Students give UnitedHealth poor reviews

Zack Brown was jogging on East Campus last August when he suddenly lost hearing in his right ear.

“No loud noises, no trauma, it simply cut out,” he recalled.

Brown, a fourth-year graduate student in environmental sciences and policy at the Nicholas School of the Environment, said he went to Student Health the next day and was referred to an ear, nose and throat specialist, who classified the condition as “a medical emergency.” Brown said he then underwent a brain magnetic resonance imaging to rule out the possibility of brain cancer.

With two weeks of steroid treatment, Brown’s inexplicable problem went away, and the MRI results were negative for cancer.

But with medical bills of about $1,200, Brown said his problems were far from over.

“I called [UnitedHealthcare StudentResources] to check about coverage and they informed me that hearing problems were not covered unless they were related to a ‘disease process,’” he said.

Brown added that phone calls with UHCSR representatives were “hopelessly unproductive,” leading him to question why he has health insurance.

“What good is insurance if it doesn’t cover something like this?” he said.

“What’s remarkable to me in all this is that my wife and I are among the lucky ones—we have medical insurance,” said Matthew Whelan, a first-year graduate student in the Divinity School. “And when we needed things to go smoothly—both being graduate students, expecting and then receiving our first child—it was quite overwhelming to have to deal with UHCSR in the way we did.”

Pregnant and insured?

Whelan said he and his wife, fourth-year Divinity graduate student Natalie Carnes, found fighting for maternity coverage to be taxing. Originally told that the birth center at which his wife delivered was in-network, Whelan said the couple was surprised to later discover that the service was out-of-network.

“It literally felt like a part-time job dealing with them over the phone this summer in order to resolve the manifold bills we kept on receiving from providers, fighting just to get UHCSR to cover the things their policy states that they cover,” he said.

Carnes noted that health care providers seem to be facing difficulties under the new plan as well.

“One thing that has surprised me in this process is how frustrated I have seen health care providers get with UHCSR, too,” Carnes said, adding that two hospitals she has visited have expressed confusion and frustration with the current plan.

Jered Wells, a second-year graduate student in medical physics, said he expected his wife’s UHCSR insurance to cover the majority of her pre-birth care, but then the couple was billed $721 for a fetal ultrasound. Upon probing further, Wells said the details he unearthed were surprising.

 “I found out that Duke had billed my second ultrasound as an X-ray,” he said. “Being as I am a student in the medical sciences, I should know that an x-ray is certainly not equivalent to an ultrasound. My inquiries to [UHCSR] indicated that, due to the mix-up in billing, [UHCSR] was unable to cover the cost of the procedure unless a full prenatal workup and ultrasound results could be provided by the hospital.”

Wells said the insurance company paid the ultrasound bill six months later.

Searching for doctors in Beaufort

Students at the Marine Lab in Beaufort, N.C. said they have been frustrated with UHCSR guidelines they feel are unfair to those who spend their time outside Durham.

Myriah Cornwell, a fourth-year graduate student in the Nicholas School living at the Marine Lab, said BlueCross BlueShield of N.C. provided students with more health providers in the area than UHCSR does. She said she and her fellow students in Beaufort brought their concerns to UHCSR, which asked for a list of all providers in Carteret County.

Michelle Blickley, a sixth-year graduate student in the integrated toxicology program at the Nicholas School, said she and other students at the Marine Lab then submitted 10 names of medical providers near Beaufort to UHCSR.

“Out of the 10 or so names we submitted, only two have been added to the program,” she said.

Blickley noted that the lack of access to physicians has been very inconvenient for her.

“When Duke switched to UHCSR, I had to change all my doctors because none of them accepted UHCSR,” she said. “Even more upsetting is that the physician list on the [UHCSR] Web site only lists 39 doctors within a 30 mile radius [of the Marine Lab] that accept our insurance.”

Blickley said UHCSR representatives told students to look within a 50-mile radius.

Cornwell also said a clause in the health plan that limits students to one medical visit a day is unfair to those in Beaufort.

“Many of us Marine Lab students schedule doctors’ appointments in Durham—since our coverage in Beaufort is so dismal—and we like to do them in one day since it’s out of our way,” she said.

 UHCSR is re-examining the clause, said David Kahler, Graduate and Professional Student Council treasurer and Student Health Insurance Advisory Committee member.

Miscommunications

Other problems stem from—as Brendan Nyhan puts it—“administrative incompetence.”

Nyhan, who graduated last year with a doctorate in political science and now researches health policy at the University of Michigan, said he was billed for his two-year-old son’s vaccination—a charge UHCSR did not cover because his son was listed as his spouse.

“We determined that I was being charged higher premiums than I should have been, since insuring a spouse is more expensive than a child,” he said. “Apparently the fact that my son was two years old didn’t tip them off.”

Other administrative problems arose from confusion on Duke’s end about where claims should be sent.

Cornwell, who does research at the Marine Lab, said that initially, every medical claim she filed was denied.

“Every time I contacted the UHCSR help line, it was as if I was talking to a wall,” she said. “I explained my situation, and they denied ever receiving a claim and offered no help in dealing with the hospital or paying my bill.”

Jean Hanson, administrative director of Duke Student Health, said that from August to October of last year, the Duke Patient Revenue Management Organization sent student insurance claims to the main UnitedHealthcare office instead of the college-specific subdivision of UHCSR.

But Cornwell said she believes the problems could have been resolved quickly.

“At no point did anyone at either United branch figure this out or pass along my claim to the right office.... It was as if they were forbidden from talking to each other,” she said

Hanson added that the error was not unique to Duke. In a November 2008 message posted on the GPSC insurance forum, Hanson wrote that because the problem was so prevalent among other schools, UHCSR developed an information sheet about claims submission, which is now posted on the Student Health Web site.

She said in an interview that claims submission problems have been addressed and are in the process of being resolved.

For some students with other options, changing insurance providers appears to have been the simplest choice.

Wells said he and his wife decided to leave UHCSR six months into her pregnancy.

“My wife and I abandoned the Duke system… in order to avoid the hassles with the insurance,” Wells said.  “Needless to say, the remainder of the pregnancy was worry-free.”