When Priyanka Raeburn arrived in Kansas City in January 2017, she was prepared for a long immigration process. What she didn’t anticipate was how long it would take to get the medical examination required to gain permanent residency.
Raeburn moved to the U.S. from New Delhi, India, to pursue higher education and join much of her immediate family. While she chipped away at her immigration process, she obtained two master’s degrees, one from Southeast Missouri State and another one from the University of Missouri-Kansas City. She even went to law school at UMKC.
But it wasn’t until this last year she received a medical examination required by U.S Citizenship and Immigration Services.
These exams can’t be carried out by just any doctor. The physician needs to be qualified by Immigration Services to conduct medical examinations for individuals applying for immigration benefits.
The exams include a medical history review, physical examination, chest x-ray and blood tests for syphilis. The physical portion will at least include an examination of the eyes, ears, nose and throat, extremities, heart, lungs, abdomen, lymph nodes and skin.
There are only 17 locations listed in the Kansas City metro that have civil surgeons — doctors designated to perform the examination required for most green card applicants — and costs can vary. With a growing immigrant population, that means hundreds to thousands of people per location, which in turn means growing waitlists.
And while it is a medical exam, it is not considered a replacement for a physical or a health cost, and is therefore not covered by most insurance. At one provider, Raeburn was told the exam would cost $1,400, well out of the range she could afford. There is no regulation limiting how much can be charged for these exams.
“And that is exclusive of any vaccination if they found that I need it,” Raeburn said. “So just imagine this is just an extra cost over all the other immigration fees you have to pay. Imagine if you have to support parents or children as well.”
Ultimately, Raeburn found a cost-effective option at KC CARE Health Center, where services include primary, dental, mental health and women’s health care — after learning community health centers may be cheaper than private practitioners. KC CARE offers the exams at a base cost of $250.
Dr. Craig Dietz, chief medical officer for KC CARE Health Center, said the purpose of these exams is two-pronged. They serve a regulatory purpose by screening people for communicable diseases and ensuring vaccine records are up to date, and they serve as a first point of contact into the health system.
“If people are coming here for immigration services I’m not just doing that. I'm trying to get them into dental appointments, if they need mammograms, diabetes, hypertension,” Dietz said. “I treat all kinds of conditions in the immigration clinic. All the usual things you would think of in comprehensive primary care.”
KC CARE launched the immigration clinic about a year ago when Dietz saw a patient who asked if he could provide the necessary exam. He couldn’t at the time, but made it a point to get licensed so he could help in the future.
What started as a weekly clinic quickly grew. Dietz said demand is so high he could do these exams all day. He estimates this clinic has seen 500 to 600 patients so far, including Raeburn. Last week he had 38 people show up in one day.
Patients have driven from Nebraska and Iowa. They’ve come from more than 60 countries. Each new country gets a tack in a map he has hung in his office.
A report from the U.S. Office of the Inspector General pinpointed many areas of improvement needed for this process, including proper vetting of physicians. In some cases, doctors with histories of patient abuse or criminal records were certified.
“USCIS may be placing foreign nationals at risk of abuse by some civil surgeons,” the report reads.
Dietz said controls on vaccine costs could provide more relief on his end provide reasonably priced exams to more folks. Raeburn, on the other hand, argued for some sort of subsidy that would ease the financial burden on immigrants.
“Immigrants who don't know a lot when they're trying to come and make a life in a new country, they don't know where to begin, it’s easy to take advantage of,” she said.
“There's like kind of a catch-22 in the sense that usually the immigration process takes forever, so if I was communicating (a disease), I would have already spread it by then,” Raeburn said.
Despite concerns immigration advocates have expressed over how President-elect Donald Trump might crack down on immigration, Dietz doesn’t see demand slowing down in the immediate future.
“The number of people who are already here in need of services is so great that I don't expect demand to drop off much if at all,” Dietz said. “In fact, some might feel pressured to get their paperwork done more, so in some ways, I expect to be busier as a result.”
