UnitedHealthcare, Duke's student medical insurance administrator, was listed among the top three health plans in overall member satisfaction in the South Atlantic region, according to a national study. But another survey placed its health plan well below other options.
The insurance provider came in just behind Humana in the J.D. Power and Associates 2009 National Health Insurance Plan Study released in April. Also in the top three was Blue Cross Blue Shield of North Carolina, which had provided health insurance to Duke students for 30 years ending in April 2008, said Jean Hanson, administrative director of Duke Student Health.
In its third year, the study measured member satisfaction among 131 health plans in 17 regions across the country. North Carolina, South Carolina and Georgia make up the South Atlantic region. The survey examined seven factors, including coverage and benefits, provider choice, claims processing and customer service, said Jim Dougherty, executive director of the health care practice at J.D. Power and Associates.
Susan Barry, marketing director at UnitedHealthcare, said the organization has always supported national measurements of health care quality, believing that greater transparency and accountability will improve the quality, safety and cost-effectiveness of care.
"The J.D. Power and Associates study provides us another view of how we are serving our members," Barry said. "This is evidence that our dedication to improving customer service, claims processing, member communications and network development are yielding positive results."
However, Barry noted that the survey does not specifically examine UnitedHealthcare StudentResources, a division of the company that provides insurance to college students, but rather ranks the insurance company as a whole.
In April 2008, the Student Health Insurance Advisory Council, a group of graduate and undergraduate students and administrators, replaced BCBS with UnitedHealthcare as the health plan provider for all Duke students who do not have insurance.
Hanson said the decision, which followed two years of research and deliberation, was largely based on the fact that BCBS did not independently provide customer service. A separate customer service organization, Massachusetts-based Gallagher Koster, provided administrative management of Duke's student medical insurance plan.
"We aimed to do a comprehensive bidding process, and part of what we were looking for was a customer service component," Hanson said.
She recalled that coordinating the three separate bodies-Duke, BCBS and Gallagher Koster-was a "nightmare."
"Duke is the source of information-we have the files of who is eligible to enroll-but someone had to be in charge of enrollment, terminations, payments and answering questions about problems of insurance," Hanson said.
She said UnitedHealthcare not only offered both coverage and customer service, but also agreed to mirror the former BCBS policy and paid for all services that had been previously covered.
However, other insurance rankings starkly contrast with the J.D. Power survey, rating UnitedHealthcare among the least satisfactory health insurance plans in the nation.
UnitedHealthcare was ranked No. 39 out of 41 national preferred provider organizations, in a September 2009 Consumer Reports ranking, 19 spots below BCBS of North Carolina. The findings were based on responses from 37,481 subscribers reporting on their experiences with Preferred Provider Organizations over the course of a year.
Several Duke students have expressed frustration with UnitedHealthcare StudentResources, noting that they have been facing problems they never encountered with BCBS.
Nicole Moore, who graduated from the Department of Pharmacology this year, said UnitedHealthcare has repeatedly misinterpreted billing codes she submitted from the hospital as services that cost patients more, such as emergency room visits.
"It has been 11 months since I incurred a charge in question, and after about nine claim resubmissions, countless hours on the phone with the hospital and [UnitedHealthcare], one complaint to the N.C. Department of Insurance and unquantifiable frustration, I received a letter in the mail this week that they will 'reconsider the charges,'" Moore said. "Now if that gets me anywhere, we shall see."
She added that she was personally relieved to "be through with the mess that Duke student health insurance has become."
Moore, like many other University graduate students, has taken to the Graduate and Professional Student Council's online health insurance forum to voice her frustration. A folder entitled "Let's get rid of UnitedHealthcare" is the forum's most active discussion, with 89 responses as of Monday night.
Hanson, who was aware of the negative feedback among graduate students in particular, said problems many have experienced are largely due to misunderstandings and miscommunication errors that occurred in 2008.
Hanson said that from August to October 2008, the Duke Patient Revenue Management Organization, which is a separate company within the Duke University Health System, sent student insurance claims to the wrong clearinghouse.
"Our claims are all taken care of in Dallas, Texas, which is not where the big UnitedHealthcare is located, and so people were getting denials," Hanson said.
Although UnitedHealthcare StudentResources pledged to mirror the BCBS policy, Hanson said the company did not honor this agreement.
"In January or February this year, we realized that this isn't right. We knew BCBS had covered some things-we had proof-but [UnitedHealthcare] had made some changes in the way they were paying the claims," Hanson said.
UnitedHealthcare has pulled the claims that were paid incorrectly, however, and is working to "straighten things out," Hanson added.
Glitches often accompany any major change, and discontent is a natural by-product of a shift as significant as a new health care provider, she noted.
Although students initially responded with anger, "most of everything has been sorted out, and we hope this year will be good," Hanson said.
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