I’ve never been more grateful to be healthy. At least, I hope I’m healthy. At a recent telehealth appointment, my clinician recommended I get a blood test to look into the hacking cough I had since February. Then, she found out I was living in New Jersey. According to Yale’s Out of Area Coverage policy, students can only receive in-person care outside of Connecticut in limited circumstances. Although Yale suspended this policy when COVID hit last spring, my clinician explained that in August, we were “no longer in emergency conditions.” I could not receive a test until I returned to New Haven. Until then, we’re both hoping it’s allergies. 

Yale, unlike many peer institutions,  does not offer health coverage through a major insurer. Instead, it typically covers routine, in-person treatment only at Yale Health’s facilities. For the university, this policy is likely a cost-cutting measure. When I contacted Paul Genecin, the CEO of Yale Health, about why it limited off-campus coverage, he noted the plan is “designed to serve students when on campus.” But he did not explain why the university designed a policy that only covers some of the students during most — but not all — of the year. For those not on campus, this policy often means paying out of pocket or going without treatment.

Even when Yale does cover treatment, the process of funding care is byzantine. When I called about getting a flu shot in September, Member Services told me to front the bill and mail in a reimbursement claim. About a month later, I received a letter informing me my claim had been rejected. When I called for an explanation, the claims department told me I should have obtained a coupon from Yale instead. I was told to mail in an appeal, a process that would presumably take another month. By now a veteran of the process, I instead called member services, who informed me no appeal was necessary after all. Thankfully, my bill was only $25. I have not been forced to pay thousands of dollars like some of my peers with more serious conditions. But despite hours spent on phone calls and emails, I’m still not sure what coverage I do have, nor do I know who to ask.

At the beginning of this year, I was told to register in absentia, which enables graduate students who have advanced to candidacy and are traveling for research to receive care through Aetna. But my application was rejected because a “change [was] in the works [due to COVID].” I was assured that I would “have the same benefits as all students, including those registered in absentia.” When I followed up with member services to ask about this new system, they told me the registrar “alone” was responsible for the new system. But when I emailed the Registrar’s Office, I was told that I needed to register in absentia. When I noted that my absentia request had been denied and asked about the new system, I received no response. 

Experiences like mine are probably why Genecin — when commenting on this piece — advised that students living off campus should purchase a different plan “that better suits their needs.” With many students living off campus due to COVID-19, the limits of this approach have become more visible. But even in normal times, many graduate students live off campus. Still more live on campus but visit friends and family during vacations. These trips should not be perilous. A fellow student told me she once had a fever that lasted over two weeks while visiting family for winter break. When she called Yale Health to ask if she could visit a local doctor, she was advised that it was a “gamble.” Unless she were hospitalized, she would probably have to tough it out until she got back the following month. 

Yale should fund routine, in-person care for students when they are off campus — as Yale did last spring. While the current system may cut costs for the university, students end up paying the bill. Yale should also take common-sense steps to improve the process, especially students with limited means. For instance, students shouldn’t have to pay upfront and wait months for reimbursements. Nor should they have to hunt for reliable information about their coverage: although Genecin recommends students contact member services, my and others’ experiences suggest they often cannot predict what other branches of the bureaucracy will do, forcing students to cope with uncertain and sometimes incorrect information. Finally, students should be able to email important documents: no one should have to use snail mail in 2021.

You don’t need to attend the School of Public Health to learn a lesson about the woes of America’s healthcare system. It’s free with your Yale Health coverage.

NATHANIEL DONAHUE is a JD-PhD (History) student at Yale. Contact him at nathaniel.donahue@yale.edu.