Health - - A. Roadmap

What if I have questions? Some resources to *definitely* check out.

Clare Forstie

f you have questions about Northwestern’s health insurance, what it covers, what it doesn’t cover, and how much it’ll cost you to have any kind of health care services, your first stop should be the health insurance office in the Searle building (where the health center is located, on Emerson Street).

You can also do some research yourself, although I find that talking to an actual insurance representative is helpful (and the folks at Northwestern are actually pretty helpful).

There’s the general Northwestern health insurance page: http://www.nuhs.northwestern.edu/evanston/insurance.aspx

There’s also the Northwestern health insurance “Frequently Asked Questions” page, which also addresses some of the topics I’ve described here.

http://www.nuhs.northwestern.edu/evanston/insurefaq.aspx

Northwestern’s “Student Health Insurance Plan Brochure” is THE handbook that explains (not especially clearly) what your health insurance plan covers. I highly highly highly encourage giving it a look-through, even if it’s difficult to make sense of it.

https://www.aetnastudenthealth.com/schools/northwestern/brochure1314.pdf

Aetna Student Health website

https://www.aetnastudenthealth.com/

Health - B. How and Where to Obtain Medicine?

Prescriptions (Rx)

Clare Forstie

There is also a small pharmacy on campus (in the health center), and they stock many common medications, both “over-the-counter” and those that require a prescription. “Over-the-counter” medications are those you can purchase without getting a prescription from a doctor (like cold medicines, for example). You’ll need a prescription from a doctor for other kinds of medications. If you’re bringing any prescriptions with you and have any questions about that process, your best bet is to stop by the pharmacy on campus and ask them. If you need a new prescription, probably the easiest thing to do is to make an appointment with a doctor at the health center. Here, too, you are free to fill prescriptions at other pharmacies in the  area.

Health - C. Introduction to Health Care in the U.S.

What does health care look like in the U.S.?

Clare Forstie

Health care is incredibly complex in the U.S. (isn’t it everywhere?). Health care is provided in public and private hospitals and other healthcare facilities, and hospitals, by law, cannot deny care to anyone who needs it, even if individuals are stuck with expensive bills after they receive care. Most of these institutions are non-profit, but some of them are for-profit. State-sponsored health care is limited to very particular populations (veterans and prisoners), and most people need health insurance to cover healthcare costs. There are public and private health insurance plans, too, and most of them are for-profit. Health insurance plans vary widely in terms of what kinds of services they cover and how much they cost. Most Americans receive their health insurance through their employer, which means that they’re kindof stuck with the plan that their employer provides. Employers may pay for part of the monthly cost of health insurance, but, again, it varies by employer. Smaller employers are not required to provide health insurance to their employess, and It’s not unusual for a single individual with no family and no children to pay $500/month or more for health insurance and still pay co-pays, co-insurance, and a deductible on top of that.

There are still many millions of people in the U.S. who don’t have health insurance, and, without it, individuals are responsible for covering the very expensive costs of their health care. For example, if an individual goes to the Emergency Room with chest pains and doesn’t have any health insurance, the hospital may send them a bill for $2,000 or more to cover the cost of their services (depending on what happens). Lack of health insurance is a big problem in the U.S. and leads to serious issues with debt and poverty.

For a little more information about the health care system in the U.S., wikipedia is a decent place to start: http://en.wikipedia.org/wiki/Health_care_in_the_United_States

Here’s an interesting article that may give you some perspective on the health care system in the U.S. It’s about the variable costs for something very basic - saline, or salt water. http://www.nytimes.com/2013/08/27/health/exploring-salines-secret-costs.html?_r=0

Health - D. Services for Women

Women’s Health Services

Clare Forstie

Just like mental health services, you can choose to use the health center for women’s health services, or you can choose to find a separate provider on your own. Some people like the convenience of going to the health center (and it’s free for students. Generally speaking, many grad students use the health center for routine physical exams and check-ups because it’s free. But for women’s health services specifically, as with mental health services, you don’t need a referral to see a doctor outside of Northwestern.

Health - E. Where to Go When I Feel Sad?

Mental health services

Clare Forstie

I’m putting mental health services in a different category for two reasons: graduate students often need mental health services (like appointments with a therapist) to help them (us!) deal with the difficulties of graduate school. And the rules for mental health services are a little different. First, you don’t need a referral to see a mental health service provider outside of CAPS (Counseling and Psychological Services), which is also located at the health center. Some people prefer to make an appointment at CAPS first because it’s convenient and CAPS counselors can give you a list of in-network providers who best meet your needs. For example, you might have a gender preference for your therapist, or you might want to see a therapist who understands your cultural context, or you might want a therapist who specializes in working with LGBTQ people (or all of the above!).

