Traveling to the city for medical care (when money is tight)
I live in the most beautiful place in the world. Humboldt county has the best beaches, mountains, and forests that I ever expect to see. I’m sure I’m not biased at all ;)
I’m not alone either. One in 5 Americans live in a rural area. Rural means it can be hard to find a doctor nearby, especially a specialist. That is doubly true for people who have a rare disease and are looking for someone with experience in it.
So that raises a question, how do you get to the city for your appointment?
Option 1: Figure it out yourself
This is the most obvious answer. Many people treat medical appointments the same way as going to the city for a baseball game or a concert – they drive. If they need to, they stay overnight. For many, this works well, as long as the patient can ride safely upright in a car, they don’t have medical needs to complicate things, there is someone who can drive, the car works, and there’s gas money.
There are also self-pay options like taking a plane, a train, or a bus, especially for people who can’t/don’t drive themselves. (Rome2Rio is a site which can help you find available options, but be warned it is full of ads and the price comparison is imperfect.)
Pros:
Full control of the plan and timing. May not have to set up in advance. Usually a familiar experience with your own stuff (car, music, temperature controls, etc). Don’t need a scheduled appointment. If you carefully log mileage and expenses, can get a tax break if you itemize.
Cons:
Expensive. May not be accessible in situations like
Wheelchair user
Stretcher needed
Uncontrolled seizures
Heavy oxygen user or ventilator dependent
Uncontrolled asthma
Recent orthopedic procedure – think casts, braces, stabilizers, and large metal contraptions
Complex mental/behavioral needs
Option 2: Call Insurance, Get a Free Ride
Often, for people with Medicaid insurance (Partnership in Northern California) or some commercial insurance (through work, for instance), there are transportation benefits. This means insurance will give you a free ride to your scheduled appointment, even in another city hours away. This is for people who do and do not have medical-related travel needs. This may look like a wheelchair van, a small bus, or a regular car depending on your medical needs and scheduling.
To arrange this, you will typically need to have an appointment scheduled, and you need to call them (For Partnership: (866) 828-2303) at least a few days in advance. You may have to leave very early in the morning (e.g., 3 am), wait for other people who are riding with you to the big hospital in the city, or wait at your destination before or after your appointment.
There are also commercial, out-of-pocket medical transport companies who offer similar services, usually with an ambulance or airplane.
Pros:
Free if using insurance. Will almost always get to appointment on time. Can handle wheelchairs/stretchers and other equipment and provide medical monitoring (e.g. for seizures, blood sugar emergency, behavior issues, etc.)
Cons:
May be waiting or inconvenient timing. Have to plan in advance and coordinate. May ride with other patients. May be a long ride. May or may not be able to bring a companion or service animal.
Option 3: Call the VA (or your VSO) and Take the Bus
If you are a veteran with VA health benefits, you may have already found free shuttle service from your hometown to the nearest big city VA. This will vary quite a bit based on where you are in the country, so the best way to find out about particulars is to call your VA social worker and ask. If you don’t have a social worker, call your VA and they should be able to assist.
Like with insurance rides, VA rides may involve waiting at either the shuttle pick-up spot and/or at your destination before/after your appointment. You will need to plan this as far in advance of your appointment as possible.
Secret option 3.5: VA/VSO Beyond the Shuttle
Many veteran service organizations (VSO) will also provide rides to city VA hospitals or other appointments, DAV is the most well-known for this, but they aren’t the only one. If you are connected to a VSO, ask about rides to appointments. These can be similar to other kinds of transport, in that it’s usually a van or small bus, there may be other passengers, and there may be waiting.
Sometimes, the VA social worker can help you get a free place to stay overnight at your destination, give you gas cards to help pay for driving yourself, or have other benefits for you – whether you are going to the VA hospital for your appointment or to a different health system. It’s worth asking!
Pros:
Free, effective, sometimes covers lodging. Have a social worker to coordinate and arrange plans. Some options for wheelchair users and/or people who need help getting in/out of a vehicle. May be medical supervision available.
Cons:
Limited to veterans, waiting may be involved. Have to plan. Sometimes ride with other patients. May or may not be able to bring a companion or service animal.
Option 4: Call a medical social worker!
Often when people are traveling for medical care, they are going to a big hospital or health system. Sometimes they are going to a private practice with a referral from their regular doctor (PCP). Most of these places (hospitals, universities, big clinics with many doctors) have social workers available to help patients with transportation.
Usually, the bigger the place is, the more resources they have for social work. For example, if you are going from a small country doctor’s office to a big university system in the city, then call the big city hospital first. They are more likely to have someone to help you, but if they don’t, then call your regular doctor’s office.
If you call to ask about transportation help, the social worker you reach will usually try to help you use your insurance or VA benefits first. If you don’t have those benefits or they don’t cover everything you need, they may be able to offer you something else. For instance: gas money, a medical Uber (usually just like a regular Uber ride), a cab voucher, a place to stay, or some cash.
