Dear Dr. Jeff: It seems like we have a different health insurance plan this year. I've gotten a little confused about coverage for referrals and lab tests. Can you help clarify? -T.K.
Dear T.K.: There are indeed some important differences between our old and our current insurance plans.
We used to have a mandatory plan. Everyone was covered by our plan (and charged for it) whether or not they had coverage through their parents' plan. Others didn't have other coverage, needed our plan, but wished it was more comprehensive. As a result, we changed to what's known as a "hard waiver" system, meaning that students are automatically enrolled in Bowdoin's plan, but can waive it if they prefer and have comparable coverage.
About 40 percent of students are now enrolled in Bowdoin's new Accident and Sickness Plan through Koster Insurance. About 60 percent have waived and will rely on their own policies.
The Bowdoin plan is effective from August 15, 2005 until August 15, 2006, including the times the College is not in session.
To repeat what I wrote in last week's column, all students, regardless of their insurance plan, have unlimited access to all of the services at the Health and Counseling Centers, free of charge.
Any service that requires off-campus care, however, such as a visit to a specialist, hospitalization, or send-out lab testing, will be billed to your insurance.
It's important that you bring your insurance card with you when you see us or any off-campus providers so that the billing can be handled appropriately.
If you have other insurance, your insurer may or may not require a referral for off-campus care, and they may or may not accept a referral from Dudley Coe. They may only allow you to see providers in their network. They also may or may not pay for send-out lab tests. It is up to you to call your insurance carrier and find out what they will allow. Their phone number is on the back of your insurance card.
If you have our plan, you must receive a referral for any off-campus care. Your providers here at Dudley Coe will take care of making your referral, as long as you see us prior to your off-campus visit.
If you see an off-campus provider without consulting us first for a referral, your Bowdoin plan will not cover your off-campus care. Important exceptions to this policy are when the Health Center is closed or when you are more than 50 miles away from campus. During those times, you can see any provider without a referral, and the charges will be covered.
If you see an outside provider, and that provider is part of the CCN Network, the Bowdoin plan will pay for 100 percent of the visit (up to the plan's maximum.) If the provider is not part of the CCN Network, the Bowdoin plan will cover 80 percent, and you will be responsible for the difference.
To learn if a provider is part of the CCN Network, you can visit www.ccnusa.com. For our plan, there are no co-pays or extra charges for send-out lab tests.
By the way, Bowdoin plan referrals are needed to see Dr. Avery at the Health Center, and for Physical Therapy for an injury not due to IC sports (even if the PT is with Todd on-campus).
If you need to visit the Emergency Room, and are covered by the Bowdoin plan, there will be a $50 co-pay (waived if admitted). Almost all other insurance plans will have a similar co-pay, but you should check with your provider specifically.
When you see an off-campus provider, or when you need send-out lab tests, the insurance "bill" will be sent to the insurance policy subscriber in the form of an "Explanation of Benefits" or EOB (it's the one that says across the top, "this is not a bill").
The EOB details the services provided and the amount to be billed. If you have Bowdoin's Plan, the EOB will be mailed to you at your campus address.
If you have other insurance, the EOB will be mailed to the subscriber's address (presumably your parents).
If your appointment or tests are confidential, and you don't want the subscriber to see the EOB, you must tell the provider's office not to bill your insurance and to send the bill directly to you (or simply pay at the time of the visit).
Please remember, as I mentioned last week, that Health Center lab tests which are confidential in nature, like pap tests, pregnancy tests, and STD tests for women and men, will be paid for by the Health Center and not charged out to any insurance plan.
For all student athletes, Bowdoin has secondary coverage for athletic injuries. Secondary coverage means that bills for your athletic injuries (again, injuries that require care beyond the scope of what is offered by Dudley Coe's clinicians) will be sent first to your regular (or "primary") insurer. If there is a balance of the bill that remains unpaid by your primary insurer, it can be sent to Bowdoin's secondary insurer (a special sports policy) for payment.
There will soon be updated information on the health section of Bowdoin's web site about how to handle bills for athletic injuries.
All of this information, including details on how to read an EOB, has been summarized in a series of handouts available at the Health Center. In addition, Insurance Coordinator Leslie Hill can help answer any insurance questions. you may have.
Leslie's office is on the second floor of Dudley Coe, and she can be reached at (207) 798-4284.
Please feel free to provide feedback on our new health insurance program to Leslie, or to Caitlin Gutheil, our Student Health Program Administrator (and virtual co-author of this column!).
We hope to have an insurance system in place that meets the majority of families' needs, and would truly welcome your suggestions as to how we can improve Bowdoin's insurance offerings.
Be well!
Jeff Benson, MD
Dudley Coe Health Center