Kim Bradford reviews her daily, comparative list of insurance policies seen at Sewanee. Photo by Max Saltman (C’21).
By Max Saltman
In late July, I received a letter at home in Massachusetts asking for $625, all for visits I’d paid to the Wellness Center during my sophomore year. I was shocked. I have health insurance, and I thought I was covered while in Sewanee. What I didn’t realize was that my plan wouldn’t cover care outside of New England (Massachusetts, New Hampshire, Vermont, Maine, Connecticut, and Rhode Island) unless I got a referral for out-of-region “urgent care” visits. More than a little annoyed, I paid Sewanee with money I’d made that summer and appealed to my insurance company.
My appeal worked, and I was happy to get my money, but I was mostly embarrassed. Embarrassed and curious; probably half of the ads on TV are for insurance companies, and healthcare has been a defining issue in the past three presidential election cycles. How did I know so little about insurance? Was my situation common at Sewanee?
I visited Sewanee’s resident insurance expert, Kim Bradford, in her office, nestled at the back edge of the University Wellness Center. Bradford is the university’s “Student Insurance Coordinator.” She’s the person who takes your call if you have a problem with insurance. It wasn’t our first time meeting; Bradford was the person who made sure I got my refund. I asked her if other students at Sewanee had similar problems with insurance.
“Absolutely,” said Bradford. “There’s a huge representation of types of insurance at here at Sewanee, and we see everything.” She further explained that while students may have the most common type of insurance, Blue Cross Blue Shield, with the most generous PPO, or Preferred Provider Organization, they still may not get full coverage at Sewanee.
“A student may have great insurance, with no restrictions, they can go to any provider in a BlueCross network,” she said, “But the family may have a $20,000 family deductible, or the individual may have a $10,000 deductible.”
A deductible? Bradford explained, “Think of your deductible as the money the patient has to pay before their insurance will start meeting what it agrees to cover.”
So, if you have a $10,000 deductible on BlueCross at a PPO, your insurance will most likely cover 80% of the costs. But since your deductible is so high, you may end up just paying out of pocket in order to help meet that $10,000 goal for medical expenses.
Bradford turned on her computer and opened an Excel spreadsheet. It was a big one, with three columns separated horizontally by dates going back until January 13. “I’ve just been keeping up with the types of insurance we’re seeing on a day-to-day basis since classes started.”
Each day had about fifteen or more different policies catalogued under it. Bradford pointed to the first column, which recorded the insurance brands seen on campus. “And you can see, scanning through, most of the ones we deal with daily are BlueCross/BlueShield. A lot of PPOs.”
A quick note: none of the information in the spreadsheet was confidential, and there were no names or Banner numbers. It was simply a list of policies.
The second column listed deductibles, and immediately, the size of the numbers caught my attention. 10,000, 5,000, 20,000 –many even had two numbers, one for the individual deductible and one for the family. Bradford drew my attention to one plan in particular. “Aetna – ChoicePlus, a $0 deductible, but there are no primary care providers for this patient in our area.” This means they would have to pay out of pocket if they came to the University Wellness Center.
I asked Bradford why she began keeping this list.
“I’m on my third year,” she said, “of just anecdotal phone conversations with parents and with students who are calling, asking if we have a student health insurance plan.”
Sewanee actually offered student health insurance less than ten years ago. Between 2006 and 2014, Sewanee provided its students a health insurance plan. The university stopped offering it in the summer of 2014 because the 2013 implementation of the Affordable Care Act made the plan unnecessary.
“The Affordable Care Act was a huge relief,” Bradford said, “Fewer people were going to be enrolled in the plan that we provided. We couldn’t try and keep the premium down for our students who needed it, but with the ACA, getting on insurance was not a problem.”
A premium is the monthly payment one makes to stay on their insurance policy. Bradford says she’s spoken with a father whose premium for a family of five was $35,000 a year. And his child wasn’t even covered by their plan to get medical treatment at the University Wellness Center. He had called to ask about a student health insurance plan.
Under the ACA initiatives, Bradford added, “you wouldn’t be seeing these $6,500 and $13,000 deductibles.” However, the overall cost of health insurance is rising again as the mandates in the ACA end. Bradford has seen the numbers grow first hand, and she and her colleagues in the Wellness Center believe that it’s time that Sewanee offers its students health insurance again. And after listening to her, I’m pretty convinced, too. I’m extremely lucky that I had the time and energy to get paid back for my out-of-pocket costs. But what about students who don’t have that time, or whose insurance won’t cover illness at Sewanee even with a referral?
“We’re seeing a lot more restrictive insurance coverages,” Bradford noted, including Medicaid plans from out of state that the Wellness Center isn’t able to bill. Many students have insurance and are fully covered, but Bradford said, “a huge majority are either under-insured or not insured at all.”
Under a student health insurance plan, every undergraduate would be enrolled, and premiums would be covered by financial aid. Those who have credible insurance that covers them at Sewanee would provide documentation to remain under that plan. In the industry, this is known as a “hard waiver,” and it’s put in place to make sure students have health insurance. This is the system used at other colleges that offer health insurance, schools like UNC, Washington and Lee, Davidson, and even our cross-state rival, Rhodes College. So do Morehouse College, Hendrix College, Spelman College, Southwestern University, and Trinity University. And that’s just in the Southeast.
Would tuition be raised to cover the premiums? Possibly, and it may be difficult to keep Sewanee’s generous promises about tuition with insurance premiums added to the cost of attending. Yet premiums would certainly lower if everyone is enrolled in the plan, and it seems more expensive to have to pay for medical expenses out of pocket if one’s insurance doesn’t work on campus. Uninsured or underinsured students may have trouble with retention, as well; Bradford pointed out that some families may have to choose between the costs of sending their children to school and medical bills.
The prospect of underinsured or uninsured students at Sewanee also seems more dangerous. Bradford has spoken with students who avoid going to the Wellness Center when they’re sick in order to avoid costs because their insurance won’t cover it.
“Healthcare can’t be a burden for students,” she said, “We’ve seen students put off coming to see us, and treatment periods can double in length and cost that student more in the long run.” Bradford stresses that every student has options, even if they’re under- or uninsured.
“My ideal vision,” she said, “Would be for all of our students to have health equity that is financially sound and sustainable. For everyone.”
It’s an admirable vision, and one we all should share. If we covered students in the past, it’s certainly possible again. Until new legislation protects Americans from rising medical costs, Sewanee should offer its students health insurance.