College students go without healthcare

Etheldreda Collins, University of Memphis Medical Director, says about 60 percent of the students treated at the campus health center -- which served over half of The U of M's student body during the 1999 school year -- did not have any form of health insurance.

"Some students probably can't afford to go to school and get health insurance too," Collins said. "(The campus health center) is a tremendous service for the students, and the city ... because if they weren't coming here, they would be going to the emergency room or somewhere else, I would worry about the students who didn't have the resources. They may fall out of college."

Collins said a student does not need insurance to be treated at The U of M campus health center. Most medical services are provided to students at no cost. A few others entail a fee, but the center does not make a profit.

"Immunizations, such as the meningitis shot, sell for less than we

buy (them) for," she said.

Collins said health care insurance is a complex situation, and she's glad the campus health center doesn't deal with it. Collins, who is also a clinical instructor for internal medicine at Methodist hospitals, said she doesn't think students fully know all the services the health center offers them, and more services are consistently added -- many donated.

"Dr. Grogan, an allergist, comes out twice a year," Collins said. "He's not paid by The University, just a pure volunteer."

Collins said Grogan's service enables every U of M student to be tested for allergies free of charge twice a year, once in the fall and once in the spring.

Grogan is not the only volunteer. Collins said there are other specialists from the community who donate their expertise to the campus health center to help take care of students.

"Usually once a month, some of the resident physicians -- who do have their M.D. degrees and licenses -- come to the health center and make their service (of internal medicine care) available to students ... at no cost to the student or The University."

Many students said they can't afford to pay for medical insurance.

Junior Demetre Harris, 20, said he is among those uninsured for financial reasons.

"(Not having health coverage) is not a decision that I make, but right now, it's money issues," he said.

Harris, though, recently had a medical scare. He said he'd been experiencing chest pains for quite some time, especially after playing sports. A few weeks ago, after playing a game of basketball, the pain wouldn't stop.

Harris, who works part time, said his sister told him about a clinic downtown that bases the cost of care on his income. He said he wasn't aware of all of the services offered by the campus health center. Harris, who had a heart murmur at birth that it was thought he would outgrow, turned out to have a heart ailment called Wilke's Parkinson's Syndrome, which means his heart had an extra pathway of current, causing Harris years of chest pain. Harris needed an operation to close the extra pathway. He said being uninsured and needing a heart operation made him more nervous about money.

"I was kind of worried," he said. "I thought I had to pay for everything ... on top of a student loan."

Harris said he knows he got lucky. He said he paid $30 to $35 for office visits, and through the low-income program, had his surgery at Methodist Central.

"The cardiologist doesn't normally accept charity cases because he really doesn't get paid what he should (through the program)," Harris said. "However, the doctor, who had been seeing me for a month, worked with the cardiologist (who performed the operation) and somehow got me approved."

Harris acknowledges the importance of medical insurance coverage, but said he still doesn't plan to get any in the near future.

"I'm thinking about companies that may offer insurance after I graduate," he said. "I understand now that I need it, but I'm going to try to hold out for a few years."

Other students said money is a big issue for them as well, but luck and timing enabled them to have health insurance.

Delcenia Killion, 27, a sociology major with one child, said she grew up on state care. Although the state care program, TennCare, has undergone several policy and benefit changes in the past seven years, Killion said she still qualified as an adult.

"I applied for state care when it first turned over," Killion said. "I was eligible then, and I just renew it every year. It probably had a lot to do with my timing. If it weren't for a complete financial change in my life, they probably would have dropped me."

Killion said she takes care of her own and her child's medical needs through the TennCare program. However, she said she couldn't afford coverage if she did not qualify for state-sponsored insurance.

Another student, 23-year-old Chuck Holliday, a graduate student majoring in journalism, said he's always been covered under his mother's policy because he's a student. He hasn't had to seek other sources.

"I assume my mother's insurance is good because she works for a hospital," Holliday said. "It's not something I've thought a lot about ... other than contacts and dental visits. I've been fairly lucky as far as doctor visits, I guess because I'm pretty young, although I'm getting old."

Holliday said he is used to having eye exams and dental cleanings at no charge under his mother's plan. He said her policy covers him until he turns 24. However, lucky timing will keep him covered with no gaps. Holliday said he landed a job with The Desoto Times Today this past December. The company offers insurance that he plans to take out, and the 90-day grace period that allows his on-the-job coverage to begin coincides with his 24th birthday.

However, Holliday said the benefits will probably not be as good as he's used to under his mother's plan, and he understands how some students take chances by not having coverage.

"So I'll give back to them money I could be making, which makes me sometimes think about taking the risk," he said.

Holliday also said he's debating whether to take out the dental and vision coverage, services he said he's used to under his mother's plan, but ones that would cost extra through his new job's policy.

Other students who are covered under a parent's policy aren't quite as fortunate as Holliday.

Lindsay Hedgcorth, a 22-year old U of M senior majoring in human development, said although she is still covered under her father's policy, she had a taste of what it was like to be uninsured. She said her dad recently changed jobs, which left her uncovered for three or four months. Hedgcorth said she applied for the TBR coverage offered through The U of M to bridge the gap, but said it was a lot of trouble.

