CAMPUS CARE QUESTIONS AND ANSWERS FROM DAVID WURSTER

The following questions were submitted from the GEO membership to David Wurster, Director of Campus Care, for the February 25th General Membership Meeting in which he answered the questions in person.  Some questions were not covered due to Wurster needing to leave the meeting.

We hope to address the remaining questions in the upcoming Labor Management Meetings.  If you have questions or concerns with your Campus Care coverage, please let the GEO know!  We can help.  Also, if you’d like to improve the quality of Campus Care through the GEO’s Health Care Working Group, we’re always looking for new members.  Email geo@ to learn more.

Campus Care Questions and Answers from meeting on 2/26–compiled

• Why can’t Campus Care cover birth control over the summer?  We understand that it’s covered under the Student Health Services Fee during the regular school year, but we don’t understand why Campus Care can’t add coverage for this basic care during the summer.

1. 1. If contraceptives were added to Campus Care, there would have to be a $50 increase in the premium per semester.

   2. This is something we can advocate for if enough of our members want to.

• We understand that the maximum amount of coverage was recently increased to 2 million per year and Campus Care experienced some losses as a result of that caused the maximum amount of coverage to go back down to $500,000 lifetime.  Was there no middle ground considered here, like $500,000 per year or 2 million lifetime?  It’s such a huge leap to go from 2 million per year to only $500,000 lifetime – we would like more information about how these decisions are made and why we can’t take steps toward providing more coverage without doing it in an unsustainable way, which is what seemed to happen with the large increase to 2 million per year.  

1. 1. It seems unlikely that the lifetime limit will be increased because the losses to monetary reserves that happened when they increased the limit to 2 million yearly.  Campus Care must have a certain amount of dollars in reserve to cover claims, and they have decreased the lifetime limit back to $500,000 to meet this requirement.

• How can we request changes to coverages like those mentioned above?

1. 1. In order to understand the decision-making process better, we can try to speak to student representatives on the Campus Care Oversight Committee, which is a part of the Student Fee Advisory Committee.  The SFAC is comprised of 4 students and 9 faculty/staff members.  If we make a request that the SFAC wants to take up, they will make a recommendation for a change in coverage, which must then be approved by the Board of Trustees.

   2. The GEO will also be pursuing

• The Campus Care website is confusing to us regarding emergency coverage at Advocate Hospitals in the Chicago area.  Are we correct in understanding that we would be covered for the same cost as going to a University Hospital unless the care is performed by an independent contractor at Advocate?

1. 1. Facility charges assessed by employed doctor or facility are considered IN NETWORK.

   2. Any charges incurred by independent contractor physicians: students have to pay OUT OF NETWORK.

• Why does Advocate have independent contractors who are billed separately?  Can this be changed to make billing more transparent and fair?

1. 1. The independent contractor setup is the result of a ruling by the Federal Trade Commission.  While we don’t have all the details, Campus Care representatives made it clear that due to this law, no changes in the way independent contractors are billed would be forthcoming.

• How can patients easily determine who is an independent contractor at Advocate Hospitals?

1. 1. You can’t. There is no way of determining who is an independent contractor without asking.

   2. There are over 2500 independent physicians in the Advocate system (about 50% of their total physicians), most of which are hospital-based providers like anesthesiologists and radiologists.

   3. If you have a claim that exceeds $5000, you can contact Campus Care to see if they will negotiate on your behalf to get a reduction in charges.  If Campus Care negotiates a reduction in charges, it will apply to your deductible.  For example, if there is a 30% discount, that discount will apply to your deductible so you will pay 30% less.

   4. You can also try to contact Advocate to ask if they will write off the costs of health care since we are students who are not paid very much.

• What sort of sensitivity/diversity training do employees of the University Hospitals and Family Medicine Centers receive?  

1. 1. Ethics training (like all University employees)

   2. Wurster recommends that if a member feels s/he was treated with insensitivity or was discriminated against, first contact: Dr. John Hickner of Family Medicine, and if the problem is not resolved, then contact the Office of Access and Equity to make a formal complaint.

   3. While Dr. Wurster suggests contacting Dr. Hickner or the Office of Access and Equity, the GEO recommends contacting our office before filing any complaints with those the university.  The GEO can help walk you through the process and be an advocate who only has a vested interest in helping you, as opposed to Dr. Hickner and the Office of Access and Equity, who have a vested interest in protecting the University/Campus Care.

• What laws govern Campus Care?  They don’t have to comply with ACA, or the state it seems, so are there any laws that do govern it?

1. 1. Campus Care is governed by the Religious and Charitable Trust Risk Pooling Act, the details of which are available here:  http://www.ilga.gov/legislation/ilcs/ilcs3.asp?ActID=1271&ChapterID=22.

   2. The GEO will be working to better understand how this act operates and whether areas exist for improving coverage as a result of it.

   3. Campus Care is NOT, in general, governed by the Affordable Care Act.  There are some areas in which coverages offered by Campus Care are mandatory because the Affordable Care Act mandates that any entity providing a “minimal essential coverage plan” adhere to certain standards, but they are not a legal insurance company, so most of the provisions of the ACA do not apply to them.

