PSU healthcare may not measure up

Portland State students whose only health insurance is the Basic Health Plan provided by the University are putting themselves at serious financial risk. However, even those students who cover their bases by purchasing the Extended Plan could end up paying a lot more out-of-pocket expenses than they expect if they become sick or injured.

“The Basic Plan is good for being paired with other coverage, such as insurance through a parent or spouse,” said Mary Beth Collins, director of counseling and psychological services at the office of student affairs. “It will sometimes cover the deductible, or help get you in the door [of a doctor’s office]. What lots of students don’t understand is that the Basic Plan is way, way inadequate for major medical.”

All students taking nine credit hours or more are automatically billed a student health fee and enrolled in the Basic Plan. This gives them access to the Student Health Services at 1880 SW Sixth Ave., as well as some coverage for major events like hospitalization and surgery. The Basic Plan does not cover prescriptions, shots, intensive care, nurse services or inpatient anesthesia, and pays $20 on a maximum of five visits to physicians, physiotherapy, psychotherapy, treatment of substance abuse and prenatal care. The Basic Plan covers 80 percent of the cost for up to three days of hospitalization, and 50 percent of surgeon fees up to $2500.

According to Christi Zeigler of Acordia Somerton Student Insurance Services, the company that provides the coverage, 14,465 students enrolled in the Basic Plan during the Fall 2005 quarter, 965 of whom were international students. During the same quarter, 824 of the 1,324 students enrolled in the Extended Plan were international. Only 500 of the 13,500 domestic students in the Basic Plan opted to pay another $70 a month for the additional coverage of the Extended Plan.

“The Basic Plan is barebones,” said Karen Seccombe, director of Portland State’s center for public health studies, “It’s better than nothing, but it’s really not adequate coverage. If this is all they have, students are gambling. I teach classes on health insurance, and I can tell you anecdotally that less than half of my students have other additional coverage.”

All students enrolled in the Basic Plan have the option of buying the Extended Plan. Although this coverage is, according to Collins, “on par with major medical,” students who purchase the Extended Plan should be prepared for significant out-of-pocket expenses if they become ill or injured.

Erin Braithwaite, a post-bac student completing her premed requirements at PSU, thought she was covering her bases by enrolling in the Extended Plan. Then, in January of 2005, she went to the emergency room with abdominal pains so severe she could not walk. “Even before I went, I tried to call and find out which hospital I should go to, to make sure the insurance would cover it. But the phone system wasn’t easy, and I was in so much pain I couldn’t deal with it. I had to have my neighbor drive me to the OHSU ER, which was closest – It definitely felt like an emergency.”

To this day, Braithwaite does not know whether she had a kidney stone or a burst ovarian cyst. “The pain subsided a little once I got there, but they wanted to keep me there under observation. I was worried about the cost, so I refused an ultrasound and some other tests.”

A few weeks later, Braithwaite received a bill for “about a thousand dollars, and that was after the insurance had paid their share. They paid for the doctor, but not the room, and then there was the deductible. I called the insurance company, and I was really angry. The rep was really apologetic, and she basically said it was a bottom of the barrel plan, one of their lowest plans.”

Ultimately, Braithwaite’s parents had to help her pay the emergency room bill. “I’m lucky that my parents were in a position to do that,” she said.

That same month, Braithwaite had to wrangle with the insurance company again over the bill for her annual well-woman exam, a routine cervical cancer screening that insurers are legally required to cover. “They sent me a $300 bill when I tried to stay with my regular doctor, who was on their preferred provider list. I had to get my provider to go to bat for me to get them to pay. I had to call them time after time, and it turned out they had me down on the Basic Plan, even though I’d paid for the Extended.”

Braithwaite estimates that she spent somewhere between $1200 and $1300 on healthcare last January, in addition to her Extended Plan premium for Winter Quarter, which was over $200. In the end, she went looking for a part-time job that would provide her with better insurance, and dropped her PSU coverage.

“The extended coverage is on par with major medical. I don’t know why anyone would call it ‘bottom of the barrel,'” Collins said. “If a student has the Extended Plan, and has a medical emergency that is considered sickness, there is no facility coverage, and there is an additional $500 deductible. However, the plan does cover 80 percent of the costs if the student goes to a preferred provider. A list of preferred providers is available on the Student Health website. There may also be problems if the student goes to the emergency room when they could have gone to urgent care.”

According to Zeigler, “In the 04-05 policy year [the year Braithwaite went to the emergency room], facility charges were excluded on the plan. But the 05-06 year they are not. The facility charge is actually part of the ER charge.”

“The Extended Plan is still a minimum,” Seccombe said. “The student pays 20 percent, which is still plenty of out-of-pocket expense. The Extended Plan is comparable to some of the weaker programs that an employer would offer. There’s a maximum payment of $50,000 [per injury], which isn’t much. Major surgery can cost more than $50,000. In one of my classes, I had a student who’d had a shoulder incident that cost more than $50,000. Most employers will pay more than $1 million.”

“This is a student plan, not an employee benefit plan,” Zeigler said, “Student plans are intended for the average, healthy, 4-year student. Obviously, there will be people with severe injuries and illnesses, and students who take longer than 4 years, etcetera. But these plans are built to be affordable for the average, healthy student."

According to Zeigler, a typical employee plan would have a higher maximum, but would also demand a much higher deductible than $150, which is what PSU students on the Extended Plan pay.

Zeigler, Collins, and Seccombe expressed concern that many students do not understand how health insurance works.

“The terms of benefits are available, but many students are busy,” Seccombe said. “They don’t know the ins and outs of plan, and just assume they’re covered.”

“One thing students don’t understand is that they can’t get sick and then buy insurance,” Collins said. “The Extended Plan has a preexisting condition clause. Students must have the insurance for six months before it will kick in [and cover a problem they already had when they first enrolled].”

Neal Wallace, assistant professor of public administration at the College of Urban and Public Affairs, said, “There’s nothing about the PSU plan that’s so bad. If you want more, you have to pay more. The real difficulty is the tremendous expense of healthcare. Given the costs, 20 percent can be huge now, and it’s certainly worse for students to have to pay that.”

According to Seccombe, healthcare costs in the United States are rising by 10 percent to 15 percent a year. “Healthcare is one of the major social issues we are facing. Many strikes are now based on healthcare benefits rather than wages – PSU is to be applauded for being concerned with providing a minimum floor, but Portland State’s is not really good coverage.”