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Parents of college students may be paying twice for the health insurance of their children. Most four-year schools require students to show proof of health insurance as a requirement for admission. Then the schools charge students a fee to use the college clinic for health care.

NPR's Patti Neighmond reports.

PATTI NEIGHMOND: Take Bill Buyer(ph). He's even a health benefits consultant for the federal government. But when his son went to a private college on the East Coast, Buyer counted up the tens of thousands of dollars that it cost to send his son to school.

Mr. BILL BUYER (Health Benefits Consultant for Federal Government): You've got tuition, residential, food, meal plans.

NEIGHMOND: But no health insurance. Then one day, Buyer was talking with a friend who asked if his son had a health insurance through the family for the college.

Mr. BUYER: I ended up pulling up my bill. And I looked, and I couldn't tell by the bill whether I was paying for the health services and health coverage for my son at school or not.

NEIGHMOND: So he called the school, and officials told him yes. He was paying for health insurance for his son, about $1,100 a semester, $2,200 a year.

Mr. BUYER: Then I said well I have insurance on my son as a parent, so do I need to pay you $1,100? And they indicated no. I could get a waiver. I would have to prove to them that I had health insurance on him, and at that point they would waive that charge off my tuition.

NEIGHMOND: Which they did. What irks Buyer is that he'd already paid thousands of dollars which weren't reimbursed. But more than that, he's bothered that the health insurance fee is literally buried in the overall college bill.

Mr. BUYER: They make the assumption that you're going to accept their health coverage, and they just included it in the overall tuition cost.

NEIGHMOND: In fact, most colleges don't take private health insurance. And just like some doctors who don't take insurance, students then who have private health insurance have to pay cash up front at school clinic, then go back to their parent's insurance company and hope the company will reimburse them. Dr. Brian Liang directs the Institute of Health Law Studies at California Western School of Law. Liang says less than one-quarter of those college health clinic fees ever get reimbursed by private insurers. He says that's because reimbursements are difficult to file for, and most parents don't have the time or sophistication to do it.

Liang says things have to change on college campuses.

Dr. BRIAN LIANG (Director, Institute of Health Law of Studies at California Western School of Law): You have to change with the times. And schools that are kind of hold tightly to the good old days or bad old days, depending or you're the provider or the student - well, we don't do that, we don't accept private health insurance - really are not looking to ensure the best approach to their students.

NEIGHMOND: The attorney general of New York State is now investigating college disclosure policies about health fees. Chad Henderson defends the university fees. He directs health services for Rhode Island University. He's also president of the American College Health Association. For most colleges, Henderson says, excepting private health insurance is just an administrative nightmare.

Mr. CHAD HENDERSON (President, American College Health Association): Which is multiple carriers with multiple different policies, multiple different beneficiary bundles. And when we spread that for people all around the country coming to a single institution, it becomes more complex than Harry's Urgent Care located in North Kingston, Rhode Island, who is seeing primarily Rhode Island-based people who are primarily insured by Blue Cross Blue Shield or United or potentially Aetna.

NEIGHMOND: But some colleges are starting to find ways to deal with that complexity. They're hiring outside consultants to handle their claims. That costs money, but if colleges keep their medical costs lower than their insurance reimbursements, then they could come out ahead.

Patti Neighmond, NPR News.

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