The New York Times on Saturday examined how a "fee-for-service approach has become increasingly common" at college health care centers, which can result in "substantial health fees and out-of-pocket costs" for "parents who are already buying their own insurance." According to the Times, many college health centers traditionally rely on tuition, general fees or specific health fees for funding and do not bill private health insurers for students' care.

Andrew Menter -- founder of Highland Campus Health Group, which bills and collects third-party insurance for college health centers -- estimated that 2% to 3% of college centers nationwide are in-network providers with large insurers. According to Menter, some students pay for care and then seek reimbursement through their insurance. However, about one in eight claims are reimbursed for out-of-network providers, and reimbursements sometimes can be a fraction of the charge, Menter said.

According to Dana Mills, director of student health services at Marquette University in Milwaukee and chair of the student health insurance task force at the American College Health Association, as health care costs rise, some colleges are looking to preserve the quality of campus health centers by collecting payments for services rather than raise tuition and fees. While some colleges have introduced fee-for-service programs and copayments for care, others have contracted with companies like Highland to bill insurance companies for services.

Richard Keeling, a former president of ACHA, said insurance billing is a "good and very reasonable" step for college health centers but added that colleges still must have a way to cover some medical services and nonclinical expenses, such as wellness and counseling programs. Jim Mitchell, another former president of ACHA and director of student health services at Montana State University, said, "In my opinion," direct billing is "not the most desirable method for providing accessible, convenient health care to students," adding, "My sense is that universities are going there out of necessity, not because they want to" (Mohn, New York Times, 2/23).

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