When heading off to Penn State University for her freshman year, the last thing Loren Cicalese, now 20, was worrying about was her healthcare.
Covered by two insurance plans between her divorced parents --as she had been during high school--Cicalese was also confident that she pretty much knew the ropes when it came to your average doctor’s visit.
But she still wasn’t prepared for the unexpected.
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“I had to go to the ER for a broken ankle, but I didn’t have my [insurance] card with me because I was thinking I would never need it. I had my prescription card, which didn’t help,” says Cicalese.
And while she wasn’t turned away, not having her card with her meant weeks of paperwork and headaches.
“They billed me and from then it was all this different sending of all these different bills out to my mom and my dad. I think I had like four or five bills. They would have sent it straight to my insurance if I had my card,” says Cicalese. “I learned my lesson. It’s in my wallet right now!”
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As thousands of students head off to college this fall, chances are their thoughts are occupied more with late night parties, pow-wows with dorm mates, and study-hall dates than with their first stomach flu away from home. But while there’s no question that college will be one of the greatest experiences of their lives, part of that experience will likely mean seeking medical care without mom or dad for the first time.
Taking the time to prepare for this new responsibility before they land on campus could be just what the doctor ordered.
Before You Leave
“College is a time when there is a transition that happens,” said Dr. Alan Glass, Director of the Habif Health and Wellness Center at Washington University in St. Louis. “Previously, there was another person directly involved in a student’s healthcare – now they are responsible for their own healthcare.”
According to Glass, students should assume this role before they head off to college, starting with a discussion with their parents about their insurance coverage, their medical history and any chronic conditions, such as diabetes, for which they will need on-going care.
Glass cautions students against taking a “new start, new me” approach by discontinuing medication or other medical treatments without first seeking professional advice.
“Every year we see students who have been on mental health medication or asthma medication who plan to stop it when they get to college,” Glass said. “Stay on them – don’t go off.”
Students also need to be aware that the dramatic change in lifestyle they are about to experience could also lead to brand new health issues. Changes in diet, late nights, alcohol use and stress can lead to everything from weight gain to mental health issues.
“When it comes to healthcare and health treatment, students going off to a new environment should be aware that a change in their lifestyle could lead to health issues that they’ve never had before,” cautioned James A. Boyle, President of College Parents of America.
Most colleges assume a proactive role in informing students about what kind of medical treatment they can expect once they start clases. Students and parents can assume the college orientation kit mailed to the student ahead of enrollment will include health information, such as required immunizations and general information about the college health center. By now, most colleges also have a section of their website devoted to their health and wellness center, with contact information, and an overview of services provided. Glass recommends students and their parents familiarize themselves with it before the fall semester begins.
Some of those sites include information on what to do before heading off to college, but in general, the following is recommended:
--Get a physical
--Bring a copy of medical records
--Know your medical history
--Get or update medical ID bracelets for diabetes or allergies to medications, etc.
--Renew prescriptions and/or take note of medications
--Ensure immunizations are up-to-date (this is usually mandatory)
--Pack a First-Aid kit, including bandages, disinfectant, Tylenol, and a thermometer, among other items.
Like Cicalese, most students are covered under their parents’ insurance plan, but it’s important to read the fine print and confirm coverage with both the provider and the college before heading off to school-- especially if the student is headed out of state and possibly beyond the scope of their parents’ coverage.
“Most schools will have insurance offices with folks who can discuss coverage options with them,” said Glass.
In some cases, where students may have gaps in coverage, it might make sense for the student to get supplemental insurance.
“Supplemental health insurance is often very low-cost because young college students are low-risk from an actuary perspective,” said Boyle.
In general, most policies allow children to remain covered by a parents plan as long as they are enrolled in college full-time or under the age of 22. However, some plans cut dependents off at 21 or even 18, and a changes in enrollment status can jeopardize coverage. For example, if a student elects to drop down to part-time study mid-semester, he would need to know if that will affect his coverage. It is very important to know what the coverage requirements are.
For those students who aren’t insured through their parents, most colleges offer an optional plan, managed by a provider, such as Chickering, which is a subsidiary of Aetna. For the most part, these plans offer excellent coverage at a reasonable rate. Health insurance offered by the college can even be an added convenience.
“If they have Chickering insurance, then the health center bills Chickering directly for lab tests, dressings, x-rays,” said Marilyn Halam, assistant director of the Brown-Lupton Health Center at Texas Christian University in Ft. Worth. “The only thing that goes on their account is prescriptions. [For which] they file a claim.”
Though many schools offer their own health insurance plans, just three schools in the country, including Washington University in St. Louis, require students to enroll in the school’s plan, as part of the school’s fees. At Washington State, for example, the cost for the college's insurance plan runs about $660 for the 2006/2007 academic year, with coverage for a full 12 months. An optional prescription plan is available at an additional $94.28 a year.
