Josh Potter said he needs a specialist to closely monitor tumors growing in his thyroid, but he cannot use his university health insurance to pay for it.
Potter, 24, of Tallahassee, Fla., said he arrived on campus this fall to begin his graduate assistantship in speech communication, but when the university’s insurance office looked over his health forms, they said they would not be able to help him cover any of the costs associated with his condition.
“When I went to the insurance office, they looked at the one form and said my condition was pre-existing, and that’s all they said,” Potter said.
Last year, the Student Health Center at Florida State University, where Potter obtained his master’s degree, discovered three tumors on Potter’s thyroid and quickly referred him to an endocrinologist, Potter said. The cancer specialist began to closely monitor the growth of the tumors and put him on a medication that would potentially shrink them.
“It is a rare condition in men, and the potential is that I could die,” Potter said. “Another more likely scenario is that I would have to drop out because I can’t afford care.”
Jake Baggott, associate director of student health, said the pre-existing condition clause is a standard health care feature, and students who have pre-existing conditions can continue to pay insurance fees for one year, making them eligible for benefits. He said no student is ever dropped or denied benefits; they are only denied coverage for conditions that existed before their enrollment.
“Because the way the program works here, if I want the clause to lapse I have to (continue) to pay the fees,” Potter said. “In a year, they will let me use the coverage; but what am I supposed to do until then?”
Rosemary Simmons, director of the counseling center, said students who come to the university with pre-existing mental health conditions are subject to the same policy.
“If a student would need hospitalization with a pre-existing condition, it wouldn’t be covered,” Simmons said. “If the students are in danger of killing themselves, then the state takes over.”
Potter said the next step is to have another specialist determine whether the medication is helping and if he will need surgery. He said the associated costs would be out of pocket and would include $700 for an ultrasound, $3000 for a biopsy and up to $30,000 for surgery.
“One of the things we have to be cautious about is that sometimes people enroll (at SIUC) just to get insurance, creating a liability the university isn’t intended to cover,” Baggott said. “We know it happens.”
Jim Hunsaker, the university’s insurance administrator, did not return several calls for comment Monday.
According to the University of Illinois’ Web site, students with pre-existing conditions are not excluded from their student health plan and a pre-existing condition is defined as any medical problem diagnosed prior to purchasing the plan.
Potter said he is struggling to make ends meet and has filed a complaint with the Illinois Department of Insurance. He said he recently received a letter from the department saying they were looking into the situation.
According to the Illinois Department of Insurance’s Web site, beneficiaries under the Health Insurance Portability and Accountability Act cannot be held under the pre-existing clause unless their existing coverage has lapsed more than 45 days.
Potter said there was never a gap in his coverage, but he was still denied.
“It wouldn’t have been so bad if the university was up front about (the pre-existing clause),” Potter said. “They didn’t make it clear.”
Christina Spakousky can be reached at 536-3311 ext. 258.
