My Young Invincible, His Lost and Found Toe, and University Health Insurance That ‘Technically Isn’t’

IMG_1225 - Version 2Last fall I wrote about my 26-year-old son who lost his right big toe in a freakish university gym accident a day after his student health insurance officially took effect. (See my blog post Young Invincible Health Insurance Saga 10-5-13). He had aged out of my university job-based health insurance three months before and, much to my consternation, had ‘gone bare,’ unable to afford any of the health insurance plans available to him at that time. He signed up for the University of Washington’s School Health Insurance Plan (SHIP) as soon as he started in a graduate program there. As I drove him to the (University-affiliated) emergency department with his (found) toe, and then as a wonderful physician cheerfully sewed it back on, I breathed a huge sigh of relief that his SHIP would at least cover most of the cost.

Although, on second thought, as I wrote then:

“Even though he officially has health insurance to cover his expensive ED visit (X-rays, sutures, IV Vancomycin, physician quips) and ortho follow-up, I do not trust it. There are pages upon pages of exclusions to his health insurance plan, including bungee-jumping and intercollegiate sports–neither of which would seem to apply to losing a toe in ballet/karate. But I know how crafty and devious health insurance companies can be in trying to deny medical claims. I would hope that the university where I am employed and teach (and where my son is now a student) would have a decent health insurance plan option for its students. I guess I’m about to find out.”

And now, almost seven months later, I have discovered a very surprising answer: his university health insurance ‘technically isn’t health insurance.’ Silly us for assuming that something called a ‘Student Health Insurance Plan’ offered through a major U.S. public university was really health insurance!

This was explained to me today by a nice young representative who answered the phone at LifeWise, the insurance company that underwrites and administers University of Washington’s SHIP. I called to ask (nicely) how it was that they could still legally include a pre-existing condition exclusion since ACA/Obamacare requires insurance companies to cover people with pre-existing conditions (including the ‘pre-exisiting condition’ of being a woman, for which insurance companies charged more). I had done my homework on this, reading the user-friendly Healthcare.gov website to find that there was one exception to this rule: the benignly named ‘grandfathered individual health insurance plans.’ I wanted to know how SHIP could possibly qualify for this ‘grandfatherly’ exception category, and if they did, why they didn’t include that statement clearly in their information brochure as mandated by the ACA. LifeWise has hassled my son to prove that his torn off toe wasn’t a pre-existing condition and has refused to pay for some of his other healthcare claims.

The LifeWise representative’s answer was that they weren’t a grandfathered plan, but that they didn’t have to follow many of the ACA mandates because ‘technically this isn’t a health insurance plan, it is a disability plan.’ Huh? She went on to explain that the fine-print ‘Note’ clause on the front page of their consumer brochure ‘clearly states this.’ I had the brochure on the screen in front of me and sure enough, right under the large purple banner/title “University of Washington/ Seattle ‘SHIP’ Student Health Insurance Plan” it has a teeny tiny “Note:This coverage is blanket disability insurance. Coverage provided is “excess” only and does not contain a “coordination of benefits” provision.” 

That is so (not) clear and transparent for any self-respecting university-attending Young Invinsible, not to mention their University Professor parent who, oh I don’t know, perhaps has a doctorate in health policy? Now I happen to have both ‘real’ health insurance and ‘real’ disability insurance through my university job and I know the difference between them.When I asked the LifeWise representative to please explain how SHIP was really S-DIP I suppose, she replied that she really couldn’t explain it: “of the hundreds of different insurance plans I deal with, this is a unique policy.”

Unique indeed. How can a university (‘my’ university no less) offer what it clearly labels ‘student health insurance’ when it isn’t really health insurance and therefore doesn’t have to comply with current ACA mandates? What will it take for our country to get a saner health care system?

 

14 thoughts on “My Young Invincible, His Lost and Found Toe, and University Health Insurance That ‘Technically Isn’t’

  1. this is amazing. But most of all is that you have a 26 year old son!!!! h Heather Andersen, Ed.D. Principal, HumanSource http: //www.Humansource.net

    1624 7th Ave West Seattle, WA 98119

    Tel. 206-282-4492 Cell 206-963-8211

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  2. Thanks for the information. My 28 year old daughter will start the MSW program at the UW this coming fall. She has health issues that mean she needs to have health insurance. She just got a personal plan through a broker that is cheaper than any plan we have had before and provides good coverage. I had thought we might give that up but see now what a bad idea that would be.

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    1. Hi Judy,
      The UW has announced they will no longer be offering student health insurance starting next fall quarter. Or, I should qualify that: it will only be available (and still mandatory) for all international students.

