Parents and students have been experiencing difficulties with the waiver process for opting out of Duke’s Student Medical Insurance Plan throughout the summer, after Duke switched to a third-party clearinghouse to handle waiver requests.
All students are required to have “adequate health insurance,” and students are automatically enrolled in the Duke SMIP, which costs over $3,000 per student. Students who are already enrolled in plans that offer similar coverage can request to waive their enrollment in Duke’s SMIP.
The process for securing a waiver was previously in-house and handled through Student Affairs. For the 2023-24 school year, Duke is handling waiver requests through JCB Insurance Solutions, a company not affiliated with Student Affairs.
Unlike in previous years, waiver requests are now initially reviewed through an automated process. If waiver requests are denied, JCB allows students to submit appeals, which are reviewed manually.
Parents say that JCB’s process resulted in rejected waivers for the same insurance plans that have been deemed acceptable in previous years, leading to them having to pursue alternate means to secure waivers. Duke has not changed its requirements for coverage, according to Student Affairs personnel.
“The requirements for waiving the Student Medical Insurance Plans for the upcoming academic year (2023-24) remain consistent with those of the previous year,” wrote Margot Cardamone, student affairs chief of staff, in an email to The Chronicle. Cardamone added that the switch to JCB was made to “ensure a more precise and impartial evaluation of waiver requests.”
When Laura Rhoads’ daughter sat down to submit her waiver request on JCB’s website, she was met with an automatic denial. Last year, Hope Rhoads, a sophomore, was able to secure a waiver with relative ease through Duke’s in-house process. After being denied, Laura got involved.
“I've spent a good 15 hours of my personal time doing this, and I've worked in the [healthcare] industry,” Laura Rhoads told The Chronicle on Aug. 2. “It's not like I don't know what I'm doing. It's just hard to figure out what they want.”
She said that JCB was rejecting her insurance policy because they deemed Duke Health to not be in-network, a requirement to secure a waiver. However, Rhoads has confirmation from her insurance company that several providers within Duke Health — both generalists and specialists — are in-network on her daughter’s policy.
Other parents said that their insurance policies were denied for similar reasons, taking to both informal and moderated Duke parent Facebook groups to share their concerns throughout July and August.
“My sons have both used Duke Health, always been charged as in-network — for basic health and well beyond,” wrote Anne Dowling, Trinity ‘92 and a parent of three Duke students, in a July email to The Chronicle. “To claim that after four years of waivers, we now suddenly don’t qualify is just silly.”
‘Proxy for the whole network’: Duke’s denial process
After her daughter was met with an automatic denial, Rhoads spoke with multiple employees at JCB who offered assistance on how to submit documentation for JCB’s manual waiver process.
Rhoads submitted this documentation, and her daughter’s insurance waiver was approved in July — but only temporarily. A few days after receiving her approval, her daughter’s status was switched back to denied.
Rhoads then called her insurance provider and asked them if someone from Duke had called them to verify coverage. Rhoads’ insurance provider told Rhoads that Student Affairs Insurance Specialist Calvin Vennie had contacted them to verify that specific physicians under the Duke Health umbrella were in-network.
In particular, Rhoads said that Vennie asked her insurance provider whether Student Health Medical Director P. Hunter Spotts was in-network. While Rhoads says that her coverage is valid with several other Duke Health providers, because Spotts is out-of-network, her waiver was denied.
Rhoads has continued to seek a waiver by contacting other employees at JCB. She said that as she continued this process, Vennie called her insurance provider once again on Aug. 9, this time asking whether Duke Health physician Melanie Trost, an eating disorders specialist, is in-network. Trost is also a physician in the Division of Student Health.
“Why they're taking one or two physicians as a proxy for an entire network, I don't understand,” Rhoads said.
Rhoads also says that she’s confused as to why Duke Student Health doctors specifically need to be covered by insurance. Rhoads said her daughter has visited Student Health in the past and her visit was not billed to her insurance, instead falling under the student health fee. The student health fee covers most routine services, including physical exams, medical care for minor injuries and laboratory analysis conducted at Student Health.
Vennie did not respond to The Chronicle’s request for comment on Aug. 2 and referred The Chronicle to Cardamone.
“When assessing insurance plans for approval, our focus is on plans that designate Duke Health as an in-network provider for all services, encompassing primary/routine care and behavioral health services,” Cardamone wrote. “[Student Health doctors] are Duke Health credentialed professionals, but Duke Health and its associated services are much broader than that.”
Cardamone responded to the request for comment in an Aug. 24 email, in which she indicated that 95% of waivers have now been approved, in comparison to last year’s 96%.
Cardamone did not respond to The Chronicle’s request for comment about whether specific physicians are considered as proxies for whether a service is covered under the Duke Health umbrella.
Rhoads has still been unable to get her daughter’s waiver request approved, and is currently attempting to contact University administrators about her situation, without much avail, she said.
An ‘out of the blue’ approval
Dowling, on the other hand, was able to get her student’s waivers approved — but only after persistent communication with multiple administrators both at JCB and at the University. She contends that part of the reason she was able to get in contact with Duke administrators and that her situation was resolved is because she is an alumna and is actively involved in the University community as a parent.
“I still have a parent who still hasn't been able to figure it out,” Dowling said, adding that she has spent over 27 hours in the approval process. “They're still having to pay.”
Similar to Rhoads, her sons’ insurance was automatically denied, even after attempting to provide alternate information to JCB’s system, such as using her son’s Duke residence hall address instead of a home address.
At that point, Dowling reached out to Vennie herself and had a back-and-forth email conversation with him about the process she followed with JCB. She also emailed other Student Affairs administrators with questions about the approval process.
“I was like, ‘I don't understand, we've never had an issue,’” Dowling said. “... ‘You can't just hit us with another $7,000. It’s extremely inconvenient for my husband’s staff to change their insurance based on Duke’s denial or for me to drop my children from our insurance, which we don’t really think is beneficial.’”
To her surprise, Dowling said she then received an email from Martha Murphy, a senior vice president at Gallagher Insurance, JCB’s parent company.
Dowling spoke with Murphy and walked her through her plan’s benefits. Dowling said Murphy told her she would look into her waiver, but was ultimately denied once again. After this, Dowling continued communicating with other Duke administrators, and at one point in August, the denials turned into an approval.
“I sent one [email] to the vice president saying it’s really unfathomable to me that with the [explanation of benefits] staring you in the face saying ‘in-network’ to tell me that I’m out of network,” Dowling said. “And then out of the blue, literally out of the blue … we got an email saying your insurance waivers are approved.
“[I submitted] no additional documentation,” Dowling said, adding that the approval email stated that it was determined that her plan is in-network at Duke Health. “Yeah, well no s***, Sherlock.”
Outstanding insurance waiver requests are due Sept. 14.
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Adway S. Wadekar is a Trinity junior and news editor of The Chronicle's 119th volume.