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Admins wrangle with UHCSR problems

In response to dissatisfaction with UnitedHealthcare StudentResources, University health administrators have sought to resolve student issues with the insurance company.

“We tend to hear from the people who have problems, and we’ve been working to address concerns,” said Dr. Bill Purdy, executive director of Student Health.

In 2008, UHCSR replaced BlueCross BlueShield of North Carolina—the University’s Student Medical Insurance Plan administrator for 30 years—a change that has come under fire from graduate students frustrated with UHCSR’s coverage and service, as investigated in Part one of the series.

Untangling problems

University administrators said they are aware of the problems students have experienced with the new plan and are working on a case-by-case basis to get them resolved with UHCSR. Purdy and Jean Hanson, administrative director of Duke Student Health, said they have made it a priority to respond to student concerns.

Hanson said she strives to be “the intermediary between the student and UHCSR.”

Although UHCSR pledged to mirror BCBS of N.C.’s coverage in its contract, many students have come forward with ­complaints against the new insurance provider.

It came to Hanson’s attention, for example, that BCBS of N.C. paid for provider visits and office procedures done on the same day, while UHCSR did not. The issue is common, Hanson noted, in visits to psychiatrists for medication, followed by appointments with psychologists for therapy.

After Hanson intervened on behalf of disgruntled students, however, she said UHCSR reviewed the claims and corrected payments to match what BCBS of N.C. would have charged.

Some students frustrated with coverage problems said they were impressed with the University’s swift response.

Nora Hanagan, a sixth-year graduate student in political science, said after bringing her problem to the attention of Student Health, the complaint was promptly addressed. She added that she has been reimbursed for erroneous charges on her account.

“My sense is that Duke really is trying to take care of its students and that many of the problems that have occurred have been fixed for Duke students,” she said.

Hanagan noted, however, that such personalized attention may not be paid to all college students with insurance problems.

“I worry that students from schools with less clout than Duke have not been treated well,” she said, adding that a customer service representative at UHCSR said the denial for her type of claim was “standard practice.”  

On a larger scale, Susan Barry, director of marketing at UHCSR, said the company is committed to ongoing refinement of the SMIP, as requested by University representatives.

Indeed, Hanson said administrators are working closely with UHCSR to examine its maternity coverage—one of the areas that has been particularly problematic.

But such a change is a lengthy process, she noted. And for all the problems that have been posed—and Hanson acknowledged that there have been legitimate concerns—there is a limit to what can be done.

“We’ve fixed quite a few things this year, and sometimes the answer is, ‘Sorry, that’s just the way it is,’” she said.

Purdy, too, said that some glitches were bound to occur.

“As with anything, this plan is not perfect and we know there are problems,” he said. “We wish there weren’t.”

But all things considered, “there have been students that have really liked this,” Purdy said.

Possible changes

University administrators are entertaining the possibility of switching to an entirely different model for providing student health care coverage.

The University currently subscribes to a “fully insured” plan—UHCSR is therefore responsible for paying for the total costs of all claims.

David Kahler, treasurer of Graduate and Professional Student Council and a member of the Student Health Insurance Advisory Committee, said the University holds a contractual agreement with UHCSR, stipulating that if the paid premiums are substantially higher than the paid claims, Duke will get some of the difference back.

But Purdy said for the future, he is looking at the option of partially self-funded plans for coverage .

In fully self-insured plans, an entity that is not an insurance company—usually a university in a higher education context—manages the funds to pay insurance claims, said Kahler, a graduate student in civil and environmental engineering. The insurance provider usually exists in this plan solely to provide customer and support services.

“But the defining quality is that the entity holds the funds and pays the claims,” he said.

Kahler added that when a self-insured plan is “partial,” the University would buy additional insurance to protect itself from unexpectedly large claims.

A few colleges and universities around the country have experimented with self-funded insurance plans to keep costs low and benefits high, with positive results, Purdy said.

Heather Pineda, health plan administrator at the University Health Services of the University of California, Berkeley, said UC-Berkeley adopted a self-funded plan in the mid-1980s.

“The main benefit about being self-funded is that we control more about our plan,” she said. “For example, we can customize our benefits to best meet the needs of college-aged students.”

More than 20 years ago, Dartmouth College also introduced a “very successful” self-funded insurance plan, said Gordon Taylor, associate dean and executive officer at Dartmouth College. And the institution will likely stick with its plan.

Taylor added that the plan allows Dartmouth to provide extensive coverage for students at a very reasonable cost and with a very high level of benefit.

“I would argue strongly against ever going back to an effectively purchased provider like UHCSR,” he said.

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