<p>My son a freshman in Columbia tries to waive his medical insurance since his mom working for Duke University has a Duke Select family coverage. His request is denied due to the reasons below. I would appreciate your suggestions how to appeal. </p>
<p>---response from CU
The Insurance Office has carefully reviewed your request to waive the Columbia Student Medical Insurance Plan for the 2013-14 coverage period. Your request to waive has been denied as your insurance plan with Duke Select has been determined not to be comparable to the Universitys plan because it only provides emergency care outside your local area.</p>
<p>The University requires that students have access to routine specialty care in New York City that cannot be provided at Columbia Health.</p>
<p>I looked up your plan on line and Columbia may be right. Duke Select doesn’t provide out of network care except in emergencies. You need to call them and see if they cooperate with another national network like MedImpact or PHCS to provide OOS in-network treatment. That’s what we had to do for our kids. It was quite the ordeal to get it all straight. </p>
<p>If they really don’t have in-network providers, your wife needs to switch plans if you want it waived next year. I searched on the BlueCross plan and they have doctors in the same zip code as Columbia.</p>
<p>But call Duke Select first to see if they cooperate with another network out of state. As I said, ours (Harvard-Pilgrim) did. You’re not likely going to be able to switch health plans in the middle of a plan year. If they don’t have an in network option, you’re going to have to buy the Columbia plan for 2013-2014.</p>
It’s worth trying to call this a significant enough of an event (son moving elsewhere) to see if the plan administrators will permit a change outside of the normal switch time. They might be willing to do it for this (IMO they ‘should’ do it for this).</p>
<p>Also, IMO (not that anyone asked), a college shouldn’t require anything other than emergency coverage to permit a waiver. Outside of an emergency type of situation there’s really no need for most students to see a doc in the area of the college. Students (maybe most) can and do typically schedule their more routine doctor visits with their established doctors in their hometowns when they come back on breaks. Somehow I think the college makes some money out of this deal.</p>
<p>Good idea about trying to call this a significant enough event. </p>
<p>Student health generally provides non-emergency medical care like routine illness, injury, food poisoning (really a bigger problem than generally acknowledged), and mental health services. You don’t need an emergency room to treat strepped throat or to lie on a gurney with an IV. It’s way too expensive.</p>
<p>I can see why the university wants students to have access to comprehensive medical services beyond emergency. You hope they won’t need it, but sometimes they do. My normally healthy D was injured while at school and needed to go to an orthopedist three times last semester. It wasn’t an “emergency” exactly, but it wasn’t something the college health center could handle either. Having to travel home and back to see an in-network orthopedist would really have disrupted her education, and it wouldn’t have been cheap either.</p>
Totally disagree with this. As noted, there are many non-emergency circumstances that could require ongoing medical care and can’t wait for a trip home. The student in this case would be left with the choice of foregoing care or paying completely out of pocket (in NYC!)–neither one a good option. And if the concern is that the college is somehow profiting from the insurance plan (in my experience the college health plans are competitive with other options pricewise), the alternative is to secure coverage elsewhere.</p>
<p>I think anything outside of an emergency situation should be left up to the family to decide how to handle - not the big brother of the college.</p>
<p>I don’t think it’s any of the college’s business how the family decides to handle this type of personal situation.</p>
<p>I’ve never heard of a plan that only covers emergencies outside of a certain zip code. Ours have always covered anything, anywhere, with in the US at least. We might have to go out of network and pay a little more if in an area with few options but that’s it.</p>
<p>IMO if S determines he needs care (mental health…broken bone…major but treatable disease like strep) but it’s not covered and he can’t pay for it, that affects his education and thus Columbia has an interest.</p>
<p>When S1 was at Chicago, they not only wanted verification that routine stiff would be covered by our plan in Chicago, but also they had checks on the percentage covered – for most things, Chicago wanted to see 80% coverage, including for mental health visits (which was by and large not the case when he was heading off to school).</p>
<p>We have friends whose coverage only covers visits with a certain geographic region. For folks who are in small group or individual plans, these may be the only plans that are available/affordable.</p>
<p>Don’t know about New York, but many states have laws requiring college students to have health insurance meeting some minimum standards. Generally, emergency only coverage will not meet those minimum standards.</p>
<p>If one does not like the policies of a particular college, one can always decline to attend.</p>
AFIK most colleges have this health coverage requirement so they have the students (and families) over the barrel on this and the students have limited choices so they have to abide whether they want to or not due to this extortion. But you’re right - they can always just not go to any of those colleges if they don’t like it which we all know isn’t a practical solution so we pay (or have outside coverage they’ll ‘accept’).</p>
<p>^^ I’m not sure whether it’s a state law in my state. I’ll check on that. If so, it’s a silly law but there are plenty of those nanny type of laws.</p>
<p>I’m able to figure out the recourse without these basics being pointed out to me.</p>
<p>I worked in student affairs at Columbia for 2 years (I am a grad student here), and there were MANY cases I saw where a student needed non-emergency care in the vicinity of New York for various reasons. Emergency care only stabilizes you; sometimes the student needs ongoing procedures or care but can’t afford to go home and disrupt the entire semester. One example from me personally is I developed a pilonidal abscess; I went to the ER to have it incised, but I had to have follow-up care afterwards that was provided at a doctor’s office. I wouldn’t have wanted to buy a plane ticket and fly home for that.</p>
<p>It’s not about extortion; it’s about making sure that students are safe and healthy and have access to care when they are on campus. Having the option to see an orthopedist if you get hit by a car, a physical therapist if you have a sports injury, a neurologist for persistent debilitating back pain or a psychiatrist if you can’t get the school CPS to work for you is a pretty basic thing that you want your child to have access to (and I’ve seen all of these things happen).</p>
<p>This is becoming a big issue. Some family insurances are now dropping students from coverage if the student attends a college that requires insurance, stating that the student needs to get his insurance that away instead of freeloading off the parent’s insurance. I was incredulous when I first heard about this, and have subsequently heard about more cases. There is a lot going on here.</p>
<p>As it stands right now, a college can require what it pleases in terms of insurance from students. How it would hold up in a challenge, I dont’ know, but it’s untested territory. There is so much going on in this field. I don’t think it’s any business of a school to dictate what sort of care is covered under a policy, and the fact of the matter is that it’s up to a family and student as to whether they want to cover a member in a certain way or not. Ironically, it has been to some people’s advantage not to be covered. Medicaid can be an advantage at times.</p>