropped from coverage. She calls me the little miss that could.

10 am– A team member’s marketplace appointment runs late and Irene, a 56 year old woman walks in. She’s super tiny but so fashionable in her fuchsia sweater. She’s furious after having been dropped by her health insurance two months ago and has been really lost about where to get help. She calms down after she hears she will be eligible for medicaid in Illinois, which is a vast improvement for her financially since she doesn’t work and depends on the house she rents. With the downturn in the economy, she shares some thoughtful comments on surviving in an industry where no one is renting right now. I end up giving some tough love and ask her to go get a social security card. She fights me tooth and nail but once I let her know how smoothly I want her application to go, she placates me and promises to be back this afternoon.

10:38am— My 64 year old client walks in early thankfully! It seems like a small difference, 22 minutes, but it means the world in a packed day. Altagracia enrolls in a Marketplace plan and I’m able to help her get a plan that saves her $200/ month, cuts her deductible in half to $3,000, and covers her generic medications without costs. She is ecstatic leaving the office– she had to call five other places before she found us.

11:35 am– 21 year old Beatriz walks in with her mom, Ana, who is also applying. I end up chatting with Beatriz. “I don’t need health insurance right now but my mom tells me that I need to get it,” she says. It’s smooth sailing for her application and luckily her mom is able to simultaneously enroll her and her husband in the marketplace. With the help of a teammate, mom, dad, and daughter all have coverage within an hour’s time.

11:55am– A team member comes and grabs me- the tell-tale signs of “uh-oh” are etched on her face. Esperanza is a 36 year old female. She was healthy, she was all smiles when I met her over the summer and helped her enroll. She now carries the weight of her body gingerly, slumped in a chair. Her eyes are sunken, her hands shake. She wears a vibrant head scarf to hide the effects of the brain tumor she has been diagnosed with in the last few months. She applied for CountyCare, the adult medicaid program over the summer, back when we were telling people, “expect to hear back within 75 days.” At 125 days since application date, her application represents a gross anomaly in the application turn around and she wasn’t worried about it until her medical story changed. She was fine. She was okay. She thought she would be enrolled and things change. Life happens.

She breaks down in front of me and I have to bite my cheek so I don’t cry too. I have to will myself to be strong and clear-headed for her but it’s hard. She looks too much like my mother. She tells me how since her diagnosis she has been seeing doctors wherever possible, with whomever will work with her and her friend’s finances. She begs me to help her get insured, to find out what’s going on. I end up escalating her case to our senior management team. She’s one of us now, we need to care for her until the state does on paper.

She and I chat for 20 minutes, but those 20 minutes mean the world. I promise to take on her case myself and I have. As she walks away she says, “I come back here because you and your team, you all have honest faces. You can tell that you mean what you say,” and with that she seals her place in my heart and a constant nag in my gut that promises I won’t be forgetting her all day. I don’t. “Thank you for helping me. I don’t have anything to pay you with and I can’t promise you that I will ever be able to pay it back, but I know that God will.”

12:15pm– I get a call from the Emergency Room at Saint Mary and Elizabeth Medical Hospital- there’s a woman in need of assistance. I take a brisk walk over and see her. Carmelita is 59 and she has the kindest eyes and smile I have seen in a long time. She lost her job a few months ago and is now living in a shelter in a church. She is uninsured and really worried about the pain in her back. I get her enrolled in CountyCare and she and I dedicate a good amount of time to the game plan as I call it. She has no reliable cell: “They give a phone but I use up the minutes so quickly since there are such few minutes.” We agree that I will be in touch with a sister at the church and make a plan to meet if she should receive any communications. She also asks me to become her approved representative so I can also receive her correspondence. I wholeheartedly agree. As she leaves she says, “Thank you for being nice and not making me feel bad. No one is ever nice to people like me.”

1 pm-– An ED attendant spots me as I’m getting ready to leave and asks me to see someone. Josselyn is taking care of her mom who just got admitted into the ED. She had applied for CountyCare over the phone over the summer at the central office but her application was inexplicably incomplete. Her mom has now been admitted and definitely needs insurance. I start to ask Josselyn her mom’s information and she stops me– “I’ve been up all night. My brain is fried.” I stop her and say, “It’s okay. Go home, rest, and if you think about it, grab your mother’s state id, social security card, and utility bill. I’ll come see you here at the hospital whenever you’re ready.” Updated note: Josselyn called me the next day and asked me to come to their hospital bedside, and I did. Mother is now enrolled in CountyCare and her emergency room visit and stay will be covered.

2 pm– I finally make it back to the office. Team mate grabs me– rumor around hospital is there is a free holiday lunch!

2:35pm— 19 missed calls. Get back to calling everyone back. Too many scheduled appointments and answered questions it all starts to blur.

3:30pm— I get on the path of starting to figure out what’s going on with Esperanza’s case- I’m on hold for 45 minutes and don’t hear anything new.

4:15pm— CountyCare policy changes get announced- I get on the line with administrators at CountyCare and try to get on the investigative trail of some applications I’m worried about.

4:55 pm—  I chat with senior leadership about Esperanza’s case and get advice on next steps.

