As a leading provider of student-centric health insurance solutions for colleges and universities, Wellfleet Student focuses on empowering students and helping them receive accessible, quality care. We understand that every school’s needs are different, so we adapt each school’s plan to best serve their student population.
Commercial insurance carrier networks can create limitations for students searching for the right provider that may not be in the carrier’s nationally contracted network. This can lead to unnecessarily high out-of-network charges from those providers that aren’t contracted, even if those providers are amicable in treating students from the local college or university.
Because Wellfleet is not tied to a single network, we can tailor our provider solutions based on the school’s location and needs. In this case study, we see one example of how our team created a custom provider network for a large university partner, as well as how we optimized behavioral health access and inclusive care opportunities.
Identifying the client’s needs
When determining how to create the best network solution for our client, a large university with approximately 22,000 members enrolled in their student health insurance plan, we discussed their needs for local and national provider access.
They wanted a strong in-state medical network as well as a robust local community behavioral health panel for their students. Additionally, the school wanted students to have quality network coverage outside of the university’s home state for when students traveled during breaks.
A few of the other student health insurance priorities this university emphasized were creating more inclusive benefits for its diverse student population and improving the efficiency of on-campus pharmacy services.
Our discussions led Wellfleet to create a tailored student health plan that fulfilled the following:
- Comprehensive in-state and out-of-state network coverage
- Access to key local behavioral healthcare providers
- Inclusive care, including comprehensive LGBTQIA+ services
- Efficient on-campus pharmacy services
Building a custom network
Wellfleet takes a unique approach when building first-of-their-kind network solutions for our clients. While other carriers are limited by their current network contracts, Wellfleet can build multi-tiered layers of provider contracts based on best-in-class partnerships.
When creating a PPO network for our student health insurance clients, we emphasize:
- Medical expertise
- Proximity
- Demographic fit
- Experience with a student population
- Cultural diversity
Expanding the client’s behavioral health network
The first step in tailoring this client’s health plan to their needs was customizing their network. They wanted their students to have top-of-the-line in-state coverage plus out-of-state coverage that gave students ample options for care when home on breaks.
They also wanted to rework their behavioral health care offerings by adding key local providers to the network. We wanted the university students to receive the right behavioral healthcare, which for that school included access to local behavioral health providers who regularly treated students. We built relationships with local providers and created a custom behavioral health panel of local providers to layer on top of the state-wide network.
“Our client didn’t want the best package on the shelf at the cheapest price,” said Brian Judy, Executive Vice President of Student Health at Wellfleet. “They wanted the best of everything, customized. That meant looking at each component of the program to provide the best provider network, attracting and reinforcing what was available in that network, and then optimizing how that network allowed claims to be processed. We wanted to help our client deliver best-in-class coverage for their students.”
Wellfleet’s approach to provider solutions goes beyond traditional networks.
For this university, we combined two networks, one that provided excellent in-state coverage and another that offered comprehensive out-of-state coverage. Then, to go one step further, we worked individually with about 1,000 key local healthcare providers, including many behavioral healthcare specialists, to ensure our client had the most robust network possible.
In the end, our team was able to provide our client a network that included:
- Access to an in-state network of 80,000+ providers and 380 hospitals across the state
- Access to a national network of more than 1 million providers
- Access to an additional 1,000 local behavioral health providers
“We were able to deliver the very best for them even though it didn’t exist in the market already,” said Judy.
Learn more about what Wellfleet is doing to improve students’ access to quality behavioral healthcare through our Behavioral Health Suite.
Inclusive benefits for diverse populations
Another priority for our client’s student insurance plan was helping their diverse student body receive equitable access to the care they needed. They wanted students from all social, racial, gender, and cultural groups to have access to quality healthcare.
Learn more about eliminating healthcare disparities on campus.
Notably, our client wanted to lead the way in the gender-affirming care space. At the time, gender-affirming care guidelines were in their infancy within the industry, and most health plans only had minimal coverage pertaining to gender-affirming services.
We worked closely with the client to ensure their students received coverage for gender-affirming care services, including:
- Top and bottom surgery
- Hormonal treatments
- Behavioral healthcare
- Facial feminization
Additionally, our client wanted their chief medical officer to have the ability to review non-standard claims to determine coverage. Reviewing claims in-house gave the client greater flexibility with covering transgender healthcare services beyond standard coverage for fully-funded health plans.
This client was a large state university, so they could have joined the health plan chosen by the rest of the universities in their state. But they’ve chosen to stay with Wellfleet, in large part because we’ve prioritized a good relationship and we’ve been able to provide so much customization for them.
Enhancing on-campus pharmacy efficiency
The final step in optimizing our client’s student health plan was the pharmacy program. The client wanted to improve efficiency as well as reduce expenses, and their on-campus pharmacy was a priority because it provided convenient access for students to receive their medications.
Our Pharmacy team helped the client build a robust pharmacy benefit program and supported them with implementing new pharmacy benefit management claims billing practices. Our team’s work on customizing their pharmacy plan gave students easier access to affordable medications.
What we built
Once the team finished our work customizing this client’s health plan, we produced:
- A state network of 73,000+ PPO providers, 375 hospitals, and 12,000+ mental health providers
- An out-of-state national network of 1 million+ providers through Cigna
- Enhanced local behavioral health support for students through access to 1,000 community providers who provide behavioral healthcare to university students
- Inclusive benefits that met the diverse needs of the student population
When our client came to us looking to revamp their network and inclusive care coverage, we provided more than would have been possible with a cookie-cutter plan already offered on the market.
Learn more about what has set Wellfleet apart over the last 30 years in student health insurance.
“Most fully insured health plans lack flexibility. But with this client, we gave them the customization that normally is only available with a self-funded plan, plus they got the added security of a fully-funded plan. This is a powerful and unique combination in student health insurance,” said Judy.
Whether a client is looking for customization of their network, inclusive care guidelines, mental health offerings, or pharmacy benefits, Wellfleet can create a tailored healthcare solution. We’ll build what your students need to thrive.
Learn more about Wellfleet
Visit WellfleetStudent.com to learn more about how we can create a provider network and student health insurance solution that’s built for you.
