Tuesday, September 08, 2015

Follow Up on Parity and Tuition Reimbursement Insurance

I recently wrote a post about the discriminatory practices by Dewar Insurance -- a company that offers insurance for tuition reimbursement in case illness prevents a college student from completing the semester.  For some schools, the reimbursement is less and the standard of proof is higher if the illness is a mental disorder. 

The issue was originally brought to my attention by Maryland psychiatrist (and parent) Dr. Mark Komrad, author of  the book, You Need Help, wrote back with what he learned at freshman orientation at his son's college.  

A couple of weeks ago I discovered the lack of mental health parity in the tuition reimbursement insurance available through my son's college. And a few of us did research and found this parity problem common to many colleges, including in Maryland, but not all. Withdrawals for mental health reasons have tuition reimbursement at a lower percentage than "medical" withdrawals. Also, unlike medical withdrawals, mental health withdrawals require two days of hospitalization as part of the eligibility criteria to pay out.

I'm moving my son into college, and had a meeting about this with the directors of Student Accounts and a representative from the Dewar insurance company, the underwriters. I thought I would share some notes from that informative meeting:

  • -My son's school is on top of this issue and next year the tuition reimbursement insurance will have full parity for mental health, WITHOUT requirement of hospitalization!!!

  • -No family at this college has ever complained before about lack of parity until I raised this--neither prospectively as now, nor when a policy had to be used for mental health reasons! So there was no incentive to change, although the fairly new director of student accounts was troubled and was already taking initiative to change it before I got involved

  • -Only about 100 families buy a policy, most don't think they'll ever need it. So there is much interest here and elsewhere in making the policy automatically included as part of the bill next year, but with an option to opt-out. Like with all insurance, the more people who participate, the less expensive the premiums are.

  • --There has been a steep rise in withdrawal for mental health reasons nationally just in the last 4-5 years. The majority--about 70%-- of health withdrawals nationally now are for psychiatric reasons. Prior to that they were the minority reason. Nobody is quite sure why that is.

  • -Dewar would actually like to offer parity policies but many colleges have not been interested. Again, this is not a particularly popular product so colleges haven't paid much attention to the non-parity status quo that goes back several decades. Many are just starting to notice the non-parity issue now, and are moving to correct it. Dewar is happy to try and make that possible for any of its college customers.

  • --This policy places NO extra financial risk on colleges. That is NOT the reason colleges haven't sought parity.

  • -Dewar doesn't really challenge doctors notes vigorously. Docs have to fill out a form. There are no internal  "medical consultants" that review and deny coverage--unlike health insurance companies. With the policies that require psychiatric hospitalization, that requirement has been waved in many cases.  It's a holdover from many years ago when these policies were first crafted.

  • -For the business model to work for parity,  psychiatric (now the most common cause for intra-semester withdrawal) and medical can't BOTH be covered at 100%. So policies that now cover medical at 100% and psych at 60% will need to be restructured for the two the meet in the middle. Losing that 100% for medical may be one of the inhibitors to change

So, if we are going to go after this parity issue in Maryland, my sense is that it needs to be on a college by college basis to increase their consciousness about this issue, and, for those who have contracted with Dewar, to let them know that this can be potentially corrected.


Anonymous said...

This really seems like not a big deal - a holdover from pre-parity. Since no one ever complained before (and rates of students (parents of students) buying ANY of this sort of insurance are extremely low to begin with), I'm sure it was never even a consideration. And yes, it should be, but now we have parity -- and look at that! The first parent to ever bring it up got it fixed. To me, that shows that parity is working - in this instance - exactly as it should be. Let's look at some real issues with parity, those that affect millions of americans daily rather then just those whose parents can afford to send them to private universities and take out insurance policies for potential, and unlikely, medical withdrawal.

Priorities, people. Come on.

clairesmum said...

thanks for getting the information. lack of clarity about what college health insurance covered and did not cover meant we kept our son on our insurance through graduation...we lived in Massachusetts at that time, and their health care reform (including parity) measures were already in place.
It makes sense that it won't work to cover one type of issue 100% and the other only 60%, and that the shift would be partial but equal coverage of both types of illness/treatment.
Resistance to loss of complete coverage by some is NOT an ethically acceptable rationale for the disparity in coverage and the systemic bias against people with mental illness that underlies the lower coverage for tuition losses by students with mental illness.

Clark said...

It's a non-issue. Someone noticed it wasn't equivalent coverage and voiced it. It was immediately fixed. That's exactly what should happen.

But as the other poster said, an optional insurance for an unlikely withdrawal from a private college where wealthy psychiatrists send their children is not where mental health parity needs to be fixed. Maybe you could address some of the real issues that face most people in the US with mental health care needs who can't afford basic coverage or access basic counseling or medication services, often times even with medical insurance. That is the parity battle that needs to be fought, not the optional and rare coverage for wealthy children of wealthy psychiatrists.