When Tufts sophomore Julie* made a visit to her doctor in her home state of New York last summer to take care of a wheezing cough, she didn't anticipate the long string of bills and phone calls that would ensue.
Julie, who is covered by the Tufts' student insurance plan, said that because her visit was categorized as preventative care - which is not covered by the Tufts student health plan - she was told she would have to pay the $350 bill out of pocket.
Working with the doctor's office to help clear up miscommunication and re-categorize the nature of her visit, Julie has been seeking reimbursement from Aetna, the provider of student health insurance at Tufts, for nearly a year.
"Since then, there's been a huge ongoing insurance battle between me, my doctors' office and the insurance company," the sophomore said. "There are a bunch of things that I'm really unhappy with, with the student health insurance."
For students like Julie in Massachusetts with Qualifying Student Health Insurance Program (QSHIP) plans, oft-inadequate coverage and administrative difficulties can cloud the ultimate goal of receiving proper care and treatment.
Andrew Cohen, the community research coordinator for Boston-based healthcare advocacy group the Access Project, explained that legislation in 1989 under former Massachusetts Governor Michael Dukakis began requiring that all college students in the state have health insurance, either through private plans or by purchasing QSHIP plans through students' respective universities.
"When they were passing this mandate, there was a big problem with students not having enough insurance, and they made some basic guidelines that insurance had to follow to make sure that students were going to get good coverage," Cohen said.
The legislation passed nearly two decades ago, however, is now creating difficulties for current-day college students in Massachusetts.
"What might have been good for students at the time, in 1989, has not changed enough to keep up with the times and is now inadequate," he said. "For instance, on many of these student policies, they're inadequate because ... they have very low coverage caps."
The QSHIP coverage cap, which places a limit on the amount of treatment paid for by an insurance plan, is currently set at a minimum of $50,000 state-wide. The Tufts QSHIP coverage cap, however, is twice that of the minimum and is set at $100,000. The Tufts plan, which costs approximately $1,600 annually, also caps pharmacy costs at $1,500.
Tufts junior and Access Project intern Aaron Marden, who is working with students across Massachusetts to alleviate some of the problems associated with student health insurance, said that the financial terms of many QSHIP plans across Massachusetts can prevent students from seeking treatment.
"What I've been finding mostly with students is that they are pretty well aware of the possibility of getting screwed over, so what happens is they avoid care altogether, which is just horrible," he said. "Some [Tufts] kid spoke to me who said he tore his Achilles tendon and was avoiding surgery and basically walking around crippled."
"I guess the big thing is that these students are forced to buy plans that are broken, essentially," he added.
Marden also explained that if students under QSHIP plans receive expensive emergency care, they can be left with problems from lingering debt.
"These kids who are in debt, it goes to billing agencies, and then if they don't pay it or they can't pay it, it affects their credit," he said.
Julie has faced such a situation in trying to resolve her reimbursement troubles. "I had a collection agency come after my dad because he refused to pay [the bill that was supposed to be covered by Aetna]," she said.
Universities determine their own individual QSHIP plans through a bidding process, in which the school negotiates benefits and prices with insurance companiesstudents an affordable option should they not have private insurance, according to Senior Director of Tufts' Health and Wellness Services Michelle Bowdler.
In a recent bid process, Tufts determined that Aetna provided the best plan for students. "Aetna was the strongest, and we signed them again - and we got a better price for students this coming year," Bowdler said in an e-mail.
"[The company we have now] is so much better than the one we had five years ago," she added.
Because private insurance can be expensive, Bowdler explained that the QSHIP plan is a good option - particularly for graduate students, international students and those whose parents' plans place geographic limits on where students can be seen. According to Bowdler, over 2,000 students purchase the Tufts QSHIP plan each year.
Elizabeth Baltaro is one such student. After working as a teacher, Baltaro enrolled in Tufts' post-baccelaureate pre-medicine program last January and remained at Tufts through the summer. Having had a private insurance plan before coming to Tufts, Baltaro decided to try the student plan - and experienced many bumps along the way.
"At the very beginning, for example, I had trouble getting in the system and staying in the system," Baltaro said.
She explained that for her first several visits to the health clinic at Tufts, she was thought to be uninsured by officials there, despite a letter of confirmation from Aetna that she was enrolled in the insurance plan.
Both Baltaro and Julie acknowledged problems with getting care both off campus and during the Tufts' health clinic's off-hours. For Baltaro, the limited summer hours of the clinic at Tufts was cause for concern.
"Basically, the health clinic really wasn't as accessible during the summer, and that was scary to me because it's my first doctor all year round ... I don't have a choice about when I get sick, and if it happened in the summer time, that could be really bad," she said.
"I feel like if this is the primary option for graduate students who live here, then they ought to have some options for people who are here year-round and maybe who the clinic isn't the most convenient place to get to," she added.
Julie was similarly frustrated with off-campus limitations.
"As long as you're on campus and as long as you go to Inman Pharmacy, everything is covered," she said. "It's just - don't leave Tufts."
Baltaro also experienced difficulties when she began having prescriptions filled and realized she was paying full price rather than the discounted rate provided to her by the insurance plan. Like Julie, she contacted Aetna for reimbursement and experienced multiple delays.
"Basically, the whole summer was going by and I still hadn't heard from them [Aetna]," she said. "Nobody was helpful on the phone."
Eventually, Baltaro contacted Mary Daley, Business Supervisor of health service, to help speed up the reimbursement process. After months of waiting, Baltaro finally received her check.
Daley, who works with students and Aetna to resolve issues with referrals and billing, said that while extensive complications are relatively infrequent, she encourages Tufts students who take up issue with any aspect of their coverage to seek her help.
"It's kind of like a learning process for the student, too," she said. "I'm trying to teach them how to deal with insurance companies and make sure they document, get a name - make sure they know who they're talking to, so that if something comes up and it's not taken care of, they can fall back on their information."
Both Bowdler and Marden agreed that similar problems with health insurance are not Tufts-specific.
"Aaron and I are working together on what really is a very tough issue - giving the right insurance to the largest number of students we can at the best cost (since so many students have limited incomes)," Bowdler said.
"[These administrative problems] are with all health care systems and all health insurance," Marden said. "You have to be a really good self advocate or else you could be screwed over."
*Name has been changed due to student's ongoing correspondence with Aetna.
