Affordability is at the top of mind for the Wellfleet Student team. As the only health insurance plan designed specifically for college students, we understand how important it is to provide high-quality and affordable student health insurance.
In this blog, learn how Wellfleet secured $210,000 in savings after correcting billing errors for a student member who gave birth to twins.
How Wellfleet Student insurance works
Our team of experts designed Wellfleet Student to optimize healthcare plans for students. Partnering with more than 200 colleges and universities nationwide, we provide modern student health insurance plans you can trust.
Partnering with Cigna, our students can access more than 1 million healthcare providers across 6,000 facilities nationwide. Additionally, while most formularies are created for older adults, our student-centered formulary is tailored to the needs of young adults, containing 40+ relevant medications with a $0.00 copay.
Our team understands the needs of schools and their students, and we’re dedicated to finding ways our members and schools can lower the student health insurance cost. One way we create affordable student health insurance is by identifying and fixing billing mistakes. Learn about how our team dropped the cost of care by $210k when a student gave birth to twins.
How does our team lower student health insurance costs?
Now that you know our team works hard to find savings for schools and students, how do we find those savings? The process is multi-pronged, and we use several strategies to make our plans affordable while retaining high-quality care for our students. These include:
- Low deductibles and co-insurance amounts to decrease student healthcare costs
- A student formulary with 40+ $0.00 copay medications — that are highly needed by students
- Utilization management techniques, including step therapy, prior authorization, and quantity limits — all of which decrease care costs for students and plans
- Case-by-case claim review to find billing errors and correct them, leading to long-term plan savings
In this blog, we’ll talk about that last strategy in the list and how mistakes in billing for a twin baby delivery could have led to six-figure inflated care costs if left unnoticed.
A twin birth story: how a student was overbilled for her twin babies’ hospital stays
One of our student members — who was on a Wellfleet Student health plan while pursuing their degree — welcomed twins to their growing family.
The student welcomed a little boy and girl by C-section at 37 weeks gestation. Twin pregnancy, which accounts for 3% of live births in the U.S., generally finishes around 36 weeks gestation,1 compared to 40 weeks for single pregnancies.2
The deliveries went without complication. While small for his age, the boy was healthy and went home from the hospital a few days later with his mom. The girl, also small for her age, initially had trouble breathing and some other minor issues, and the hospital had to keep her longer to rule out an infection. After a few days of care, she was strong and healthy enough to go home, but the hospital waited a few additional days before sending her home.
How resolving the twins’ billing led to $210k in savings
When the claims for the babies’ hospital stays were sent to Wellfleet, our team completed a thorough analysis of the billing and found that the hospital used the wrong billing codes for both twins, resulting in much higher costs. The boy went home without complications, but the billing code stated that he had “major problems.” Correcting this mistake led to savings of more than $125,000 for the student’s plan.
Additionally, the baby girl’s billing was incorrect, also stating that she experienced “major problems.” While she did need some additional care and testing in the days after her birth, none of it was considered major. So, we downgraded the coding while still accounting for her problems after birth. By lowering the severity of the baby girl’s hospital billing code, our team saved the student’s plan $85,000.
When we combined the savings from both twins’ hospital stays, we reduced costs to the student’s health plan by more than $210,00. By lowering overall health costs for the school, Wellfleet is reducing the long-term cost of care. This can help lead to more favorable premium rates for students the following year.
A team dedicated to your best interests
In this case and many others, our Chief Medical Officer and Payment Integrity team scrutinize the claims we receive to ensure they are entered correctly. If our team finds mistakes, we collaborate with the healthcare facility to correct them.
Rest assured that Wellfleet is working hard to ensure our members get the care they need, and that it’s at the right price. Our multi-tiered claim review process is one of the reasons for our affordable student health insurance.
Build a health plan for your students
Now that you know more about Wellfleet’s commitment to affordable student health insurance, contact our team to learn more about creating a plan built for your students.
References:
1 Gill, P., Lende, M., & Van Hook, J. (2023, February 6). Twin Births. NIH National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK493200/#:~:text=Twin%20births%20 account%20for%20approximately,percent%20of%20all%20twin%20gestations
2 American College of Obstetricians and Gynecologists. (2022) Definition of Term Pregnancy. ACOG Clinical. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2013/11/definition-of-term-pregnancy
