One low-income student was forced to pay thousands of dollars for off-campus mental health therapy. Another gave up trying to find a therapist because the process was too long and too complicated. Others described being denied access to much-needed specialty care for auto-immune conditions.
What were these students told about the Yale Health Plan’s failure to cover the health care they needed? Pay out of pocket — or go buy insurance on the Affordable Care Act exchanges, if they can afford it.
In April, we wrote about how lack of clarity over what kinds of health services would be covered under the Yale Health Plan raised significant red flags about coverage for off-campus students. We asked students, “are you covered?” After a Qualtrics survey of students of two Yale graduate schools and free dissemination, we received responses from 61 college and graduate and professional students. Their individual stories are renewed evidence that, for many students, the Yale Health Plan is inadequate. For too many Yale students, particularly the significant number now living off campus or outside of New Haven, the answer to our original question is, “you are not covered.”
In response to an inquiry about this piece, Chief Executive Officer of Yale Health Paul Genecin reiterated that the Yale Health Plan is designed to be a limited, health maintenance organization coverage plan. In an email, Genecin said, “Lacking the national network of national insurers, Yale … coverage is designed for students who spend the majority of their time in New Haven.”
In the spring, we imagined that Yale Health’s limited scope of coverage would stop off-campus students from seeking potentially expensive care in the first place. Yale’s prior authorization guidance does not guarantee that authorized care will ultimately be covered and the health plan excludes preventative care. We were mostly wrong: roughly 40 percent of survey respondents continued to seek elective care. However, roughly half of the respondents said that uncertainty about what services would be covered changed whether they sought care they otherwise might have.
We were right about what we least wanted to be true — students who did seek treatment faced a number of obstacles. Of the fifteen students who reported receiving mental health care since March, six said their care was not covered by the Yale Health Plan. Four of sixteen students who filled prescription medications while off campus noted increased out-of-pocket costs, and another three students noted logistical challenges obtaining their medicine.
Many survey respondents found the system opaque, inconsistent and difficult to navigate. Over half said that Yale insurance policies were unclear and six students described the policies as “extremely unclear.” For example, one student’s long-term therapist was covered, but a psychiatrist who could prescribe necessary medications was not.
In an effort to provide mental health services to off-campus students, Yale contracted with Magellan Health, a managed health care company. Student complaints about their experiences with Magellan were common and experiences seemed sharply bifurcated — some students found it easy to use, and others found it took weeks of persistent effort. One student described calling Yale Health to set up an initial intake appointment, waiting several weeks for the hour-long session, calling Magellan to get prior authorization and waiting to receive it — all before finding a therapist. Expecting students struggling with mental illness to engage in such an extended and complicated process is unreasonable.
One undergraduate student found the Yale Health Basic Plan useless, because they were off campus this spring, when they needed care the most: a family crisis in which members of their family contracted COVID-19. The student, who has a chronic condition requiring regular care from specialists, wasn’t able to get any of the specialist care they needed under the Basic Plan. The student is now uninsured because the Yale plan covers so little of their needs — and because the system was so opaque, they said.
The uncertainty about what care is covered is especially problematic given the number of complaints about contradictory advice from Yale Health care providers and administrative staff. Seven survey responses explicitly referenced the difficulty of communicating with Yale Health. Lack of clarity in insurance policies can be a major barrier to seeking and receiving treatment. The undergraduate student who dropped the Yale Health Plan explained, “I had no idea how to do the kind of self-advocacy I needed to do, especially right now.”
At at least one graduate school, students returning to New Haven were told explicitly that if they anticipated being off campus and needing prescriptions or doctors’ visits covered, they should buy insurance on their state’s private insurance exchange. Unfortunately, such insurance is often significantly more expensive than the Yale Health Plan, rarely covered by financial aid and requires students to navigate frequently complicated health care marketplace systems without support.
Other large universities provide student health insurance through partnerships with a national insurer, meaning that students can still access in-network doctors when they’re not at school. The Yale Health Plan, however, is “self-funded,” meaning that the University provides its own insurance to students. Often, self-funded institutions claim that they provide higher-quality, better tailored insurance for students. In Yale’s case, the COVID-19 pandemic has exposed how narrow and flawed self-funded plans are.
An informal survey conducted by students in a subset of the University’s population is insufficient to show anything other than that some members of our community are struggling. Yale Health should conduct its own thorough, prospective evaluation of its insurance policies and publish the results. It should also coordinate more formally and transparently with the student body, for example, through a student body advisory board or representative.
In the near-term, Yale Health should create an advising service for off-campus students seeking help on private insurance exchanges. The University should also consider giving such students financial assistance to ensure they are able to afford private insurance offering coverage comparable to the on-campus Yale Health Plan. Yale should also consider a long-term partnership with a national insurer. Lastly, Yale must be a leader in advocating for national policy change, including reform of telemedicine laws to increase access to care.
During a period when many are suffering — from family job loss to loss of family members — it is critical that Yale Health make clear, to students and to its own staff, how you can get covered.
EVAN WALKER-WELLS ’13+1 is a JD candidate at Yale Law School and MBA candidate at the School of Management. BLAKE SHULTZ is a JD candidate at Yale Law School and an MD candidate at Yale School of Medicine. Contact them at evan.walker-wells@yale.edu and blake.shultz@yale.edu.