UnitedHealthcare StudentResources Insurance Denial
College Student Health Insurance
Students have many options for health insurance. They can remain on their parent’s plan until they are 26 or, if they are working, get a plan from their own employer. Students can also purchase an individual plan from the Affordable Care Act marketplace or directly from an insurer. And several students receive health insurance through their colleges. Many colleges require their students to carry health insurance coverage. One student health insurance plan, UnitedHealthcare StudentResources (UHCSR), is from UnitedHealthcare. Most college students are young and have few health issues. But getting a health insurance denial when the treatment or medication prescribed is expensive is not uncommon. This page discusses United Healthcare college student health insurance and also what you can do if you receive a UnitedHealthcare StudentResources insurance denial. If you receive a denial, reach out to the Law Offices of Scott Glovsky because we can help.
What is United Healthcare StudentResources (UHCSR)?
UnitedHealthcare StudentResources is a division of UnitedHealthcare Group, the largest health insurer in the country. This division started in 1987. Hundreds of universities and colleges across the country offer UHCSR plans. And each school may offer multiple plans.
Do I Need to Enroll in My School’s UnitedHealthcare StudentResources Insurance Plan?
As outlined above, as a student you have many options for health insurance. You may or may not need to enroll in your college’s UHCSR plan. If you do enroll and you are also covered under your parent’s plan, your parent’s plan often will be the primary health insurance. This means that you submit your claim first to your parent’s plan and then submit the claim to UHCSR to cover the remaining expenses.
UnitedHealthcare Student Resources recommends that you compare plans before selecting one. It suggests that your school-sponsored UHCSR plan might be a superior plan to alternative plans because it is specific to student needs.
Is UnitedHealthcare StudentResources Insurance Coverage the Same as Non-Student Insurance Coverage?
UHCSR suggests on its website that StudentResources maybe even better than non-student health insurance. It claims that the younger and healthier student population equates to lower premiums than other non-student health insurance premiums. The company says its plans don’t overlap with insurance coverage that is already covered in student tuition. This tuition coverage applies to the student health centers at most schools. UHCSR also touts additional benefits including telehealth, injury and sickness plans, and emergency medical travel services. Other benefits potentially include insurance for study abroad and summer programs and vision and dental plans.
Are UnitedHealthcare Student Resources Plans Compliant with the Affordable Care Act (ACA)?
Most UHCSR plans are in fact compliant with the Affordable Care Act and meet the ACA standard of essential minimum coverage according to the UHCSR website. This minimum coverage includes ten healthcare services such as ER, hospitalization, and outpatient mental health. It also includes prescription drugs, maternity care, lab services, rehab, and habilitative care. Finally, it includes pediatric, outpatient and preventative, and wellness services. And the ACA eliminated all coverage caps for these services.
Do UnitedHealthcare StudentResources Plans Cover Non-Medical Insurance?
UHCSR plans vary by college or university. Although plans vary, oftentimes dental, vision, and pregnancy are covered. Plans that are ACA compliant must cover the essential minimum benefits outlined above. Of course, like many non-student health insurance plans, there are also services that are not covered. Typically, these services include cosmetic surgery, infertility treatment, bariatric surgery, hearing aids, and others.
Will a United Healthcare StudentResources Plan Insure My Entire Family?
Sometimes students have dependents. While specific coverage varies by university or college plan, some UHCSR plans cover the families of students. Eligible dependents sometimes include spouses, domestic partners, and dependent children under the age of 26.
Are UnitedHealthcare StudentResources Plans Cheaper Than Other Health Insurance Plans?
The cost of each plan varies by school. In general, UHCSR suggests that its plans are competitively priced because the student population is younger. And many insurers price policies by the age of the insured. For this reason, young children are much less expensive than older adults. Oftentimes the premiums are less expensive, and the deductibles are lower for UHCSR plans than they are for other insurance plans.
What Are Reasons That UnitedHealthcare StudentResources Might Deny My Health Insurance Claim?
Like other health insurers, United Healthcare Student Resources denies some claims. There are many reasons why your claim may be denied including the following:
- Your healthcare provider sent the claim to UnitedHealthcare instead of to UnitedHealthcare StudentResources.
- The claim has an incorrect medical code or other error.
- UnitedHealthcare StudentResources didn’t receive the necessary supporting documentation from your provider.
- The insurer considers your claim not medically necessary or experimental/investigational.
- You don’t have Prior Authorization for this service.
- UHCSR wants you to try a different option first. For prescription drugs, this is called “Step Therapy.” In this case, you must try a different (often less expensive) prescription first. Then, if that drug doesn’t work, UHCSR might have you try yet another different drug. Only if various drugs don’t work does your insurer return to the prescription your doctor requested in the first place.
- Your UHCSR insurance policy doesn’t cover this service. While every policy is different, some services that may not be covered include cosmetic surgery or infertility care.
- Your healthcare provider or the facility is “out-of-network.” Out of network means the facility or provider isn’t part of your UnitedHealthcare Student Resources policy. In other words, the provider or facility is not “in the network.”
Sometimes health insurers delay paying claims. They might claim they didn’t receive the right paperwork or that they are waiting for a medical professional’s assessment.
Other times insurance companies underpay claims or only reimburse part of the cost. This includes when they offer to cover a less expensive treatment instead of the one your doctor wants to perform.
What Can I Do If I Receive a UnitedHealthcare StudentResources Insurance Denial?
If you receive a UnitedHealthcare Student Resources health insurance denial, the first step is often an internal appeal. United Healthcare Student Resources has a form that you complete and send to the company. When doing so, you must comply with deadlines. We recommend that you speak with an attorney who focuses on health insurance denials before you do so. This lawyer can help guide you through the best path to take. And if your first step is an appeal, the attorney can help ensure that the letter optimizes your chance of receiving approval.
If there is bad faith, you can often sue the insurer for damages you suffered. Sometimes you can also sue for punitive damages. Punitive damages are damages to discourage this wrongful behavior in the future. Bad faith can include several things. Perhaps UHCSR denied your claim for something that is not reasonable. Or maybe it didn’t thoroughly investigate your claim prior to denying it.
What is the Full UnitedHealthcare StudentResources Appeal Process?
Health insurance appeals often must adhere to state regulations. In California, for example, you have 180 days to file an internal appeal from your claim’s denial date. Then the insurer has 30 days to complete a pre-service claim appeal and 60 days to complete your appeal if you already had the service. You can also request an expedited appeal if your situation is urgent. And the insurance company must give you a written decision. We often hear from people that they never received a written denial.
If your internal appeal is denied, then often you can ask for an external appeal. Generally, an independent 3rd party conducts an external appeal. This process can take a maximum of 60 days in California. And again, you can request an expedited appeal. Your insurance company must accept the determination of the 3rd party. We recommend that you do not get an external appeal before speaking with a qualified health insurance lawyer. Why? Because if you lose this appeal, you may have little chance of getting the healthcare service you are requesting.
Has the Law Offices of Scott Glovsky Represented Students Against UnitedHealthcare StudentResources?
Our firm has litigated cases against most health insurance companies, including both UnitedHealthcare and UnitedHealthcare StudentResources. We focus on health insurance and attorney Scott Glovsky is nationally recognized as a passionate advocate for the rights of health insurance policyholders. Because we take on a few cases, Scott has the time to get personally involved with every client and every case. And our cases have not only helped our clients but in some cases changed laws to help millions of other policyholders.
Contact The Law Offices of Scott Glovsky if You Receive a UnitedHealthcare StudentResources Insurance Denial.
We’ve been fighting for the rights of insurance policyholders since 1999 and may be able to help.