HMOs prove viable option for students

By Raya Tahan
Arizona Daily Wildcat
January 31, 1996

Karen C. Tully
Arizona Daily Wildcat

Lori Piper, insurance coordinator for Campus Health Services


HMOs have been scrutinized across the country lately.

How does the University of Arizona's measure up?

Arizona has 11 health maintenance organizations designed to bridge patients, physicians and insurance companies into one network.

Campus Health Partners, offered at the Campus Health Center (formerly the Student Health Center), is administered through Partners Health Plan, the state's fourth-largest HMO.

A Gallup Healthcare Poll administered last fall found that 86 percent of Arizonans who received medical care from an HMO were somewhat or very satisfied with the health care they received. The findings were consistent with those of past surveys.

Joyce Meder, assistant director for health and wellness at the Campus Health Center, said, "Students covered under Campus Health Partners seem to be satisfied."

Campus Health Partners is reviewed every one to three years by the National Committee for Quality Assurance. It assesses the center for quality of care and patient satisfaction. It then determines whether the plan should continue to be accredited, Meder s aid.

The most common complaint about the plan, Meder said, involves the registration procedure. It is available only via RSVP during the time of course registration. The 14th day of each semester is the last day to enroll for the plan. The deadline this semest er was Jan. 25.

"All of a sudden, students realize that the time frame is closed and they didn't know they could only do it then," she said.

But students can sign up anytime during the semester if they are dropped from another insurance program, said Lori Piper, campus health insurance coordinator.

This sometimes happens if students get married, have a child, or get too old to be carried on their parents' insurance policy. Piper said the age limit varies, but when students turn 23 or 24, they are dropped from their parents' policies, full-time stude nt or not.

Piper said this is the main reason students show up mid-semester looking for health insurance.

To qualify, students have 30 days from the time they lose their insurance to apply for Campus Health Partners.

Five thousand UA students are enrolled in the plan, which costs $354 for the spring 1996 semester and continues coverage through Aug. 15, she said.

The fee is prorated for anyone signing up after the deadline. The fee for a student who registered today would be $329.52. Married students who wish to include their spouses in the plan pay $1,142. Single parents who wish to include their children pay $1, 997 for themselves and all children, and students with a family pay $1,411 to cover themselves, their spouse and all children.

Undergraduate students must be taking at least five units to automatically qualify for Campus Health Partners. Graduate students must be enrolled in a graduate program.

The costs, benefits and terms of Campus Health Partners differ from the regular Partners HMO. A bridging option allows recent UA graduates to transfer their Campus Health Partners plan to Partners HMO after graduation.

The question of where HMO patient complaints should be directed is under debate. Currently, no single state agency is responsible for overseeing HMOs. The State Health Department and Department of Insurance are two places to present complaints as the matt er is being debated. Complaints should initially be taken to the individual physician and HMO, said Sen. Ann Day of Tucson, chairperson of the Senate Health Committee.

The supposed advantage of HMOs over traditional medical coverage is a cost reduction to the patients. However, some think this is accomplished by compromising convenience and sometimes even needed medical care.

Tucson pediatrician Eve Shapiro said, "My concern is when it's a for-profit corporation, that profit is still the goal and health care takes a secondary role to that. It often pits the doctor against the patient."

Most HMOs, including Partners, discourage their doctors from using hospitals, specialists and other expensive care by giving bonuses for not doing so. Yet this information is not released to the patients, according to information obtained by The Arizona D aily Star.

Meder said the policy does not carry over into the Campus Health Partners plan, although the doctors are reviewed for cost-saving purposes. Campus Health physicians actually receive a straight salary, rather than a per-patient reimbursement.

"We have a limited budget here. Our doctors don't get bonuses for anything," she said.

A Partners disclosure form states that the organization "does not compensate its plan providers in any manner where the physician would have any reason to withhold services or limit medically necessary referrals to specialists or other providers."

Dr. Harvey Buchsbaum, a medical director for Partners Health Plan, said the bonuses are designed to encourage physicians to provide more preventative care such as immunizations and regular checkups, rather than to deny patients necessary care.

"Physicians have always been reimbursed for taking care of sick people," he said. "We're trying to switch the paradigm, to say we'll reward you to keep people well."

Pediatrician Susan Dolby said she approves of Partners' use of bonuses for patient satisfaction, but she disapproves of bonuses which encourage doctors to minimize special care.

"I think it's a real blatant conflict of interest," she said.

Shapiro said, "It's true that HMOs pay for immunizations, which is a very big positive, and they do stress preventative care."

Lab tests at the Campus Health Center cost anywhere from $7 to over $80 for uninsured patients, Meder said. Most are fully covered by Campus Health Partners. X-rays, which cost $40 to $100, are fully covered by the plan. For a gynecological general exam w hich costs $37, the plan covers $27 with the patient responsible for a $10 co-pay. A co-pay is also used to lower specialist charges, including dermatology and physical therapy.

Many of these services, such as blood work or urinalysis, must be initiated by the physician to be covered by the plan.

"We don't want health care providers to make unnecessary referrals," Meder said. "If someone says 'I'm really tired, I want to get my blood checked,' the doctor or nurse could talk to that person for 15 minutes about eating habits and sleep. The problem c ould be resolved without that test."

Many basic office visits and services are free for any UA student seen at Campus Health. Medicine from the pharmacy is not, however, and is not covered under the Campus Health Partners plan.

Students who are covered by medical insurance other than Campus Health Partners may also be free from paying many charges, depending upon their plans.

Meder said joining Campus Health Partners is an advantage to students whose families are covered by an HMO at home but whose plan does not include care done outside of their geographical area.

The plan's emergency and urgent care procedures could be a disadvantage.

The on-campus health center is only open Monday through Friday from 8 a.m. to 5 p.m. Outside of those hours, members must call a phone number and wait to be called back by a doctor on call, Meder said.

That doctor, after evaluating the case, may instruct a patient to simply ice an injury or take two aspirins. If the doctor deems it necessary, the patient may seek medical attention at an urgent care center and be responsible for no more than a $25 co-pay . Emergency room visits are handled similarly, with a $50 co-pay. If the patient is actually admitted to the hospital, the visit is fully covered by Campus Health Partners, Meder said.

A pamphlet for the plan says, "If you have a medical emergency where there is no access to a phone or when an ambulance transports you from the scene of an accident, proceed to one of the Campus Health Partners hospitals and call or have someone else call the appropriate phone number for prior authorization or instructions."

The three hospitals in the plan are Northwest Hospital, Tucson Medical Center and Kino Community Hospital. University Medical Center is not a provider.

In the case of life-threatening emergencies, the patient is permitted to go to the nearest source of medical care. The Campus Health insurance office must be called within 48 hours to obtain authorization, whether the patient is in Arizona or not, the pam phlet said.

When students covered by Campus Health Partners are away from Tucson, Meder said, they are still medically insured by the plan for medical emergencies and life-threatening situations.

"If someone goes skiing and breaks a leg or comes down with a critical illness, that's covered," she said.

Routine health problems like a cold or sore throat, however, are not paid for when not in Tucson, she said.