Dear Editor of the Spectator,

I would like the opportunity to respond to the article, “Healthcare Center Cost Inaccessible to Low-Income Students” published on 10/30/19. With this head- line, I am concerned that students needing healthcare will assume that it is expensive to access care at the Student Health Center and then not receive care at all. Also, looking out for the health and well-being of all the students at Seattle University, in addition to our community, I want students to know how they can access flu shots.

To begin I would like to explain how students can access flu shots. Most insurance companies want their subscribers to be vaccinated and usually cover the full cost of the vaccine. All students have access to the flu shot at the Student Health Center. The cost for students who do not have the Aetna Student Health Insurance would be $30; this is the full cost of the service and not a copay. The SHC provides a receipt for the student to submit to their insurance company to re- quest reimbursement. For students who are unable to or prefer to not pay for the flu shot, many insurance companies offer free or low-cost flu vaccines through local pharmacies. For Medicaid specifically, both Walgreens and Bartell’s, located 1-2 blocks north of campus, offer flu vaccines at no cost if the student has their insurance card. The SHC website has a map of local pharmacies providing the flu vaccine. We strongly encourage all students to get a flu vaccine for their health and the health of our community!

Healthcare costs are a concern for all medical providers and the Student Health Center works hard to keep costs as low as possible for students. To be seen by a nurse practitioner at the Student Health Center the cost is only $5. Most services at the SHC do not carry an additional cost. There are 18 services (tests, procedures, medical equipment) that have costs ranging between $5 – $20; these are again the full cost of the service and not a copay. The SHC has been and will remain transparent with these additional costs and they are posted on the SHC website.

Whenever an additional cost may be needed in the SHC it is discussed with the student prior to rendering the service and for many students this cost is still less than their visit copay would be seeing a healthcare provider in the community. For example, a student coming in worried about strep throat would pay $10 for the rapid strep test and $5 to see the nurse practitioner for a total of $15 for the visit; most visit copays are $20 – $40 per visit. Medicaid is an exception to this and often would carry no cost if care is accessed at an in-network provider, which the SHC is not (see further explanation below). The most expensive costs in the SHC are unfortunately the vaccines and we provide them as close to cost as possible. Like flu shots, many insurance companies will cover the cost of these vaccines if received at a contracted pharmacy. For students who do not have the Aetna Student Health Insurance, we will discuss what community resources are available to give students lower cost options.

I would like to share three additional points about low-cost care at the SHC that were not included in the 10/30/19 article:

1. How can low income students get the healthcare they need with a low budget?

The best way for students to keep their healthcare costs down is to first know the details of their health plan and who their in-network preferred providers are. This is especially important for students with Medicaid because often there is no cost if care is accessed with a contracted provider. The benefit of Seattle University’s location is the numerous healthcare providers surrounding our campus and it is likely a student could find a contracted provider within walking distance. Does this mean the SHC does not want to see students with Medicaid? Absolutely not! We have many students with Medicaid but within the visit we discuss the importance of establishing with a primary care provider in the community who can give the care and order the tests that Medicaid will not accept from the SHC.

For students with private insurance, this may also be the case, but it depends on their plan benefits (deductible, copay, coinsurance). Often the complete cost at the SHC is less than their deductible and/or copay; what would cost $5 at the SHC may cost over $100 at a community provider. For the student health insurance and students without any insurance the lowest cost option is likely at the SHC and if we know of better resources in the community we will share that information with the student.

2. Why does the SHC not bill Medicaid and insurances other than the Aetna Student Health Insurance plan?

Seattle University SHC is not in any insurance company’s plan network. This means we can’t bill directly for any services. The process to become part of a plan’s network as well as be a plan provider is complicated and requires a specialist to manage credentialing, contract negotiation, and billing. This is true for the five Washington state Medicaid plans as well as all private insurance companies. The one exception is the student health insurance plan. Our insurance broker and waiver manager, JCB Insurance, has worked with Aetna Student Health to provide the insurance plan to students at Seattle University. Due to the relation- ship of JCB with Aetna Student health, they can negotiate reimbursement for the less than 30 total services that have an additional cost at the SHC. This means Aetna Student Health will reimburse the SHC for those additional costs although we are not in their plan network.

3. Why doesn’t the SHC hire a specialist for credentialing, contract negotiation, and billing?

SHC decided to prioritize the hiring of psychiatrist in this year’s budget cycle instead of a billing specialist. By hiring a consultant psychiatrist, the nurse practitioners in the SHC can offer a higher level of care than most primary care clinics; this offers an invaluable service to the students at Seattle University.

Thank you for time, Tara Hicks, Director of the Seattle University Student Health Center.

The Spectator editorial board consists of Alec Downing, Sophia Wells, Josh Merchant, Frances Divinagracia, Myrea Mora, Jacqueline Lewis, Michelle Newblom, Nicole Golba, Elise Wang, Hana Kirchoff, and Joshua Latief. Signed commentaries reflect the opinions of the authors and not necessarily those of the Spectator. The views expressed in these editorials are not necessarily the views of Seattle University.