A happy ending to one family's health-care story

MIKE LITTWIN

August 25, 1993|By MIKE LITTWIN

Last month, we told the story of little Kelsey Binas and her family and how they fell through the health-care cracks in our country.

Well, there's good news.

Somebody filled in the cracks. The Binases, who didn't have health insurance, are now covered. The Binases, who owed as much as $40,000 in medical bills, are now paid up.

Little Kelsey, who suffers from cerebral palsy and needed surgery the family couldn't afford, had the operation yesterday. She's doing fine.

And her mother, Chris, who's also doing much better, says, "It's a miracle."

If it sounds like a happy ending, it is. Except that it never should have gotten to this point in the first place, and there are thousands of others like Kelsey who still aren't getting help.

We'll go back to the beginning. The Binases are a typical, young, working-class family from Middle River. Leo Binas has a pretty good job, but one in a small firm that doesn't offer group health insurance. With individual insurance so expensive, the Binases felt they had little choice but to go unprotected.

And then Kelsey was born a little over a year ago. In addition to cerebral palsy, she is mentally retarded. She has seizures. She may be blind. Her head is abnormally small. And there was one other problem: a hospital bill totaling $35,000.

The Binases didn't have the money, of course. Who does? They didn't have the money either for the never-ending parade of doctors and therapists and nurses they'd need.

At the hospital, the social worker helped the Binases register for Social Security Income (SSI), which covers the disabled. The Binases received money for three months until it was determined that Leo's salary was too high.

And that was where the first major mistake came.

Dr. Judson Force, director of Children's Medical Services in Maryland, explains what happened.

"Kelsey received what is called presumptive SSI," he said. "And because she was eligible for SSI for those three months, she was also eligible for Medicaid through the calendar year. Somehow that wasn't made clear to the Binases.

"There was a miss there. I don't know whose fault it was exactly."

The hospital, which was out $35,000, should have known. So should have the county social workers. Instead, bills mounted and despair was sometimes nearly irresistible.

Then their story was told in the paper, and the Binases' world changed. Ordinary people called to offer money. More than $1,000 came in. Others offered clothes and food. Even an insurance representative suggested a program for Kelsey.

"I was speechless," Chris Binas says. "It was so kind, so nice, so helpful. I never knew there were so many people who are out there who care."

Others saw the story, too, including officials at the state health department. Nelson Sabatini, the department secretary, told his people to look into the matter.

They discovered the Binases were retroactively eligible for Medicaid, which paid all the hospital and doctor bills. They discovered the Binases were eligible for Children's Medical Services (CMS), a state program with more liberal income guidelines than the federal programs. CMS paid for Kelsey's operation yesterday.

All this took the Binases completely by surprise.

"We got a call from a social worker one day, and the next week we had CMS and the hospital bills were getting paid," Chris Binas says. "Now I walk into a doctor's office, and when they ask me if I have insurance, I can say, 'Yes.' You don't know how much that means to me."

There's your happy ending. But what about all the others who aren't aware of these programs, who don't know how to apply, who are overwhelmed by the bureaucracy, who don't become special cases, who do fall between the cracks? Where's their happy ending?

Maryland's health-care program tries to address the uninsured, with a policy that provides primary and preventive care to families with income less than 185 percent of poverty level. Now, if someone -- the job falls largely to overburdened social workers -- would just let those people who are eligible know about it.

"We have to do a better job," Sabatini said. "The hospitals have to do a better job of referring people. The media have to help make people aware . . . We try, and I think we get more than fall through the cracks. No system is 100 percent fail-safe. But that doesn't mean we shouldn't do a hell of a lot better."

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