section 4: SWITCHING Everything
If you are going to college far from home, you may want to consider switching or transferring your doctors, pharmacy, and insurance. Just because you are switching doesn't mean you should get rid of the ones you have at home, but it does mean you will have access to the proper care near your new home (college). You should also consider whether you can receive the general medical care you need from student health, or whether you should find a primary care doctor near your campus.
Switching Doctors
If you are an allergic student, you and your parents should discuss whether or not it makes sense to have an allergist (and other doctors) on campus - if you go to a large university with a medical center - or close by. Here are some factors to consider when deciding whether to secure doctors near school before school starts, or whether to stick with the allergist you saw in high school:
You may currently see a pediatric allergist and other pediatric specialists. You should discuss with your high school doctors whether you should see pediatric doctors at college. The decision may depend on accessibility. Once you have figured out what doctors you'll need to have at school, you will want your home doctors to be able to communicate with your school doctors.
The idea that we should all have electronic medical records that can be seen by all of our caregivers has not yet become common practice - unless all your doctors are in the same hospital system. Instead of carrying paper records from the home doctors to the school doctors, your current medical system (if it uses Epic charts) can assign you a Care Everywhere ID number. When you identify your team of doctors at college - which in our case is a primary care doctor for primary care and endocrinology and an allergist for allergies and asthma - you give them your care everywhere ID number. Our new doctors had access to all of our old records, including lab tests. Theoretically, the doctors in both locations can see updates to your chart. And maybe more important, if you have to go to the emergency room for anaphylaxis or an asthma attack, you can give the emergency doctors your Care Everywhere number and they can see your allergens, co-conditions and any other information that might speed up treatment. We got the Care Everywhere ID number put on a medical ID bracelet so it is always accessible. Even if you aren’t going to switch doctors, you may want to Care Everywhere ID number just incase you need to go to the ER.
Switching Insurance
Are you or your parents concerned that the family health insurance policy isn't adequate for you? My parents were worried that the high out-of-pocket cost of emergency room visits in our family policy would keep me from going to the emergency room when necessary because I wouldn’t want to “waste” money. They also worried that a high co-pay for a specialist visit may discourage going when needed. So they took out a separate policy just for me. The policy requires me to pay for less at time of service and has a 0 deductible- and the monthly premium my parents pay is hardly more than what they pay for my younger sibling who is on the family plan. The young age of a college student keeps the premium low, and pre-existing conditions like allergies and asthma don't increase the price. Keep in mind that open enrollment for new health care plans starts in October. The federal government expanded the enrollment period in 2014 because of glitches with the system. Normally, enrollment period is October to December 31st.
We took advantage of the recent enrollment period for the affordable care act to improve our insurance coverage, and to make sure coverage would extend to the major medical center at college. Our insurance has local coverage and national coverage. When outside our local coverage area - where we are aware of the radiology and blood labs we can use - we have to be sure that we are using the authorized providers for that area. For instance - we can't use a certain national lab for blood draws in our region, but that national lab may be the authorized provider in the area the school is in. So, if any of your medical conditions require regular testing, make sure your new providers are covered in the college area - and don't assume that because you had to use one lab at home that is the same lab to use at school. When in doubt, call your insurance company. And of course, make sure you have your insurance card to take with you to school.
Switching Pharmacies
Switching pharmacies is super easy if you use the same chain at home and at college (for example: CVS or Walgreens). All you need to do is tell your health care provider you have switched and then ask the pharmacist at home to transfer your files to the pharmacy closest to school. Even different chain pharmacies make it easy to transfer one prescription to another. Just remember, if you are transferring to a different pharmacy chain, one thing you may want to keep in mind is, when you are home in the summer or on break, you may not have easy access to your prescriptions, so plan for that.
We also learned a couple of other things: city pharmacies receive the same amount of drugs as pharmacies in the suburbs that serve smaller populations. So, if you are used to calling for a refill the day before you need it, keep in mind that a busier pharmacy in a densely populated university area may need a couple of days to fill a prescription for asthma or allergies. Also be aware that some formulations of medications may contain allergens, and the pharmacy may may need to special order a version without your allergen. Your home pharmacy may have been doing this for you for years without you realizing. So allow extra time if your medications need to be special ordered.
Switching Doctors
If you are an allergic student, you and your parents should discuss whether or not it makes sense to have an allergist (and other doctors) on campus - if you go to a large university with a medical center - or close by. Here are some factors to consider when deciding whether to secure doctors near school before school starts, or whether to stick with the allergist you saw in high school:
- How far away will you be from your high school allergist? Would you have transportation to get there?
- How severe is your allergy? Does your allergist also treat you for asthma? How severe is that?