There are different kinds of therapists (psychiatrists, psychologists, and social workers), and CAPS counselors can explain a bit better the difference between them and which might be suited to your needs. Some are mainly focused on prescribing medication (like most psychiatrists) and some are more focused on talk therapy (like social workers). It depends on what you need.

Your health insurance does cover mental health services, and the same kinds of payment rules apply: there are co-pays, co-insurance, and mental health services apply to your deductible.

Now, you don’t have to go through CAPS at the health center to get a referral to a mental health service provider. Some people prefer not to. If that’s the case, you can search the Aetna Student Health website to find a provider and make an appointment on your own. Again, you’ll want to make sure you’re choosing an in-network (also known as “preferred”) provider. 

Health - F. How to Cover My Family?

What if I have a spouse, partner, or child?

Clare Forstie

If you need to cover someone else on your health insurance plan (like a partner, spouse, or child), that other person is called a “dependent.” The same rules I just described apply to them, but the kicker is that you have to pay for their health insurance. And it’s pretty expensive. The rates for 2013-2014 are $6,129 for your spouse or domestic partner and $3,836 for each child. That’s on top of the co-pay, co-insurance, and deductible. So, if you have a partner or spouse, and you want to cover their health insurance, your insurance is free, but you’ll need to pay $6,129 for their insurance alone. On top of that, you’ll have that $250 deductible and that 20% co-insurance for each of you (and don’t forget those co-pays!). 

Health - G. Health Insurance

Do I get health insurance through Northwestern? Is it required? What does it mean?

Clare Forstie

At Northwestern, health insurance for graduate students is through Aetna Student Health. According to Northwestern’s health insurance website, international students are required to use Aetna Student Health (and are automatically enrolled). Cost? Once you’re enrolled in the Aetna Student Health plan, you get an insurance card, which you’ll want to keep with you at all times. If you find yourself needing to go to a doctor (not the health center on campus, which is free for students), you’ll be asked about your insurance, and you’ll want to show them this insurance card.

Aetna Student Health, your insurance plan, covers some services, but not everything. It doesn’t cover dental work, for example, or vision services (eye exams and glasses) unless they’re emergencies (say, your eyeball is falling out, or something). You can purchase a separate plan for dental work (which I think is less than $200 for the year, but keep in mind that it doesn’t cover everything). If you need vision services, like an eye exam or glasses, those are typically costs you have to pay for yourself. Sometimes, you can find good deals on eye exams and glasses on Groupon.

You may notice that Aetna Student Health requires referrals for some services (with the exception of mental health services and women’s health services). This means that, if you have a non-emergency health problem, you’ll need to go to the health center on campus first so they can check you out and give you a list of “in-network providers” - health service providers with whom Aetna has a contract (also known as “preferred providers”). In other words, if you need a health service, you can’t just go to any old provider (well, you can, but you may end up having to pay for the full service out of your own pocket!). For example, let’s say you sprained your wrist, and it’s not an emergency. You’d make an appointment at the health center to have it checked out as soon as possible, and maybe your doctor at the health center says you need to get physical therapy. They would give you a list of physical therapists who are covered by Aetna, and you could choose a physical therapist from that list. When you see the physical therapist (let’s call them “Awesome PT”) for the first time, you’d show them your insurance card, and some portion of your physical therapy would be covered by your insurance. Now, you’d still have to pay a co-pay, and there are deductibles and coinsurance to consider, but I’ll explain that in a bit.

One bit of advice I have, when dealing with anything related to insurance, is to read the documents they send you carefully and visit the insurance office on campus if you have any questions. For example, if you seek health services outside of the health center on campus, you will probably receive a bill from whoever provided those services (like the physical therapist I just mentioned) and an emailed “Statement of Benefits” from Aetna. Review your “Statement of Benefits” very, very carefully. Sometimes, Aetna will deny payment for services that the plan says they should cover, leaving you with the full bill (which can be very expensive). In those cases, or if you have any questions about the documentation you receive, you should take your documentation straight to the health insurance office in the basement of the health center. Those folks are actually very helpful; it’s their job to help you negotiate the confusing health insurance (which everyone finds confusing!). You should feel free to go to the health insurance office as often as you need to, until you understand your plan and what you’re responsible for, and what Aetna is responsible for. 