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  3. “”What wil it taker for our country to get a saner health care system?”
    Surely, you pose a rhetorical question professor. English statesman Winston Churchill (mum was a yank and dad was a brit) is quoted “Americans can always be counted on doing the right thing, after trying every thing else”. We’ve tried HMO’s, PPO’s, HSA’s, now ACO’s, and we are in a bigger mess than ever.
    Hmm, we spend more on health care and have poorer outcomes than the rest of the world. What does the rest of the world do? They have two-tiered health care systems; one broad based tax-based system for all and a smaller private system for the “well-to-do”. Granted, the rest of the world struggles with health care costs but, they spend less and get better outcomes. This is a cursory examination, no doubt, however, the goal of a “sane” health care system should be clearly defined.
    Another quote, this one from Martin Luther King. “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”

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  4. I also have this “Insurance” and I can just say I am extremely thankful that my partner’s union job provides excellent coverage for me on his health plan. Otherwise I would not have made it through the ABSN program at the UW. I would just not have been able to afford to pay for the services I needed for a common health condition that came up unexpectedly.

    Now that I am in grad school at the UW I still have that same health insurance and I am doubly thankful for it. My options for treating a chronic condition that developed recently would have been prohibitive with just the SHIP coverage. I would have had to work full time just for the insurance coverage while trying to manage an illness. Where does graduate school fit in that plan? Not sure but taking care my health has to come first. I hope ACA will take care of these concerns but it is so new that I don’t trust it yet.

    I write this not to complain. I am very, very lucky and privileged. Most of my colleagues are up a creek with the SHIP coverage. Now that it is going away, who knows what will come.

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    1. Thanks for this perspective Jennifer. One of the interesting things though is that SHIP isn’t going away, except for students who are U.S. citizens. My understanding from UW is that all international students will still be required to sign up/be covered by SHIP or its equivalent as they are currently. I have someone in the Governor’s office looking into this and will post an update when I hear something more from them. Something about this just doesn’t add up.

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  5. Truly absurd situation! It is a sad day when insurnace – not- becomes so complicated even health policy experts are left scratching their heads. Sorry that your son had to go through this and for the concurrent hassle. Man.

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  6. Dr. Ensign,
    I was wondering if you had heard anything from the governor’s office?

    I registered for autumn quarter and got the following message in my email:

    “This is to confirm that you used the web today to update Insurance/Optional Charges for autumn quarter 2014 as shown below.

    STUDENT HEALTH INSURANCE

    The University optional student health insurance plan (SHIP) will terminate on September 19, 2014 and will not be offered for this or subsequent
    academic years.

    For coverage after September 19, SHIP termination serves as a ‘qualifying event’ that allows students to enroll for coverage through the
    Washington Health Benefit Exchange outside the open enrollment period. Students who are eligible for Medicaid (called Apple Health in Washington)
    may enroll anytime, even if SHIP coverage is still in effect.

    For more information, see the Student Health Insurance Plan Affordable Care web page (http://www.washington.edu/ship/affordable-care/) for links
    to the Washington Health Benefit Exchange website plus a coverage comparison tool that will determine whether you are eligible for free or
    subsidized coverage.”

    Thank you!

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    1. Yes, I finally got some follow-up on this issue earlier this week through the Governor’s Office (from someone in the Insurance Commissioner’s Office). My son was also notified this quarter that UW was phasing out SHIP starting fall quarter, but the ‘sister’ UW grad student ‘health insurance’ plan (also through LifeWise) is continuing to be offered–and they also stated that all international students will still be required to buy/have student ‘health insurance’ (I assume still through LifeWise). As the Insurance Commissioner’s office states below, it is essentially a case of ‘buyer beware.’ Which seems like a major cop-out to me, especially when the UW’s ‘technically not health insurance plan’ is specifically called a health insurance plan! I’m advising my son to apply for AppleHealth, which at least is a ‘real’ health insurance plan.
      Part of the note I got from the Governor’s Office:
      “Here is a link to the HHS regulations about student plans: http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/students02092011a.html. At the time the rule was issued the pre-x ban only applied to under 19. The ban did applied to student plans. I would expect the U of W plan to eliminate preexisting condition waiting periods when the group policy renews this fall. The plans are not technically health plans per RCW 48.43.005(26)(l). People need to review them to decide whether the plans meet their needs.

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      1. One thing I find disturbing is the lack of information provided to students. The first I heard of this happening was on this forum. Otherwise the notice above would’ve been a complete surprise to me. Also, the lack of support in signing up for the right plan is unsettling. There were all these outreach workers for people in the community. I wonder if they will be on campus for the thousands of students who will be going through this process? Not everyone has access to insurance outside of school and not everyone is the sterotypical young invincible college student. So this will be a daunting process for some. SHIP was the first “insurance” for many lower-income students. Now it is being taken away. I hope UW keeps that in mind and offers support. It is one thing to offer lip-service to “diversity”, and another thing all together to actually make it happen.

        Jinn

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