TAOS — Taos junior high school student Adora Lopez recovers from an undiagnosed illness that was hospitalized in Albuquerque for several weeks at the end of last year, and 13-year-old parents are using a health insurance system that limits treatment options outside the state. Notice that. Or you need a large upfront investment.
His father, Rocky Lopez, a Taos plaster and plaster craftsman, said:
“The same thing happened when she was nine and they couldn’t really identify anything. Now at the age of 13, she collapsed with the same symptoms, which brought her back to the hospital,” he said. Said.
After spending a week at the Holy Cross Medical Center, Adra was transferred to the University of New Mexico Hospital in Albuquerque. Three weeks later, her doctor was still unable to confirm her diagnosis when she was in sufficient condition to be discharged.
Her father said Adora’s white blood cell count was dangerously low, her liver wasn’t functioning properly, she was “covered with a rash from neck to toe,” and had a high fever of 104 degrees for several weeks.
“She had a fever for more than 30 days. There was no medicine because Tylenol wasn’t allowed and the liver was so bad. They wore a cooling blanket with us and we made her. I put ice everywhere and fought that way. Rocky Lopez said, “Finally, her fever came out and the rash began to disappear.”
The mysterious illness has healed again, but Adora’s health is still compromised, and her parents Rocky and Janel Lopez are determined to find a doctor who can diagnose and treat her.
Dr. Sylvia Villarreal, a former pediatrician at Adra and now retired, recommended seeking professional help at either Denver or the Mayo Clinic outside the state.
Unfortunately, the New Mexico Medicaid program does not cover most out-of-state medical services.
“Every state has its own Medicaid program, and virtually every state has contracts with companies (all HMOs) such as Western Skyes and Centennial Care and pays for state services,” Silver City said. Carol Holt, a broker of Tom Blanchard based in, said. Insurance with customers throughout New Mexico, including Taos.
“If there is a need for care that the state cannot meet, we need approval to do so,” Holt said. “And they usually don’t approve it unless there is a compelling reason.”
Adra’s father said the family needed to get a new insurance policy when taking her to Colorado for treatment.
According to Quintana, small business owners like Rocky Lopez can apply for planning themselves and his family at any time of the year through a priority provider organization rather than a health maintenance organization. While HMOs severely limit the network of doctors and service providers, PPOs are much more flexible. PPO allows consumers to find out-of-state services.
“On the personal side, 100% of the plans offered through the state health insurance exchange” — bewellnm.com — “HMO,” says Quintana.
However, monthly premiums for PPO plans, especially those with low deductions, can be much higher.
The work that Adora missed when she was ill, coupled with travel and accommodation expenses while she was in Albuquerque, has already exhausted her family’s savings.
“My wife has just started working and I have just finished setting up a licensed plastering company in September,” Rocky Lopez said. “I just finished littering money to school and didn’t expect this to happen. So the safety net was exhausted and licensed, but this happened in Adora.”
In January, John Pointer launched a Caring Bridge page to convince the family to inform the community about Adora’s illness, and a GoFundMe page targeting $ 4,000 to recover some of the family’s expenses. raised.
Rocky Lopez said his pride made it difficult to ask friends and neighbors for help, but said, “We are at a point where we can literally lose everything.”
He created a page on the non-profit Caring Bridge website to inform the community about his daughter’s illness and launched a GoFundMe campaign with a goal of $ 4,000.
So far, the Lopez family has raised $ 2,800.
“The support from the locals was great,” Rocky said.
This story first appeared Taos NewsSister publications Santa Fe New Mexico..
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