In an effort to protect its students from exposure to COVID-19, Yale asked all students to remain off campus for the rest of the semester. In attempting to avert one health care crisis, however, the University unwittingly contributed to another. For off-campus students, Yale student health insurance fails to cover critical medical services and subjects students to unnecessary copayments and burdensome prior authorization requirements.
Yale’s failure to provide its students with adequate coverage, and transparent information regarding the scope of that coverage, would be a problem for students during normal times. During this crisis, it is one more dangerous example of how the American health care system fails to ensure health for otherwise disadvantaged Americans and those with mental illness.
On March 15, Yale released a statement regarding health care for students no longer on campus during the COVID-19 outbreak. The statement explains that “emergency and urgent care” for such students is covered at 100 percent worldwide, including for COVID-19. It also states that Yale Health will expand its coverage outside of Connecticut for “medically necessary treatment for chronic conditions and for prenatal and labor and delivery care.”
However, even for medically necessary care, a step below emergency and urgent care, the policy requires students to “wait for approval” before booking an initial appointment, and coverage is not guaranteed. Final decisions about coverage will only be made after the visit, and once documentation from a provider is submitted. This requirement makes it impossible for students to know in advance what care will be covered and whether they will be treated equitably to other students.
Now that so many students are off campus and unable to access in-network care, their ability to see their Yale doctors has dramatically changed. Prior authorization requirements with no guarantee of coverage will cause significant uncertainty and stress — particularly for low-income students.
Many students on financial aid may have Yale Health as their only health insurance. While many students may be privileged enough to be on their parents’ plans, this crisis makes clear that even in so-called ‘normal’ times, Yale Health’s limited insurance can prevent students from accessing care.
Yale Health’s policy fails to meet student needs during the COVID-19 crisis for three key reasons. First, the expanded coverage network does not apply to preventive care or elective procedures and treatments provided off-campus. This means that critical health care, including annual physicals, wellness visits, STD screenings and some vaccinations are all not reimbursed.
Most students will remain off campus for over four months, which is long enough that — even in the absence of COVID — many will need routine or preventative care. Recognizing this, other institutions such as Harvard explicitly cover vaccines and routine physicals. Harvard also created a limited temporary medical cost-sharing assistance program for low-income students. But Yale has not.
Yale also fails to provide any information on the coverage or availability of off-campus mental health services beyond requesting that students call Yale Health “for advice and options.” This requirement again raises concerns that students may not be treated equally, and is no replacement for transparent, published guidelines. The fact that many states place legal restrictions on cross-border telehealth may pose a significant barrier should students be required to see Yale Health professionals.
Second, the prior authorization and reimbursement processes for off-campus doctors are so complicated as to likely prevent many students from getting care. In addition to needing prior authorization for a medically necessary appointment, tests, medications and follow-up visits will have to go through prior authorization, too. Prior authorization requirements have the potential to deter and delay care. Yale Health provides no information on the ease of receiving prior authorization or the scope of the “expanded” network that is being provided.
It may very well be the case that students with established off-campus provider relationships may not be able to see that provider. Other schools, including the University of California, contract with national insurers such as Anthem, and have COVID policies referring students to Anthem’s website for determining network coverage. This practice is significantly more transparent than Yale’s approach — which places additional burdens on students with chronic conditions in finding and accessing care.
Finally, although Yale Health Pharmacy says it will authorize early refills for most medications, students may be forced to pay higher out-of-pocket costs. For those who need to pick prescriptions up at a pharmacy, they must pay full cost at the time of service. Although students may submit a claim form for reimbursement, low-income students may be unable to afford the up-front costs of their medications.
Yale Health should take immediate steps to increase student health insurance transparency, including by publishing detailed network and reimbursement information, and to ensure adequate coverage of mental health treatments and necessary preventive care. Furthermore, the student insurance plan should provide assistance to low-income students subject to higher costs due to coverage restrictions. Following the University of California system, Yale should give all students the option of getting off their Yale Health plan for a refund of the enrollment cost so that they can seek more helpful temporary coverage. Yale should also consider offering options for recent graduates who may experience difficulties or delays in finding permanent employment and thus long-term health insurance.
Without these changes, Yale Health falls short of protecting vulnerable students during this time of need. Yale has an obligation to ensure that it provides adequate insurance, and to advocate vigorously at the state and national level for policies — like easing restrictions on cross-border mental health therapy — that would improve coverage.
Even in good times, Yale’s student health insurance is part of the patchwork of America’s unequal health system. But in a health crisis, it is a direct threat to the long-term wellbeing of thousands of the University’s students.
EVAN WALKER-WELLS ’13 is a JD candidate at Yale Law School. BLAKE SHULTZ is a JD candidate at Yale Law School and an MD candidate at Yale School of Medicine. Contact them at firstname.lastname@example.org and email@example.com .