Health - H. What Should I Do If I Get Sick?

If I get sick, what should I do? How do I make sure I don’t get stuck with a huge bill?

Clair Forstie

First things first: here’s Northwestern’s emergency healthcare website: http://www.nuhs.northwestern.edu/evanston/emergency.aspx

Basically, if you’re injured or sick and it’s an emergency, either call 911 or go to the Emergency Room at the closest hospital! Make sure you tell the person when you check in at the registration desk that you’re a student at Northwestern and you have Northwestern’s student health insurance. Show them your health insurance card.

If you’re not really sure if you should go to the Emergency Room, your best bet is to call the physician on call (847-491-8100) which is free to use, available 24-7, and pretty quick. Call and leave a brief message, and a doctor from Northwestern will call you back in 15-20 minutes. They’ll ask you about your symptoms and advise you on whether you should go to the hospital or wait to make an appointment with the health center.

There is also the urgent care clinic, located in downtown Evanston on Maple Ave., right across from the movie theater. They’re open on nights and weekends (8am - 8pm every day), BUT you can’t just walk in (well, you can, but it might not be covered by your insurance!). You need to call the physician on call (847-491-8100) to get a referral first. For more information about the urgent care clinic, check out: http://www.nuhs.northwestern.edu/evanston/afterhours.aspx

Probably for most people, the health center on campus (located in the Searle building at 633 Emerson Street) will provide most of your services. You’ll want to call and make an appointment for non-urgent illnesses and injuries and for routine kinds of services (like annual check-ups). Your best bet is to call them to make an appointment (847-491-8100), and you can find their hours here: http://www.nuhs.northwestern.edu/evanston/hourslocation.aspx

Remember that, aside from emergencies, you need a referral to see a health service provider outside of the health center (except for mental health and women’s health services). 

Health - I. What Do These Terms Mean in Insurance?

Co-pay, Co-insurance, Deductible, Out-of-pocket maximum.

What do they mean?

Clare Forstie

Okiedokie. On the Northwestern Insurance FAQ website, here’s what it says:

“The student insurance plan provides coverage for outpatient service due to illness, inpatient hospital care, mental health or if you need to go to the Emergency Room. The plan has a $250 deductible. After the deductible has been met, students will be responsible for a 20% co-insurance with a maximum out-of-pocket expense of $1,000. After the deductible and co-payment requirements have been met, the insurance will pay 100% of all covered medical expenses up to $500,000.  Also, there are is a $20 per office visit co-pay whey you are seen outside of NU Health Service.  This co-pay does not count toward your $250 deductible or $1,000 co-insurance.  Deductible & co-insurance amounts reset annually September 1st.”

Let’s break this down a little bit, and we can start with the co-pay. The co-pay is basically a fee you pay every time you see a doctor outside of the health center. Sticking with the physical therapy example I noted above, that means that you’ll need to pay a $20 co-pay each time you see the your physical therapist at Awesome PT.

But wait, there’s more! The deductible is the amount of money you have to pay before your insurance actually takes effect. The deductible for Aetna’s health insurance plan is $250 (this amount may change from year to year). So, let’s say that you’ve never sought health services outside of the health center on campus before, and you’re seeing that physical therapist at Awesome PT for the first time. Let’s say that the cost of an initial visit with that physical therapist is $300 (which it may well be), not including your co-pay. You’d pay your $20 co-pay and you *still* owe Awesome PT $250. You’ve paid your co-pay when you have the appointment, and you get a bill in the mail from Awesome PT that says you owe $260.

Wait, $260? Is that a typo? Nope! Here’s where the idea of co-insurance comes in. So, you’ve paid your co-pay, you’ve “met” your deductible of $250, and you still owe $10 on top of that! Why? Because all health services come with a co-insurance of 20%. That means that Aetna only covers 80% of your physical therapy costs (remember, this is for in-network providers, too. For out-of-network providers, it’s a different, and more expensive, story.). So, you’ve paid your $20 co-pay, met your $250 deductible, and your initial visit cost $300. That means that Aetna covers $300 - $250 = $50, but only 80% of that $50. Your co-insurance for that $300 initial visit is 20% x $50 = $10.

In other words, for that initial visit, you owe that $20 co-pay (typically paid when you have the physical therapy service itself) + $250 (your deductible) + $10 (your co-insurance).

