Friday, Mar. 14, 2008

Health coverage often stops on campus

Parents often don't think twice about health coverage when their children head to college, but it might be to their advantage to take a second look before doing a double-take when they see their bills.

They may wind up paying double or triple for campus health care, said James A. Boyle, president of College Parents of America, a nonprofit group based in Arlington, Va., that provides sup-port and advice for parents of college students.

On most campuses a family's insurance plan “is effectively worthless,” Boyle said. It goes un-used, he said, because most colleges do not process standard health insurance.

Andrew Menter, founder of the Highland Campus Health Group, a company that bills and collects third-party insurance for college health centers, estimated that only 2 percent to 3 percent of centers nationwide are in-network providers with the large insurance carriers.

Campus health centers traditionally have been financed through tuition, general fees or specific health fees, allowing the same access for all students. More recently, a fee-for-service approach has become increasingly common. As a result, parents who are already buying their own insurance may have to pay substantial health fees and out-of-pocket costs for laboratory tests and X-rays.

Students could pay for health services themselves and then file for reimbursement from their insurance companies, but Menter said only about one in eight claims is reimbursed for out-of-network providers. And when they are paid, he said, it is some-times for a fraction of the charge. All this can leave students confused.

Last April, Michael Feuerstein, 19, a sophomore at the University of Virginia, wrote a letter to the editor of The Cavalier Daily, the student newspaper, stating that the health center did not make it clear how billing was handled. “I feel it is a very deceptive process,” he said. “It should be easier for students who are sick and away from home.”

His views are supported by Glenn Egelman, director and physician in chief of the student health service at Bowling Green State University in Bowling Green, Ohio, which began billing the health insurers of students rather than increase fees or reduce services several years ago. “If you think about it, it doesn't make any sense,” he said. “We saw that many students had insurance; they were paying for it but weren't using it.”

The change, he said, “has been a very positive thing for us.” Revenue from direct billing has provided money for better serv-ices and increased access at the health center.

At Kent State University, more students are seeking care because they know it is covered by insurance, said Mary D. Reeves, director of university health services. “Also, they don't delay care. We have diagnosed some serious things — breast cancer, cervical cancer and severe mental illness.”

Health care costs have risen in recent years, putting a strain on university budgets, and more colleges are looking for ways to preserve the quality of care by collecting payments for services rather than raising tuition and fees, said Dana Mills, director of the student health service at Marquette University in Milwaukee and chairman of the student health insurance task force at the American College Health Association.

“It's the wave of the future,” Mills said.

Karen Allen, an Austin, Texas, mother of three, has had experience with a college that bills insurance and one that does not. When her daughter Kaitlin be-came ill twice as a college student she had to decide whether to make a two-hour trip home or go to the emergency room because the nearby hospital accepted her insurance but the campus health center did not.

“I was surprised and shocked that they have to make choices they shouldn't have to make,” Karen Allen said. But when her son Mack, a student at Baylor University, which accepts insurance, devel-oped pneumonia last fall, he went directly to the campus heath center. “He knew all he had to do was show his insurance card, just like at home.”

Nevertheless, the traditional system has its advocates.

Stephen C. Caulfield, chair-man of the Chickering Group, a unit of the Aetna Company that provides university-sponsored plans at 170 colleges and universities, said uninsured and under-insured students are a major concern.

“A significant number of college students (nearly 4.5 million, including many graduate students) do not have coverage, and many more do not have adequate coverage,” he wrote in an e-mail message. The reason colleges and universities have sponsored health insurance programs, he added, “is to promote adequate access to quality health care at a reasonable cost for all students.”

Washington University in St. Louis requires that all students buy the university-sponsored plan because it found that underinsured or uninsured students were not seeking care, putting them-selves and other students at risk. For $686 a year, all students receive full access to the center and a 12-month insurance policy.

Jim Mitchell, director of the student health service at Montana State University in Bozeman and a former president of the American College Health Association, is an advocate of the old system but acknowledges that insurance billing is likely to increase in the years ahead.

“In my opinion, it's not the most desirable method for providing accessible, convenient health care to students,” Mr. Mitchell said. “My sense is that universities are going there out of necessity, not because they want to.”

Dr. Richard P. Keeling, founder of Keeling & Associates, a higher education consulting firm in New York, sees both sides.

“It's not a black-and-white is-sue,” he said.

Keeling, also a former president of the American College Health Association, called insurance billing a “good and very reasonable” step for college heath centers. But there still has to be a way for centers to cover some medical services and nonclinical expenses, like wellness and counseling programs, he said.

The origins of campus health centers help explain the traditional system, Keeling said. Centers were established to provide health care on campus to support the academic mission of the college and help keep students in school.

“It is still the reason colleges and universities do this,” he said. The trend toward accepting insurance has already given rise to Menter's business, the High-land Campus Health Group, which handles paperwork and credentials for universities that want to bill insurance companies. Highland takes a percentage of the insurance reimbursement and sends the rest to the college, typically increasing a health center's annual budget by 10 percent to 15 percent, Menter said.

Insurance companies like the system as well, he added. If students go to the emergency room or put off care until returning home on break, it can ultimately cost the companies more money. So what's a parent to do?

Boyle suggests that parents ask college administrators: “Do you accept the health insurance our family has? If the answer is no, one question should be ‘why not?”' If enough parents ask, Boyle said, it will pressure universities to consider accepting their private health insurance.

“College health centers are not above being responsive to parents,” said Dr. Allan L. Markus, director of the campus health service at Arizona State University. Markus suggests parents handle it like any other consumer issue, and ask college administrators, ‘Tell me, what am I getting for the health fee? Can I waive out, and why not? “'

At orientation sessions for new students, he said, parents frequently ask “‘Do you take Blue Cross, Aetna?' I say ‘Yes, yes, yes. We take them all.' They say to themselves ‘that's one less thing I have to worry about.' I've not had one parent say to me, ‘It's not the right thing to do. ‘“