Health Care on Campus
The size, scope, staff and quality of services offered by campus health centers can vary greatly between schools. At a major research university, the health center is likely linked to the university's teaching hospital and may have 40 or 50 staff members, while at a small campus, students may find the health center is only open part-time and mostly refers students to local doctors and hospitals.
“If you’re a student at the University of Michigan, there you have an atypical situation because you have one of the country’s leading hospitals as the student clinic,” said Boyle.
Students at smaller schools may find services more limited, but still well-equiped to meet most of their medical needs.
“[Clinics on smaller campuses] are generally geared toward treating illnesses and injuries, common colds and flus, injuries, cuts, testing,” said Jim Grizzell, co-chairman of the National College Health Objective Committee. “But they’ve always got a connection to local medical doctors or hospital. They pretty much always have something set up where they can refer out.”
And while there’s a perception that the clinics on smaller campuses are comparable to the “nurses office in high school,” said Grizzell, “they typically have a full-fledged health center.”
Still, that doesn’t mean the doctor is always in: some clinics on smaller campuses, such as the clinic at Belmont Abbey College in Belmont, N.C., are only open part time. Students requiring immediate care outside of office hours are advised to head to nearby Gaston Memorial Hospital. Students living in residence can ask their resident assistant or resident director for a referral, but in general, it’s wise for students to find out what to do and where to go before an emergency happens.
“In the case of severe stomach pains, it could be an appendicitis attack,” said Boyle. “[Students at smaller colleges] should know they need to be treated at the local hospital. In the spirit of being prepared... they must know where the nearest full service hospital is. It’s the students responsibility to know where to go to help themselves.”
that it got in the way of their studies.
For many college students, the new responsibility of managing their own healthcare for the first time comes with the responsibility of managing an adult sex life. Questions about, and health issues related to sexually transmitted diseases, birth control, HIV/AIDS screening, the morning after pill and even pregnancy and abortion are bound to crop up.
Students and parents can assume that all the services available at a clinic or doctor’s office will, at the very least, be accessible to the student, if not always right on campus.
“In some cases, some private and public schools didn’t buy into making those services available [in the past],” said Grizzell. “But now they’re more acceptable and generally the public is agreeable that they are a good thing.”
Of course, Catholic schools, where pre-marital sex, birth control and abortion run counter to the institution’s teachings, provide the exception to the rule.
“Because we are a Catholic institution, we do not do birth control,” said nurse Susan Stipanovic, R.N., at the Abbey Wellness Center at Belmont Abbey College in Belmont, N.C.
In fact, Belmont Abbey’s clinic doesn’t even offer the diagnosis and treatment of STDs, but it’s not necessarily a matter of ideology. As a small campus of just 1,000 students, the wellness center at Belmont Abbey operates more as a referral service for health issues extending beyond primary care.
“As a part-time clinic, we don’t get into GYN care at all,” said Stipanovic. “We refer students to our area physicians if they’re insured, and if they don’t have insurance, we refer students to a free women’s clinic.”
The Abbey Center does provide information on a wide range of health topics, however, including pamphlets on AIDS, STDs and alcohol abuse. Other schools with full-time clinics, including faith-based institutions other than Catholic colleges, will even prescribe the morning after pill. In the case of a positive pregnancy test, students are given referrals.
“Normally when that happens, we would refer the student to Planned Parenthood, which would follow them through the pregnancy,” said Hallam.
Those services could even extend to abortion counseling.
“If that is what they selected, then my understanding, as a rule, is that the nurse practitioner would give the student information about various organizations where they can get more information,” said Hallam.
Overall, students and parents can expect to have access to a high standard of medical care, if not directly on campus, then definitely not too far off campus.
“There are not a lot of weaknesses in terms of medical, clinical care. Colleges do an excellent job,” says Grizzell.
Top 10 Impediments to Learning
A healthy students makes for a healthy transcript, say experts, who have found that health issues can impede learning. A survey of college students by the American College Health Association found that the top 10 impediments to academic learning, as reported for the most recent academic year, were all connected to the students' general well-being.
Seven of those 10 were related to their mental health, with stress being the top factor. Relationship difficulties, sleep difficulties, and depression/anxiety all made the top ten.
“In the last five years, people are really paying attention to the mental health issues of college students,” said Mary Hobin, director of the American College Health Association’s National College Health Assessment Program Office.
Surprisingly, alcohol use came in the last spot, with less than 10 percent of students reporting
Using the Internet
While most college orientations will include sessions on a wide variety of health topics, including everything from alcohol use and abuse, to mental depression, sexual health, and even eating disorders, students can also find plenty of health information online.
The Website 4collegewomen.com, developed by Brandeis college students, bills itself as a “portal” to health information for students everywhere. Columbia University’s health promotion program also has a question and answer-style health site at GoAskAlice.com.
The most important thing students must do for their health care, experts say, is to understand that they are now responsible for getting the medical care they need. That invovles not just familiarizing themselves with the health services available on their campus, but making use of those services when they need them.
And, advises Cicalese, remembering to always carry proof of medical insurance.