Still with me? Ok, let’s say that the cost of each follow-up visit with your physical therapist is $100, and you need 3 more visits. What do you owe? You’ve already paid that deductible, and you only need to pay it once each year, so you’d pay that $20 co-pay plus (20% of $100) $20 for each visit. That’s $40 for each visit, for 3 more visits, that’s $120.

Now, let’s say that it’s September 1st, and your doctor at the health center says that you need three more visits with Awesome PT. Your deductible “resets” each year, which means you need to pay it anew every year. That means that the first two visits count toward your deductible (and you have to pay for them in full), and your insurance kicks in for part of the third visit. Let’s do the math again. For each visit, you pay your $20 co-pay. That doesn’t change from year to year. On top of that, each visit costs $100, a total of $300 for all three visits. Your deductible is $250, so you’d owe $250 (plus those co-pays, of course), plus 20% of $50, so that’s $260 again!

To say it another way, in the new year, here’s how it breaks down:

Visit 1: $20 co-pay + $100 deductible

Visit 2: $20 co-pay + $100 deductible (you’re now at $200 toward your deductible. Only $50 more to go before your insurance kicks in!)

Visit 3: $20 co-pay + $50 deductible + $10 co-insurance (Aetna covers $40)

Make sense? Not really, I know.

The good news is that there is a “ceiling” on the amount you should have to pay for health services. This ceiling is the “maximum out-of-pocket expense,” and it’s $1,800. Let’s say that, in the new year, you’ve really badly injured yourself, and you need lots and lots of physical therapy. How many physical therapy appointments would you need to have before you hit the $1,800 ceiling, your co-insurance disappears, and Aetna covers 100% of your physical therapy? Can you do the math? If each follow-up appointment is $100, and your co-insurance is $20, $1,800/$20 = 90 physical therapy visits before Aetna covers the whole cost of your appointments. Sortof. Those co-pays are still there, and you have to pay them with every appointment. And, like the deductible, the out-of-pocket maximum resets each year. So, the $250 deductible and $1,800 out-of-pocket maximum should really be described as an annual deductible and out-of-pocket maximum.

It’s hard to imagine that anyone would need that much physical therapy, but you may need other kinds of health services, and the cost of those services “count” toward your deductible and your out-of-pocket maximum. So, in other words, if you’re getting physical therapy, and you also need to get a CT scan for something else, you can reach that deductible, and maybe even the out-of-pocket maximum, pretty quickly. To say it another way, the $250 deductible and $1,800 out-of-pocket maximum apply to all of your in-network health services; you don’t have to pay the $250 for each health service provider.

Now, there’s one more piece of the health insurance puzzle to consider. Here’s why it matters whether you choose an in-network provider: Aetna has special “negotiated rates” with particular providers. So, if you didn’t decide to go to Awesome PT, and you picked just the closest physical therapist to where you live (which isn’t on the list of providers you received from the health center), instead, you may get stuck with a much larger bill. Aetna has a negotiated rate with Awesome PT, which is why each follow-up visit is $100. Awesome PT charges other patients $200 for follow-up visits! And if you go with a physical therapist not on the list - say, SuperPremium PT, Aetna may still cover some of the costs, but not at that 80% co-insurance rate. They may only cover 50%, or less, depending on the service. SuperPremium PT may charge you $200 for the same service, and, if Aetna only covers 50% of that cost, you’d end up with a $100 bill for one follow-up appointment! Plus the $20 co-pay! Yikes!

Speaking of expensive things, if you find yourself with a catastrophic injury or illness, it’s good to know that your health insurance plan has an annual cap of $500,000. It’d be pretty rare to reach that cap, but it happens. After you reach it, you’re responsible for 100% of your costs above that $500,000.

Now, go back and re-read the quote from the health insurance FAQs. Does it make more sense now? If not, try re-reading the explanation above.

Why are things so confusing? Why do we have these co-pays, co-insurance, deductibles, and out-of-pocket maximums? Good questions! If you find yourself chatting with a health policy expert, it’d be a good idea to ask them about the histories behind these concepts. They exist for complicated reasons that have to do with the healthcare system in the U.S. and the rising costs of healthcare (and that, in itself, is complicated, too).  

Academic Culture

Matthew Beamer
Here are the links that the presentation of Academic Culture in the US contains (Thanks go to Matt for making the slides) that you may find useful:
Always ask your academic advisor about the format of your writing and the database your program will use for reading literature.