5:05pm— I call Esperanza and talk next steps. She’ll be in to see me later on in the week to chat about her care.

5:10pm– I call Irene and leave a calm nice message but really I’m thinking: “Ireennne– where are you???”

5:25pm– Team powow/ decompression minutes- we chat the world, Ke$ha, and the cases that are under our skin.

5:33pm— Irene walks in with Social Security card print out in tow– Thank heavens.

5:48pm— I finish this morning’s cup of coffee.


35 thoughts on “a day in the life of assistance

  1. Wow – what a challenging and frustrating that job must be! Thanks so much for sharing your day. Sometimes we (the public) really have no idea about all the people behind the scenes to make people’s lives easier through this whole process.

  2. You’re definitely not taking on an easy job, but thank you for your service. You are helping people gain something that should be an inalienable right but ends up costing tons and tons of money that people just don’t have. I hope things go well for you in the future.

  3. The trouble is the absence of human intervention. Just the computer is cold and raw. You seem to be a main ingredient and that is what this business needs, knowledgeable and friendly people. The problem is the volume is so great and you are only one and they need so many.

  4. As a Brit it would not be appropriate for me to comment on your health system, which is very different from ours. But I would like to register admiration for the dignity, compassion and honesty of your account in this and your other posts. Thank you.

  5. Wow, what I day! I am on the other side of the ACA. I just wrote a post about being caught up in the gridlock of the ACA. Can’t seem to find any answers and it is so frustrating. I give a lot of credit to all of you that are working on the other side. Don’t stop smiling:)

  6. imagine having to deal with 3 insurance agents trying to sell you all sorts of other products and bamboozling you with their duck or lizard on the side …… AFLACCCCCCC (THEY SPONSOR THOUSANDS OF FOOTBALL GAMES)

    • As an insurance agent – I’m a bit offended, but I completely understand your comment. Right now, with everything as confusing as it is, any agent that is trying to “sell” you anything, I would run from. I, personally, want to get through the Obamacare signups and changes for people first. They are scared and confused, and no good agent should be taking advantage of that. I know I don’t.

  7. Good post! I’m from Canada and wish all Canadians would read about the health insurance care situation in the U.S. ….especially some Canadians who complain about our own system.

    You are providing an invaluable service.

    Note: I’m not naïve: I have a sister who is physician, and other siblings who work in health care facilities in various roles with patients. They are all publicly/govn’t funded teaching hospitals.

  8. Reblogged this on Crohn's and Cupcakes and commented:
    I’m someone who signed up for the healthcare offered through the Affordable Care Act. For me it is a godsend because I have Crohn’s disease. My medications and annual colonoscopy are extraordinarily expensive and the coverage I previously had was expensive. To sign up, I went onto my state run site, which is a breeze especially compared to the catastrophe with the federally run site, and was able to sign up. To verify my identity, I walked into the local office and verified my ID with them. There, I learned of the different plans and chose one best suited for me with the help of an “assister” or whatever you want to call this newly created position. It was a breeze, again, to be assisted so thoroughly and quickly. I appreciate and thank you all for what you do.
    For the naysayers out there, please read this blog! It is an important one to read as it puts stories to the myriad of faces out there of the Affordable Care Act. It makes you realize that people do work hard and need this coverage. That it is extremely vital and important to all of us that benefit from it.

  9. This is great. We have heard a lot about the Affordable Care Act over here in Australia but to actually read how it works and the effect it is having on ordinary Americans is great. Congratulations to you and all the other Americans who cared enough to make this happen.

  10. This struck a personal cord with me seeing as how I was just alerted to my drop from Medicaid at a neurology appointment at Montefiore Medical Center. I have MS and take injections to help keep the disease at bay for as long as possible. Without insurance, I don’t know how I can keep up, and these payments are murderous on my tiny salary(I embarrassingly make under $30K/yr). But, workers such as yourself provide a great service to those in need. And, maybe my comprehension skills are slipping, but I didn’t notice a lunch break in your day. Sheesh!

    Beautiful, real, and touching. Keep it up!

    (PS – I like your blog’s theme.)

  11. I worked in a hospital before and saw firsthand the struggles from that perspective, but it was really interesting to read about the challenges on the front end of health care. Thanks for dedication and for sharing your story!

  12. I just got my Obama Care card and am excited to have insurance for the first time in 4 years. I told my friend about it and she said that she was going in a different direction, did not believe in Obama Care, she is applying for the Affordable Care Act. Politics aside, I let it go, I was just happy she was getting insured. I am so grateful to President Obama for getting this passed, and know that with people like you working, it will help so many people live without the fear of an illness or injury ruining their lives. Thank you so much for what you do everyday, keep up the good work.

  13. I think this is a really important story to tell. We often forget about the heroes behind the scenes bringing a President’s dream to fruition. Thanks for the work you’re doing, and thanks for sharing it with all of us!

  14. What a difficult but rewarding job you have … and where were you when I need you 🙂

    Despite all the bad publicity, the ACA has to be a Godsend to a lot of people — and you are one of the angels helping to save lives. Good for you! Wonderful piece and great information for those who need it, too.

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