   4. Dr. Wurster suggested that changes to the laws in this area are forthcoming as a result of the Affordable Care Act, and would be effective during the 2015-2016 academic year.

• What are the legal financial responsibilities of Campus Care, since they’re not a legal insurance company?

1. 1. Dr. Wurster was vague on the details, but we do know that Campus Care must abide by the act listed above, which requires that they have a certain amount of dollars in reserve in order to cover claims.

• Why are the premiums to add dependents so high (more than twice to add a spouse, almost twice to add a child)?

1. 1. This is the case for most insurance plans offered by employers for employees.  The employer subsidizes the costs for the employee more than they do the costs for additional dependents.

• How much do other comparable programs to Campus Care cost at other universities?

1. 1. All of this premium information comes from Campus Care itself, so we may want to take it with a grain of salt:

      1. University of Wisconsin:  $2200 for students, $6500 for spouses, and $7500 for children.

      2. Rush University:  $2300 for students, $5600 for spouses, $4500 for one child, and $6800 for multiple children

      3. University of Chicago:  $3000 for students, $5100 for spouses, and $5100 for children.

      4. Northwestern University:  $3800 for students, $7600 for spouses, and $4795 for children.

      5. All of these plans have deductibles of $250 or more and coinsurance of 12%, except for the University of Chicago, where the coinsurance is 10%.

• Counseling center lifetime limit – why is it so short?

1. 1. For mental health services, students receive 20 free sessions (additional sessions granted on a case-by-case basis; the clinician can make an appeal to continue seeing patient)

   2. Students who require additional therapy/mental health services will be referred to the Neuropsych Institute (NPI), though there are some capacity and staffing issues. Any member for whom mental health services would be medically/clinically necessary will receive treatment

      1. If the patient cannot be treated in-network, they will be provided with the necessary care out-of-network at in-network rate 

• Why aren’t biological sera (blood, red blood cells, platelets, plasma, etc) covered by Campus Care on an outpatient basis? These are often medically necessary, and when withheld, result in the need for re-hospitalization/medical emergencies. (See p. 18 of the 2013/2014 Certificate of Coverage)

1. 1. Too expensive

   2. Wurster mentioned that the policy seemed strange, but it remains on the books.

   3. This might be an area in which we can make a request for increased coverage. 

• Is it possible to set up an online scheduling program for Family Medicine Center?  

1. 1. No 

• Are students covered during the winter break?

1. 1. Yes.

   2. Coverage ends at midnight the day before spring semester begins, and coverage for spring semester begins at 12:01 a.m. on the first day of spring semester, so there should be no gaps in coverage during the regular school year.

1. Referrals outside of network for unavailable or overbooked specialists – are they available and how do we access them?  Sometimes it takes a long time to a specialist.  What are our options and how do we ensure that we’re covered if we go outside the system?

   1. Campus Care does approve referrals for outside specialists, but you must have prior approval.  This can happen when a specialist is not available in-network, or the wait to see an in-network specialist is too long (as determined by medical necessity).

   2. Who to call for this 

• Why is the prescription cap so low when prescriptions are filled in house and don’t cost UIC as much?

1. 1. 1% of students are hitting the max for prescriptions.  Campus Care pays the pharmacy the average wholesale price, so it’s not cheaper in that regard, but they pharmacy doesn’t charge a dispensary fee as most pharmacies do, so it’s slightly cheaper in that regard.   The pharmacy will work with students to help them find cheaper alternatives.

   2. Changes to the limit may be forthcoming as the Affordable Care Act may say all health plan providers have to increase the coverage limit.

• Why are visits to nutrition and wellness centers not covered under Campus Care?

1. 1. These are covered under the Student Health Services Fee.

• Why can’t we access the state employee pool insurance?

1. 1. There is a law stating students cannot join that pool. 

Questions that remain unanswered:

1. Continuity in care:  how can you ensure that you have the same doctor when you go to Family Medicine Center?

2. Lack of available services for pregnant women; we know several members who had to wait until around 4 months to receive a sonogram due to Campus Care’s coverage.  Why are they expected to wait so long to receive this necessary care?

3. Can we have a formal appeal process for denied coverage or other Campus Care complaints?

4. We understand that foot orthotics aren’t covered as a matter of course, but why aren’t they covered when they’re needed as a result of surgery?

5. Can patients request a pediatrician specifically for newborns/children, or must they see a general practitioner at Family Medicine?

6. Are there mental health services on West Campus?  By seeing a therapist, will our deductible drain faster?

7. Billing is confusing – can we get a simplified explanation of benefits that’s made available through the Campus Care website?

8. Why isn’t there urgent care during the day?  What are coverage benefits for urgent care?

9. Why is birth control so expensive?  Why are IUDs covered but my BCP is $50 a month?

10. Why is Campus Care not a licensed insurance plan?  How can we trust it if our coverage is so subjective?

11. Why does it take longer to get an appt at Family Medicine if you have Campus Care as compared to if you have other insurance?