"I hate health insurance," she said, "I had to get it through The University and it was a pain. There were, like, 1,500 steps -- so much involved. It wasn't like walk in, get it and leave."

Now that the 90-day grace period on her father's new job has passed, Hedgcorth is covered under his plan. However, she said she wouldn't be covered for long because she graduates in May. She said her latest concern is that she'll have another gap in coverage. Hedgcorth won't begin teaching until the fall, which will leave her once again without coverage for at least the summer, and possibly longer if there's a grace period to fulfill with the insurance at the school system where she'll be teaching.

Hedgcorth, whose parents are separated, shares an apartment with her mother and her sister, Kelly. She said it was agreed that her father is to provide insurance for her, but she does not fault either of her parents for the brief lapse in coverage.

Just as single fathers sometimes carry the responsibility of providing insurance for their children, single mothers do the same.

Associate professor of journalism Candy Justice has two children attending college at Ole Miss. While they are less than two hours away, she said her insurance coverage, which is through The U of M, only provides coverage for them in an emergency situation because they attend school out of state.

Justice said her out-of-pocket expenses could quickly add up if one of her children became ill with something like strep throat or an ear infection.

"If they needed medication, antibiotics, I would have to pay $80 to 90 there (in Mississippi)," she said.

Justice, who is also the general manager for The Daily Helmsman, said there's a possibility she could purchase the medicine for less here in Memphis, but would have to find time to drive to Ole Miss or express-mail the antibiotics to her kids. This would add another $10 to $15 to the cost of the medicine. Justice said insurance companies should take mobility into consideration.

"They should take into account that all families aren't in one place, especially with divorce," Justice said. "Families can be in different places at different times. They may go visit the other parent who is out of state for a few weeks, and what if they get sick (while visiting)?"

Wanda Montgomery, an associate for The U of M benefits office, said 85 percent of U of M professors carry a HMO plan through Prudential, which has no deductible and a $5 co-pay. It also only covers the insured's dependent children in an emergency situation, whether they are in or out of state. She also said if a person uses a physician not on the provider list, the insurance company would pay only 70 percent of what they think the charges should have been.

"So if something costs a $1000 and they feel it should have only cost $500, they'll only pay 70 percent of the $500," Montgomery said.

Solving the math equation presented in this hypothetical scenario shows the insurance would pay $350, leaving the patient with a $650 bill on top of the $5 co-pay and normal monthly premium.

Montgomery said another option would be the premium plan, which would pay 90 percent of medical costs, even when the person has children who are out of state, as long as they call a 1-800 number before seeking medical help. However, this family coverage plan also has a $500 deductible which has to be met annually before the 90 percent payment takes effect, and it costs a little more than one and a half times the price of the HMO coverage, depending on the employee's income. Montgomery also said the deductible for the family plan will increase to $625 on Jan. 1, 2001.

"It allows you to have your freedom, but freedom comes at a price," Montgomery said.

She added she understands the challenges of an increased premium and deductible a single mother trying to carry a premium family plan would face.

"Sometimes it's bothersome to hand (the doctor's office) a (deductible amount), at the beginning of the year," Montgomery said. "However, maybe if you establish a relationship with your doctor's office, they'll make a payment plan for you."

Montgomery says she personally carries the Blue Cross/Blue Shield coverage, which provides the maximum choices of providers.

"I don't feel limited by the provider list," she said. "I've had them since the 70s, and they've worked for me."

Jim Mitchell, a former president of the American College Health Association, said the consumer has to be watchful because health care coverage has so many options.

"It's buyer beware, and making a mistake can be very, very costly," he said.

Mitchell said managed care plans, HMO's, have geographical limits and are virtually worthless for a college student away from home because they only provide for emergency care, and most students end up sick for non-emergency reasons.

Mitchell said parents must read their policies closely to ensure their child does not get dropped from coverage. He said most health plans have an age cutoff for dependent children, usually 23, or long enough to see them through college. When they reach that age, they are automatically dropped from the parent's plan. However, some health insurers, in an effort to cut costs, have reduced the age to 21 or 20.

If the child is under the age limit, parents should check further to make sure the child meets the conditions of the policy by taking the appropriate number of credit hours in school, Mitchell said. The cut off age typically applies only as long as your child is attending school full time.

Mitchell included a hypothetical situation to illustrate this point: If the plan's cut-off age is 23, and a 19-year-old attends college only part time, chances are he'll lose coverage. Each employer may have a different definition of full-time and part-time.

Mitchell said federal law allows dependent children who have been dropped from a parent's policy to buy an additional 18 months of coverage through COBRA. However, COBRA premiums are usually very expensive.

Many students who return to college are adult students who are too old to benefit from a parent's policy, or can't qualify for state care like Killion.

Usually, though, these students strive to maintain health insurance while going to school full-time.