A place to stay.
Sometimes, if you are getting repeated outpatient treatments over several days (like cancer treatments), the hospital social worker will know about a free or low-cost place you can stay – usually with a companion or family. These are usually called a “medical-stay guest house” or “medical lodging” and often feature some shared spaces like kitchens or laundry rooms. They are designed to encourage people to get to know each other and offer emotional and physical support at a very low cost.
Cash help.
Your local social worker may know about “microgrants” you can apply for in the community. These tend to be small amounts of money ($100-$300) to help with things like travel. These types of programs tend to focus on specific types of needs (e.g., cancer or a specific diagnosis), groups of people (local to a certain area, queer, different racial or ethnic groups) or otherwise try to award money to people that fit within the mission of their group. This is also how most help for traveling for abortion care works.
Some local examples in Humboldt:
It’s also worth asking friends, family, and at your place of worship about these kinds of resources because they may know about something that you don’t. Note that many local groups will only be able to award the same person once a year.
Pros:
You get something that you need, and organizations get to fulfill their missions. Social workers can help with applications. Something is better than nothing, even if it’s not exactly what you pictured. Can work with other options (e.g., lodging and an insurance ride).
Cons:
Application process varies by place a lot. May have to wait for award and pay out-of-pocket first. May not get enough to cover the whole cost or funds may not be available when and how you need. Have to plan in advance of a scheduled appointment usually.
Isn’t that just taking charity, though? Ew!
Let me talk to you about that for a minute while geeking out about one of my absolute favorite TV shows: season 1 of Altered Carbon. Part of the show’s science fiction plot revolves around an elite and powerful group who draw their strength from specific training. The group stands out in a world where there are endless high-tech sci-fi gadgets and weapons, so much so that I paid attention to the little pieces of training sprinkled through the show. Also, the training sayings tend to be simple-sounding and easy to remember. (Perfect for my brain.) Two pieces of advice are relevant here:
The true strength of the wolf isn’t fangs, speed and skill; it’s the pack.
Take what is offered, and that must sometimes be enough.
In this context, I mean to say, sometimes we have to ask for help. That thought might make you squirm or might not have crossed your mind at all while reading so far. I think it is most uncomfortable to ask for and receive help when we aren’t used to it. Our pack – the other humans around us, paid professionals, friends, loved ones, community – they are our strength. When we do ask them for help, the only wise thing to do is accept what is offered, whether or not it is exactly what we wanted or needed or planned. I think this is also stoicism, but I prefer sci-fi to dead philosophers, so I can’t say for sure.
Option 5: Fly there
One option for rural patients and families is to take an “angel flight” to their appointment. There are volunteer pilots all over the country who can help by giving people (usually also a companion) a ride in their small plane.
They can help one time or many, for medical appointments or treatments, or even things like summer camps with other kids who have cerebral palsy (or other medical-type camps). However, they do need people to be able to sit up, get in and out of a plane, and fly without medical supervision. People are encouraged to bring a companion and service dogs are usually fine. Because small planes only have a few people in them, this can one of the best options for people with weak immune systems.
Requesting a flight can be different depending on where you live, but generally you will need to plan at least a week in advance of your appointment, and answer questions about why you need help traveling (could be for financial reasons, time of trip, medical needs, etc.)
Pros:
Faster than ground travel, free, no other patients around you, limited waiting around, can usually accommodate people using oxygen.
Cons:
Have to plan, must be medically stable, limited amount of luggage, may or may not have to plan for your own ride from the airport to the hospital/clinic, may or may not be able to handle wheelchairs/walkers, definitely no stretcher transport.
Bonus option: In-town travel
Because transportation can be tricky even when you aren’t visiting a different city, there are a few other places to look for help locally. Your local social worker can help here, you can try calling your local United Way at 2-1-1, or visit findhelp.org/. Usually, the help available will fall into one of two groups. These are options for medical appointments, but also just leaving home to shop or have fun.
Paratransit
This is part of the ADA (Americans with Disabilities Act) and the goal is to make public transportation for people with disabilities about as convenient as taking the bus for people without disabilities. Because it’s a federal law, some form of this should be available nearly wherever you are in the US. (Even if your town doesn’t have a bus line, they may have this.) Sometimes, there will be waiting, but it will usually be in your house or in an office instead of at a bus stop, which is safer for many people with disabilities. You may be around other people, but fewer than in a bus. Companions may be allowed. In Humboldt, we have Dial-A-Ride, which is usually a wheelchair van, but the program may be called something else where you live and work differently. The amount of planning involved, available times, etc. will also change from place-to-place.
Volunteer Rides
The other very common travel option is asking a volunteer! Many people stop driving as they get older, so lots of Area Agencies on Aging have programs where community volunteers give rides. (They get a little tax deduction for the volunteer miles they drive, too.) Sometimes, programs may be extended for younger people with disabilities; the one in Humboldt focuses on older adults.