- How often did you see your allergist during high school? Did you have many non-check up visits for illness, asthma or testing and treatment for new allergies?
- How accessible is your doctor at home from a long distance? Will the office write prescriptions or change a dose when you describe symptoms over the phone?
- Will you be at college during the months you are most likely to need to see your allergist (asthma is typically worse in the winter, allergies are typically worse in spring and fall.)
- Do you receive allergy shots? Will they be administered by student health or another primary care near school?
- Will you be going to a school that has a major medical center or that is near one? If it's not on campus, how would you get to appointments?
- How much confidence do you, your parents and your high school allergist have in the student health facility at your college? Our high school allergist recommended against using student health. We found an adolescent medicine practice, which typically treats teens and young adults, right on campus.
- What are your co-conditions and how easy are they to manage without being close to those specialists or a primary care that often treats those conditions? (example: endocrinologist for thyroid disease, gastroenterologist for celiac)?
- How stable is your medical situation? Unfortunately some autoimmune diseases commonly develop during the years of hormonal changes - which includes the typical time a student would be in college.
You may currently see a pediatric allergist and other pediatric specialists. You should discuss with your high school doctors whether you should see pediatric doctors at college. The decision may depend on accessibility. Once you have figured out what doctors you'll need to have at school, you will want your home doctors to be able to communicate with your school doctors.
The idea that we should all have electronic medical records that can be seen by all of our caregivers has not yet become common practice - unless all your doctors are in the same hospital system. Instead of carrying paper records from the home doctors to the school doctors, your current medical system (if it uses Epic charts) can assign you a Care Everywhere ID number. When you identify your team of doctors at college - which in our case is a primary care doctor for primary care and endocrinology and an allergist for allergies and asthma - you give them your care everywhere ID number. Our new doctors had access to all of our old records, including lab tests. Theoretically, the doctors in both locations can see updates to your chart. And maybe more important, if you have to go to the emergency room for anaphylaxis or an asthma attack, you can give the emergency doctors your Care Everywhere number and they can see your allergens, co-conditions and any other information that might speed up treatment. We got the Care Everywhere ID number put on a medical ID bracelet so it is always accessible. Even if you aren’t going to switch doctors, you may want to Care Everywhere ID number just incase you need to go to the ER.
Switching Insurance
Are you or your parents concerned that the family health insurance policy isn't adequate for you? My parents were worried that the high out-of-pocket cost of emergency room visits in our family policy would keep me from going to the emergency room when necessary because I wouldn’t want to “waste” money. They also worried that a high co-pay for a specialist visit may discourage going when needed. So they took out a separate policy just for me. The policy requires me to pay for less at time of service and has a 0 deductible- and the monthly premium my parents pay is hardly more than what they pay for my younger sibling who is on the family plan. The young age of a college student keeps the premium low, and pre-existing conditions like allergies and asthma don't increase the price. Keep in mind that open enrollment for new health care plans starts in October. The federal government expanded the enrollment period in 2014 because of glitches with the system. Normally, enrollment period is October to December 31st.
We took advantage of the recent enrollment period for the affordable care act to improve our insurance coverage, and to make sure coverage would extend to the major medical center at college. Our insurance has local coverage and national coverage. When outside our local coverage area - where we are aware of the radiology and blood labs we can use - we have to be sure that we are using the authorized providers for that area. For instance - we can't use a certain national lab for blood draws in our region, but that national lab may be the authorized provider in the area the school is in. So, if any of your medical conditions require regular testing, make sure your new providers are covered in the college area - and don't assume that because you had to use one lab at home that is the same lab to use at school. When in doubt, call your insurance company. And of course, make sure you have your insurance card to take with you to school.
Switching Pharmacies
Switching pharmacies is super easy if you use the same chain at home and at college (for example: CVS or Walgreens). All you need to do is tell your health care provider you have switched and then ask the pharmacist at home to transfer your files to the pharmacy closest to school. Even different chain pharmacies make it easy to transfer one prescription to another. Just remember, if you are transferring to a different pharmacy chain, one thing you may want to keep in mind is, when you are home in the summer or on break, you may not have easy access to your prescriptions, so plan for that.
We also learned a couple of other things: city pharmacies receive the same amount of drugs as pharmacies in the suburbs that serve smaller populations. So, if you are used to calling for a refill the day before you need it, keep in mind that a busier pharmacy in a densely populated university area may need a couple of days to fill a prescription for asthma or allergies. Also be aware that some formulations of medications may contain allergens, and the pharmacy may may need to special order a version without your allergen. Your home pharmacy may have been doing this for you for years without you realizing. So allow extra time if your medications need to be special ordered.