May-June 2012 | A Better You | Health Care How-Tos

What to do when health insurance isn’t the answer

By Suzanne Martin, PT, DPT

Do-it-yourself health care is a part of life for many dancers—and dance teachers. Over time you’ve figured out how to tame that tendonitis and soothe strained muscles, so you might be one of those people who often delay seeking medical attention.

And nowadays, there’s another reason for delay: times are tough, job security is precarious, and you’re giving every dollar a harder look before you spend it. If you don’t have employer-provided health insurance, the cost of individual coverage can be prohibitive. Here’s some guidance on your double dilemma: what health problems can you safely handle yourself, and how can you get professional care when you need it without blowing your budget?

As a teacher, you can certainly avoid using a body part that is painful or locked up. But be careful: one problem I often see is the injured dancer who doesn’t quite go all the way into full dance movement again, creating a chronic condition. It’s sad when a dance teacher writes off a movement or position when it would have been possible to go a bit farther with treatment to regain full use.

A good rule of thumb is that if something is painful for more than a week and isn’t getting better despite your home remedies, seek medical care. There are a few exceptions to that rule, starting with obvious fractures and other impossible-to-ignore injuries. Also, if you run a fever of 100 degrees or higher for more than a couple of days; if you have persistent abdominal pain that prevents you from performing routine activities; or if a body part is red, swollen, and sore for more than two days, see a doctor.

You also need to keep your vaccinations current, including an annual flu shot—especially useful if you’re teaching preschoolers—and your once-per-decade vaccination against tetanus, diphtheria, and whooping cough. Don’t forget your regular Pap tests, especially if you’re sexually active. And if you have a family history of breast cancer, heart disease, or other diseases in which heredity plays a role, regular checkups are a must.

Dancers should pay particular attention to their therapeutic musculoskeletal care. Build your care team before you hit a crisis. You’ll need passive types (professionals who do hands-on work on you) and active types (who help you learn how to fill in your weak links). Passive care requires that you sit back, relax, and receive. Masseuses are a good resource for referrals of passive complementary care such as massage, acupuncture, and chiropractic. These specialists address the aches and pains we associate with working too hard, “throwing our backs out,” and general fatigue.

Active types of medical care come from physical therapists and movement specialists when retraining, rehabbing, and guidance into a full return to dancing can be achieved. Physical therapists can provide corrective manual therapy as well as guide someone into full dance use through rehab via Pilates or other movement forms. Seek out a therapist with dance experience; sports clinics may be a good resource for referrals.

Surprisingly, even the gold standard of premium health insurance, meant to cover urgent medical necessity, often won’t cover complementary or maintenance health care, which is what a dance teacher needs. Many of my clients now carry only catastrophic coverage, with deductibles ranging from $4,000 to $5,000, which prohibits use for everyday complaints.

To find affordable care, start by identifying your region’s resources. Don’t ignore your local free clinic, usually run by the city or the county. One resource in finding care is the national Artists’ Health Insurance Resource Center (ahirc.org), which is using a grant from the Doris Duke Foundation to counsel dance professionals—including teachers—about their health insurance options and available subsidies pending the arrival of national mandates in 2014.

“Dancers are notoriously uninsured—even more so than actors or other people in the arts,” Dan Kitowski, AHIRC’s director of health services, Western region, told Dance Studio Life. “We go one-on-one with people who are uninsured or losing their insurance and see what their options are.”

AHIRC is not an insurer and doesn’t provide care. Instead, it steers callers (323.933.9244, ext. 32 in Los Angeles or 212.221.7300, ext. 265 in New York City) to free or reduced-cost options where they live. No proof of dance affiliation is required.

If you live in a major city, you may find clinical care tailored for dancers’ needs. In San Francisco we have the Dancers’ Free Clinic, located in the ODC Dance Commons complex and staffed by volunteer physicians, physical therapists, and other health professionals. Anyone who takes dance or movement classes and has a dance-related injury is eligible for its care. In New York City, the Harkness Center for Dance Injuries at the NYU Hospital for Joint Diseases offers free and subsidized services, including orthopedic and sports medicine clinics, physical therapy, and injury prevention workshops. Also ask about health resources at the reception desk at local dance centers.

To find affordable care, start by identifying your region’s resources. If you have no insurance, don’t ignore your local free clinic, usually run by the city or the county.

Do you have the drive to start a free dancer-wellness program in your area? Orthopedic physicians, chiropractors, and physical therapists often want to become more involved with health care delivery to dancers. Make a lunch date with a health care professional and explore the possibilities. Private-practice MDs and chiropractors may welcome the marketing boost of community exposure. Even setting up a health fair at your studio will fast-track you into a whole new world of wellness.

Also, check out local professional schools in fields such as acupuncture, podiatry, physical therapy, chiropractic, and massage. I got my first orthotics at a school and massages at the local holistic institute. As the lead physical therapist for Smuin Ballet in San Francisco, I have contacted the administrators of some of these schools to get volunteer help on-site at the ballet’s rehearsals and in the theater pre-performance.

The upside is that these people are being scrutinized by their teachers and are learning the most current methods of treatment. Most schools charge a low, flat rate. Volunteers for a study or for a student project often get free care. The downside is that you might get a light massage, or a half-hour instead of the one-hour massage that you’d like. And of course, students graduate, affecting continuity of care.

Bartering works, too. Smuin Ballet provides acknowledgement in its concert programs as well as free tickets in exchange for the services of the therapists who help us. I have exchanged my services for such things as housecleaning, chemistry tutoring, and landscaping. Who needs private dance lessons in your area? Look around.

Need urgent care in a pinch? Check your local mall for the walk-in clinics that fill the growing needs of those who have lost their jobs and their employer-paid health insurance. For many, such clinics are the first line of emergency care, and they’re considerably more affordable than a hospital ER. Plus, you won’t be turned away. One dancer I know, in need of emergency antibiotics, reported that the doctor at such a clinic spent 45 minutes with him and that he was very pleased with the service.

Wondering if you might enter the house of medical school rejects? Maybe not. There are reasons why a physician may opt for a job in a mall clinic. Current private medical practice is difficult. Many physicians are stressed and disappointed as insurance reimbursements shrink. Also, an insurance company usually dictates which procedures a physician may perform.

So don’t let the lack of marketing and extras fool you. I also operate on a mom-and-pop level, limiting the number of clients I see in my home office. Described as a “concierge” therapist, I don’t take insurance, but I’ll definitely take care of you. Since I run a small operation, I am one-on-one accountable to those I serve.

Also, remember that MDs, chiropractors, and physical therapists are licensed by and accountable to your state’s consumer board of affairs or other licensing body. Do contact and file a complaint with this bureau for any questionable experience. Also, check whether the health professional working with you is board-certified, meaning he or she has two to six years of training beyond med school and has been rigorously tested.

Not all situations and conditions require “the best” in care. I can’t tell you how many people tell me their medical histories and maintain that they have been treated by the “best” in their fields. How many bests are there? Are they all comparable? If I’m going to the McDoc for a cold, will I not believe her if she only ranked tenth in her class? Medical school is only the beginning of the lifelong training required in the health field. I’ve logged more than 700 hours of continuing education since I received my doctorate.

Think twice and be discerning. And be creative. You have options in your health care.

I have faith in you.