Aetna Student Health, Stony Brook University’s health insurance provider, will reimburse nearly 300 current and former students for underpaid insurance claims. From 1998 to April 2008, Aetna underpaid out-of-network claims by $5.1 million. These claims are made when patients visit a provider who does not have a contract with their insurer. More than 73,000 students were affected nationwide. Aetna will be repaying students under an agreement made with New York Attorney General Andrew Cuomo.
“Students were particularly vulnerable to being cheated because they placed their trust in health care plans sponsored by their colleges,” Cuomo said in a prepared statement.
Stony Brook students without health insurance are required to purchase Aetna insurance through the Student Health Services. The plan, which lasts one academic year, costs $959.
Aetna, the third-largest insurer in the country, had been using outdated reimbursement tables to decide how much to pay health providers. Providers usually bill patients when insurance fails to fully cover costs.
Students who are due payment will be directly contacted by Aetna, which has not released student names to any of the 200 schools involved.
“They’re going to be coming out with notices in about a month,” said Leta Edelson, manager of the Student Health Insurance Office. “That’s about all they’re telling us.”
Students will receive and must return the response forms to Aetna for either reimbursement or to authorize payment to their health care provider. If the form is not returned within 45 days of receipt Aetna will automatically pay the provider, according to a company representative. Payments will be sent out within six months.
“I wouldn’t have expected this to be allowed to happen,” said Michael Chuprin, a student covered by the university’s insurance. “But at least something is being done now.”
Under the agreement, Aetna will also invest $20 million in creating a new, independent reimbursement database. Ingenix, the largest supplier of healthcare billing information in the country, had provided the outdated rates. Ingenix has been under investigation by Cuomo’s office since an industry-wide inquiry was launched in February 2008.
