Wellfleet Student health insurance plans focus on providing top-quality healthcare that’s tailored to the needs of students. Not only can you trust the quality of the student health insurance we provide; you also can trust that we’re doing everything we can to help you lower your student health insurance costs.
In this blog, read about how Wellfleet unearthed more than $200k in health savings by scrutinizing a member’s appendectomy bill.
What is Wellfleet Student?
As the only health insurance plan specifically built for students, Wellfleet Student is committed to ensuring we deliver quality care. Young adults have unique health needs, and our healthcare plans for students are designed to meet those needs.
Thanks to our partnership with Cigna, our members can access more than 1 million healthcare providers and 6,000 facilities across the U.S. Plus, our student-centered formulary offers more than 40 medications with a $0.00 copay.
Always looking out for our members, our passionate team works tirelessly to make sure we’re providing high-quality, affordable student health insurance to our schools and members.
How do we find cost savings for members?
Keeping the best interests of our students at the forefront of our minds, Wellfleet’s Payment Integrity team works with healthcare facilities to ensure our members receive the right care at the right price. Evaluating bills on a case-by-case basis helps us reduce out-of-pocket costs for members and lower costs to the health plan.
When our members have high-dollar claims, our internal teams review each line item to make sure members received the appropriate care and it was billed correctly. Most of the time, these claims are given the green light, and we approve them without changes. However, sometimes we catch a mistake in billing or coding, and resolving it can mean a significant reduction in costs.
In this savings story, you’ll see how our Chief Medical Officer and Payment Integrity team corrected billing mistakes that resulted in six-figure savings from an appendectomy.
How an appendicitis hospitalization led to major savings
Our student members can rely on Wellfleet to have their backs with anything from routine visits to medical emergencies. When emergencies arise, having a trusted team at your side brings comfort amid the unknowns.
In December of 2022, one of our students sought help from the local emergency room. They came in with a fever and abdominal pain, and all signs pointed to their appendix. They were diagnosed with appendicitis and admitted to the hospital, where the doctors placed them on antibiotics and removed the appendix the next morning.
Appendicitis happens when the appendix, a small section of the colon, becomes blocked and inflamed. In some cases, the appendix may even rupture. The standard treatment for appendicitis is surgical removal of the infected appendix and potentially antibiotics.1
In this case, the student’s appendix had perforated, and it was removed and the colon repaired without incident. They also received antibiotics, and recovered well after surgery except for low sodium levels that stabilized with more IV fluids. The next day, the patient was well enough to go home. It was a relatively routine diagnosis and procedure, but the billing was far from ordinary.
The patient wasn’t septic! Fixing a few billing errors saved $214k
When Wellfleet’s Payment Integrity team receives a high-dollar bill, they spend time reviewing each line item to ensure the patient was given the correct services and charged for them correctly.
With this student, the bill included several errors, including billing for a diagnosis of sepsis, which the patient did not have. Sepsis is a life-threatening condition in which the body reacts to an infection. It can lead to organ damage and organ failure if left untreated.3
Though our student member went into the ER with a few symptoms that can also be seen during sepsis, an infectious organism wasn’t found in his blood, and his condition quickly resolved with surgery and antibiotics. Therefore, the student shouldn’t have been billed for having sepsis.
Our Payment Integrity team noticed the coding errors and corrected the billing, which resulted in savings of $214,406 for the school’s plan.
This savings story is just one of many examples of how our team helps reduce student health insurance costs. Here at Wellfleet Student, we work every day to ensure our student health insurance members get the care they need, and that it’s at the right price.
1 Appendicitis. Johns Hopkins Medicine. (2021, December 9). https://www.hopkinsmedicine.org/health/conditions-and-diseases/appendicitis.
2 University of Colorado School of Medicine. (n.d.). Appendectomy. Department of Surgery. https://medschool.cuanschutz.edu/surgery/divisions-centers-affiliates/pediatric/patient-care/appendectomy.
3 Sepsis: Symptoms, causes, treatment & prevention. Cleveland Clinic. (2023, January 19). https://my.clevelandclinic.org/health/diseases/12361-sepsis.