Column by Matt Feinberg

This past weekend in a wave of pink ribbons and running shoes (and pouring rain), the Susan G. Komen Race for the Cure raised awareness and money for breast cancer research.  As the spouse of a breast cancer patient, I applaud this important and necessary work.  What I can’t applaud is how easily a sea of pink ribbons masks pervasive problems in our health care industry’s approach to breast cancer. If you think this is a national issue, or that you’re too young to worry about a serious illness, please keep reading. It is important for students to know that the Aetna Student Health plan only minimally covers the surgical procedures that provide life-saving treatment of breast cancer (I’m talking $10,000 out of $50,000).

I raise this issue because it speaks to the larger problem that the Aetna Student Health plan has extremely low benefit limits for outpatient surgery ($10,000) and leaves many students exposed to financial jeopardy in case of serious injury or illness — the very thing that a plan should be “insuring” against. So, as the national healthcare reform conversation swirls around in the media headlines and the conversation too often devolves into partisan blather, it is important that students take a minute to connect this broader conversation to the concrete details of the plan that UK offers and (in many cases) provides to students. Many undergraduates on campus may still find themselves covered under their parents’ coverage, and other students may have the resources to pay for private insurance or insurance through their spouse.  For many of us here at UK, our only affordable option is the Aetna Student Health plan offered by the university.

This list includes primarily fully-funded graduate students, some undergraduates and some unfunded graduate students.  This plan is intended to work in conjunction with the services offered at University Health Services to cover students and their dependents for treatment of serious injury or illness.

If we read the plan carefully though, we note that the inpatient hospitalization benefit limit is set at $500,000. This means if you are hospitalized (more on this term in a minute), then you will have, it seems, fairly substantial coverage.  This all sounds great up to this point.  Reading more closely, it is important to note the current plan offered by Aetna Student Health and UK provides a mere $10,000 limit for outpatient surgery for students and their dependents.

If you didn’t fall asleep when I mentioned “inpatient hospitals,” then stick with me. Let’s put these numbers into context.  According to the American Hospital Association, from 1980 to 2004 outpatient surgeries have shifted from being 16 percent to 63 percent of all surgeries. On Jan. 29, 2009, USA Today corroborates this data by citing a report from the National Center for Health Statistics at the Centers for Disease Control and Prevention suggesting they are nearly 66 percent of all surgeries.

So what, you might ask?  Haven’t the benevolent actuaries at Aetna and the bureaucrats at University Health Services created a plan that will actually cover me if I get seriously ill?

Yes, and no.  This depends on whether your stay in the hospital is considered inpatient or outpatient.  For example, the very serious procedure of mastectomy, used to treat breast cancer, is typically done on what is called a 23-hour release (i.e. an outpatient procedure). Women arrive for the mastectomy and leave within 23 hours of the surgery having never technically been admitted to the hospital (though they may spend the night). Often, people come to the hospital for outpatient procedures and stay for much more than 23 hours and are never actually admitted to the hospital. According to Ed Erway, the director of the Office of Revenue at UK Healthcare, in July 2009, 144 patients stayed at UK Chandler Hospital for over 24 hours, and were administratively and clinically considered outpatient cases that entire time. Even more significantly, there were two cases where individuals spent over seven days in the hospital and were never officially admitted to the hospital.

Though the Aetna Master Policy states that 18 hours in a resident bed will get you inpatient status, I can tell you personally that it will take a barrage of letters and phone calls for Aetna to recognize their own policy.

So, for those of you that have the Aetna Student Health Plan, read the fine print and be sure that you either don´t get sick or you get very, very sick. Just hope that you don´t need an outpatient surgical procedure, because when you get the bill you’ll realize that UK decided that (under)coverage was good enough for the students at a top-20 research institution.