Costs and Coverage Archives – Academic HealthPlans
A Message from Terry Lyons on COVID-19
 

Claims are Key – a Guide to Claims Audits and Readiness Assessments

Costs and Coverage, Risk Management

Properly adjudicated claims are a key goal of claims administrators, colleges and universities, and student members alike.

Inaccurately processed claims can end up being timely and costly. Overpaid claims will negatively affect claims experience leading to higher premium renewals. These can be especially harmful for self-funded plans where the college or university holds the risk. Underpaid claims can lead to additional time processing claims and handling appeals and some unhappy members.

The good news is that claims administrators take this very seriously and have comprehensive processes in place to ensure timely and accurate claims processing. That said, there may still be some that initially slip through the cracks.

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Dependent Eligibility Audits

Costs and Coverage

When it comes to student health insurance, some universities and colleges have specific, school-sponsored plan eligibility requirements, not just for students, but for dependents as well. Contingent upon the plan, schools may or may not be able to cover dependents.

A dependent is a person(s) relying on the policyholder (the student) for support. Dependents could fall into various categories; this person could be a spouse, parent, child (under the age of 26 per the Affordable Care Act), or even a domestic partner.

Dependent coverage is only available if the student is also insured and dependent enrollment must take place at the time of student enrollment unless there is a qualifying event such as a marriage, birth, etc.

dependent eligibility audit is a process used by organizations to verify that all dependents enrolled in a benefit plan are eligible for coverage.

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The Current State of Transgender Health Care Coverage

Costs and Coverage, Student Health

As a student health professional, and a health care professional in general, it is one’s duty to show compassion and understanding for students who seek care. This can be especially true when providing support and treatment to individuals who suffer from gender dysphoria.

Gender dysphoria occurs in individuals who experience a conflict between a person’s physical or assigned gender and the gender with which he/she/they identify. Since the transgender segment of the college student population is growing, and it is often during the college years that individuals begin the transition process, it is more important now than ever that, as college health professionals, we take a deeper look into their physical and behavioral health needs and how we can work together to tailor college health programs to be a helpful and compassionate resource.

According to a 2016 article from the New York Times, data collected from federal and state agencies estimated there are 1.4 million adults who identify as transgender. The total number of transgender individuals in the United States is likely much higher, considering this number does not include children and those who have not reported their gender identity. The data also shows that 18 to 24-year olds were more likely to identify as transgender – the age range of a traditional college student. And that number is growing.

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