Kelly Hedgcorth, 26, who has one semester left in Southwest Tennessee Community College's paralegal studies program and may transfer to The U of M, said her views on health insurance have changed.

"After I finished high school, I did not go straight to college," she said. "I just needed a break, and I was ready to be done. I worked full time for about four years. I just looked at it (health insurance) as another bill I didn't need."

Hedgcorth said she went without medical insurance for years, and just paid for routine tests as she got them. However, she said her mind was changed after a recent test came back inconclusive, and expenses for further testing began to add up.

"I would never go without it again," she said. "It's definitely worth it. I can see the importance now."

Hedgcorth, who works as a waitress while finishing school, said she has insurance through her job, and has no complaints about the coverage.

"It's fairly reasonable, about 20 bucks per week," she said.

Unlike many jobs that require 40 hours a week to be eligible for benefits, Hedgcorth said she can qualify for coverage by working an average of 25 to 30 hours per week, which she says is not a problem for her.

While Southwest Tennessee does not have a campus health center like The U of M, college students at either school can purchase a health insurance plan from the Tennessee Board of Regents because they're both state schools. However, students like Hedgecorth say they prefer getting insurance from other sources because of convenience.

She said her coverage through her waitress job is payroll deducted, so she really doesn't feel the pinch of paying out.

Another student who said he doesn't mind paying for his coverage is Sauren T. Mistry, a 25-year-old international student from India majoring in information systems.

Mistry purchased the TBR plan and said he was aware that it had limits when he signed up.

"You get what you pay for," Sauren said. "We have limited resources, coming from a developing country, so I planned to buy it when I got here."

However, Mistry said he has another way around the limitations.

"I have a background that helps me treat myself -- clinical medicine," he said "It's a lot easier and cheaper to get medicines in India. So far I haven't been to the doctor. I came with all types of drugs, tablets and medications from India."

Mistry said restrictions aren't as tight in India as they are in America. He said some drugs that are considered over-the-counter in India are prescription drugs in the United States, primarily because fewer people in India take advantage of the legal loopholes.

Another student who has the TBR coverage as his primary insurance said he has experienced some frustration with the plan.

Brian Scott Johns, a 31-year-old senior majoring in broadcast

journalism, said one problem is extensive paperwork.

"They make it as complicated as possible," he said. "Every time you go to the doctor, you have to fill out ten different forms."

Johns said he pays between $600 and $700 dollars per year for the coverage, yet still has to pay for physicals.

"Even I don't understand my insurance plan," Johns said. "I just wait for the bill to come and pay it. Sometimes you see charges and wonder what the hell they're for. I had six different bills for one visit."

Other students interviewed also experienced multiple billing.

Hedgcorth said getting bill after bill in the mail spurred her to get coverage. After her first inconclusive test, she said she received separate bills for the office visit, the test and the laboratory that analyzed the test results.

Johns said insurance companies should make the process more user-friendly.

"If you're paying for a service, the insurance company should take the burden of the paperwork, not the patient," Johns said. "The only things lower than attorneys are health care coverage providers. Personally, I wish the government would step in and burn (them)," he said.

For students who don't have medical coverage, representatives from all hospitals and service providers interviewed said a student, or anyone for that matter, wouldn't be turned away in a crisis situation.

Lorita Chambers, a clerk in patient services with The Southern College of Optometry said they would first refer a person with no coverage to private charity groups like Catholic Charities, or The East Memphis Lions Club. She said each case is evaluated on an individual basis, based on income and or circumstances. However, she said some programs, like Gamma Omnicron, tend to run out of funds.

The Church Health Center, like most organizations for the poor, charge according to a sliding fee scale according to the person's income.

One can also apply for TennCare, which now requires proof the person is not insurable where they are. However, one of TennCare's plans, Omnicare, will stop offering vision and dental coverage to its recipients. Montgomery said many of U of M's part time faculty ask her to write letters on their behalf stating they are not eligible for U of M's coverage plans due to their part time status. She said most of them get approved.

Other service providers said they would go ahead and take care of the person, but they may be faced with a bill that could lead them to a medical bankruptcy afterward. Teresa Daugs, a facilitator for Methodist Germantown said she would feel really sorry for someone who had to be admitted or treated without any insurance.

"A plain x-ray is $300 to $400, depending on what's x-rayed. A finger would be $300," she said.

Daugs also said a person without insurance may not get care as good as someone with coverage would.

"If they needed a CAT-scan, it costs about $2,000. Contrast would help the doctors get a more accurate reading, but a person with no insurance would probably not get the contrast," she said.

Daugs, a college student herself, said despite the fact she knows how bad the situation could become, she still doesn't have medical insurance.

"I try to watch every step I take," she said. "If we work for the hospital, they'll try to work with us on a payment plan."

Collins said she thinks because the campus health center is equipped to handle many illnesses and diagnose life-threatening ones, students are able to focus on their studies instead of finding a way to pay medical bills.

"There are a lot of students here who seem to be pulling themselves up," Collins said. "There are a lot of unknown and immeasurable effects here, but I believe we help keep students in school and keep them healthy."