Photo: Ryan Pelham
Anastasia Depew spent three weeks in silent pain after being struck in the back of her head by an elbow during a Kountze basketball practice in November.
She knew she had a concussion; she had one before. Her hope was that the headaches and dizziness would subside.
“It was my last year, I don’t plan on playing sports in college. This was my last chance to finish things out on a good note,” said the senior, 18. “I felt like I could tough it out.”
She continued to play in games, attempting to hide her symptoms despite questions from trainers and coaches about her health. One night, she called her parents into her room, where they found her sobbing in bed.
“Her head was just hurting that bad,” said her mother, Sharon Depew. “That’s when we knew how serious it was.”
Depew was out of school for two weeks and put on medication to try to stop the constant headaches. Six months later, she has yet to be cleared to return to athletics, after many hours in doctors’ offices undergoing concussion testing.
Depew was fortunate her family had adequate insurance. Otherwise the cost of her injury might have rocketed. Or worse, she might not have not been treated at all.
“The school’s insurance would not have been good enough to cover everything that she’s gone through,” said Sharon, who works for the district as a middle school secretary. “I hate to think about the kids who get concussions and don’t have insurance. What can they do? I think the schools should be able to cover injuries that happen on their watch.”
High school athletes without insurance must rely on a flawed Medicaid system that won’t cover important concussion testing and that forces schools to provide supplementary insurance that doesn’t always cover the cost.
At a time of heightened focus on the long-term effects of concussions at the professional and college levels, younger athletes without adequate insurance are at greater risk.
“When these kids got injured it became difficult to send them places because they wouldn’t accept their insurance,” Foreman said. “I felt bad for the kids because it took them longer to get into rehab and recover from their injuries, concussions or something else.”
Foreman said in a “perfect world,” schools should be able to cover the cost of an athlete’s injury, in part, because the injury happens on school time.
“It comes down to schools not being able to foot the bill for all these kids and insurance policies that don’t adequately take care of them,” he said.
Foreman said he found allies in the battle against Medicaid.
Trainers from Beaumont Bone and Joint offered discount physicals at the beginning of the athletic season for those without access to a family physician, Foreman said. When it came to concussions, Foreman had one local option for affordable care for his athletes with Medicaid.
Kimberly Pitts, a doctor at Christus Southeast Texas and the only certified concussion specialist in Southeast Texas, has treated 174 area high school athletes for concussions this school year.
Since she began running the concussion clinic in 2011, Pitts has used the same concussion software – ImPACT – as many professional sports leagues to test her patient’s mental agility, overall reaction time and their memory. It’s a test she says is imperative for proper cognitive recovery.
Medicaid doesn’t see it that way.
“They put this testing in the psychiatric realm, they don’t consider it a necessity like they would for treatment of a broken leg,” Pitts said. “It’s up to us to fight that system, within the law, and make sure every kid gets the attention they need. But we know some kids still go untreated.”
Helping athletes, not insurers
According to Christus, more than 5 percent of athletes treated for concussions were on Medicaid, though Regional Director of Outpatient Operations Bill Klamfoth said that number could be substantially higher.
“When most of these kids or families aren’t covered, they default to the school insurance,” Klamforth said. “That makes it harder to track because the school’s insurance is listed as the primary insurance.”
Pitts and her team of four outreach trainers, who work out of Beaumont Bone and Joint, cover more than 30 schools in Southeast Texas – many of which don’t employ their own trainers.
“It would be easier to have a trainer but we don’t have that luxury,” said Newton athletic director and head football coach W.T. Johnston. “The service that they give us helps tremendously. They are the only ones who come to us on a regular basis.”
Outreach trainers go to each school at least twice a week to check on student-athletes, some of whom can’t afford to go to a doctor or are far from one.
Christus Beaumont Bone and Joint trainer Joe Martin said their responsibility is to treat the athletes, not cater to insurance companies.
When insurance won’t cover the cost of concussion treatment and families can’t afford to pay, Christus steps in.
According to Pitts, the concussion center forgives 5 to 10 percent of bills so it can provide necessary care.
“To be honest,” Johnston said, “they do everything for free for us.”
Working the system
Nederland trainer Matt Lewis has learned how to work around the Medicaid system.
When it comes to head injuries, he will list a concussion as a “multi-trauma” injury.
“It gives doctors more leeway to investigate other things and keeps the insurance companies off their back,” Lewis said. “If I list it this way, it can eliminate the possibility of a kid not getting treated.”
When Kirbyville senior running back Ty Dennis sustained his third concussion during the second quarter in a game against Bridge City, he was diagnosed not only with a concussion, but a stinger – a spine injury. The hit knocked him unconscious, but the diagnosis of more than one injury helped him get the proper treatment.
“I was so scared after that because I thought I wasn’t going to able to play football anymore,” Dennis said. “But I was lucky to have a lot of people around me who cared about me getting better and had my back throughout the process.”
Jace Duke, athletic training services department manager at Houston Methodist hospital, said non-profit hospitals can only do so much for athletes without adequate insurance.
“At the end of the day, insurance companies have to make sure they are covering what they can afford to cover,” Duke said. “It’s up to us to find a way around them while still going through them.”
Now that technology has made concussions easier to treat, Pitts hopes insurance providers like Medicaid will make it easier for young athletes to receive treatment.
“The important thing is that kids are getting treated,” Pitts said. “We just need (Medicaid) to realize how important these tests really are.”