Amanda Huff is in pain. She has impacted wisdom teeth, a notoriously painful condition that usually requires surgery. Residents of Massachusetts that make less than 32,000 dollars a year, like Huff, are eligible for Commonwealth Care, a low-cost, or in some cases free, health insurance plan sponsored by the state. This would be good news for Huff, if she weren’t a student.
“I can’t sleep very well because my mouth is in so much pain,” Huff said.
By state law, college and university students are not eligible for Commonwealth Care, but they arerequired to have either the Student Health Insurance Plan (SHIP), offered by their school or an alternate health plan with comparable coverage. Most students would qualify for much lower premiums from Commonwealth Care than the flat fee one-size-fits-all premium that school plans offer.
This policy forces people who have Commonwealth Care to drop it once they enroll in College. They are forced to stop seeing their own doctor or primary care provider, and purchase health insurance as part of their tuition. And so Huff is paying a $1,550 premium for an insurance plan that won’t cover the surgery she needs.
The plan offered by UMB is underwritten by Aetna, a health insurance giant that was recently fined in Arizona for a host of questionable practices, including failure to provide policyholders with information about their rights on appeals and services denials. Both UMB and Aetna claim on their websites that SHIP is tailored to fit the needs of students, but some students say that the coverage has gaping holes.
Huff discovered this the hard way. Although the brochure she received from Aetna said that benefits for wisdom teeth removal extend up to a hundred percent of the cost, the fine print specified otherwise.
“Basically what it boiled down to is that they will cover up to a 100 percent of $50 per tooth,” Huff said. “For something that will cost around $2,000, $50 per tooth is not a lot.”
Wisdom teeth usually start growing between the ages of 18 and 25, and so most people who need their wisdom teeth removed are also between these ages. Huff pointed out that SHIP has a more comprehensive coverage of chiropractic care than for wisdom teeth removal.
“How many normal college students have severe back problems and need a chiropractor?” Huff said.
Kathleen Golden-McAndrew, executive director of University Health Services, said that she is aware of the need to expand the coverage, but that adding coverage will likely impact the annual premiums.
“It’s a very difficult balance between cost and coverage,” said Golden -McAndrew. “The state is currently reviewing and monitoring SHIP coverage. We are interested in hearing about specific areas so we can assist in individual cases, and address them annually during premium review. We do look at utilization of the services offered by SHIP and we actually found that the coverage of chiropractic care is being utilized by students.”
Golden-McAndrew emphasized that Health Services can sometimes help students get care for medical problems that might not be covered by SHIP.
“Anyone that has any kind of medical concern, regardless of what kind of insurance they have, they need to come here and we can advocate for them. I don’t want to hear that someone’s out there is in pain. There are other resources available and we can help them explore other options for medical care in the Boston community. That’s what we’re here for.”
Students who have SHIP get the majority of their medical needs at the campus Health Services, where they are most often seen by nurse practitioners. This presents a problem in a place like UMB, where most students are commuters. Students who have SHIP find themselves traveling in poor health, often from out of the city, for medical exams and prescriptions when they need them. Huff experienced this problem last semester.
“I was really sick and it turned out I had mono, and instead of being able to go to a doctor close to where I live, in Brookline, I had to travel 45 minutes on two different train lines to come here to see a nurse practitioner.”
Mono is contagious and many schools across the country specifically prohibit students who have it from coming to classes. But in Massachusetts, sick students are forced to come to campus for care and by doing so they can increase the chances of exposing their peers.
Golden-McAndrew said that having students come in to campus for care has to do with cost saving. She explained that there are some exceptions.
“If ever a student believes he or she is too ill to commute to the University, it is best for them to call in to Health Services first and talk to the triage registered nurse or a nurse practitioner who may be able to assist with options of care delivery.”
Huff no longer has mono, but her wisdom teeth have now grown into her sinuses. This semester she bought into the Delta Dental insurance offered through the University, hoping to be able to get the teeth removed, but she was turned down by the dental insurance as well because she did not “display enough symptoms of pain”..”