Insurance Office

Karin: Good afternoon.

I am glad that you are here today.

Give us a minute or two and we will start talking about all things exciting related to insurance.

Karin: Good afternoon.

Thank you for joining the workshop.

We are letting a few more people join, so please be patient for another 30 seconds or so.

If you have questions, go ahead and put them in the Q&A.

For those we cannot answer today, or if they are too specific -- one, you can make an appointment to meet with us one-on-one.

Or two, we will be putting together an FAQ and sending out a PDF to you as a follow-up.

And regarding follow-ups, at the end you will be receiving a survey questionnaire.

It will take less than 30 seconds.

It's about four or five quick questions.

But it will help us know if this is beneficial for you, if it answered your questions.

If not, what we could have done.

And if you want something, a deeper dive coming up in the future.

We would appreciate any input.

Thank you.

We'll start momentarily.

Karin: Good afternoon.

Thank you for taking time on this gorgeous day to join the student health insurance one-on-one workshop.

It is an exciting afternoon filled with all things insurance and hopefully you will feel like it was worth your time and that you learn more than what you learn before you joined us.

My name is Karin Balow.

I am the Assistant Director of Student Health Insurance.

I have with me Cynthia Razo, Health Insurance Specialist.

She is with Morningside and also the contact for Teachers College.

In the background, we have Steve, the Senior Insurance Specialist, and he will be anxiously awaiting your questions after we go through the workshop.

So, what we are going to do today is focus on high-level insurance basics.

Most of you on the call probably have these -- a student insurance plan.

If you have your own plan but you are just curious to know about insurance, that is great because the basics will be helpful.

Even though your plan may work differently than the student health plan.

So, with that we are going to take a little dive into insurance.

At Columbia, the wellness of our students is extremely important.

We have more than 70 resources available to students on campus that are beyond just your medical insurance.

You can access resources that pertain to sleep issues, tobacco cessation, sexual orientation and diversity, eating issues, how to manage stress.

Anything that prevents you from feeling like you are truly thriving in every component of your being here at Columbia.

So, the number of resources probably goes to, I think it is around 77.

If you look at this, you will see how they are interconnected in order to fall under Columbia health.

There's Medical Services, Sexual Violence Response, Counseling and Psychological Services, Disability Services, Alice! Health Promotion, and us, the insurance office.

What are we and why are we here?

The Student Insurance Office is not here as Aetna employees.

We are Columbia.

We are all about Columbia University.

And we are here for you.

We are here to help.

We are not employees of Aetna, we are not pushing their plans, we are here to assist you in understanding their plan and in utilizing your insurance.

We can answer questions about coverage, how to obtain a referral, what to do about a claim that was not properly processed.

Right on down to the all basic question of where can I find my card.

So, we are here as a resource to you.

If you take nothing else away from this session, take away how to contact us and definitely utilize us as a resource going forward to make the most of your experience with all things wellness.

So, with that I want to dive into how to best understand your insurance.

And how to use it.

Because it is not easy.

It is complicated in the United States as far as what it is all about.

When people hear the word "insurance," they usually run as fast as they can the other way.

We want to make it less intimidating and more user-friendly.

Insurance basics.

We are starting off with the Aetna student health plan.

It's what we call an Open Choice PPO.

This means you can select your own provider within the Aetna network.

Within the network that has participating doctors, hospitals, urgent cares that like to participate and partner with Aetna at a lower cost to you for the services.

If you have a medical concern, or you have a condition, and you need to connect with a provider to establish baseline care, you want to make a medical appointment at medical services and have a consult with a provider.

Because all care starts at Medical Services.

Um, and you can make that appointment basically by going to your Patient Portal and setting it up there.

There's another option, which would be to call them directly.

So whichever is more convenient for you.

We will partner you with somebody who has the skills that relates to what your condition is, or you can pick somebody on the team who you feel looks like they would make a good partner for you in your routine care.

So, all care starts at Medical Services.

From your routine care to minor urgent care, to travel medicine, sexual health, LGBTQ, and even confidential HIV testing.

You can access acupuncture and sports medicine.

You will receive referrals for off-campus specialists at Medical Services.

They are located on the fourth floor in John Jay (Hall).

They are a must stop for obtain that referral for off-campus care.

Why do I need a referral?

You need a referral because that ensures that you are seeing the correct type of specialist for whatever it is that is ailing you.

Somebody who is qualified and reputable.

You cannot self-diagnose and say I will go to a specialist.

You need the approval or suggestion or whatever you want to call it from your primary care physician.

If your doctor does not feel it necessary for you to seek off-campus care because they can handle whatever it is on campus, then there is no need for a referral.

But you need to reach out to them first, not after-the-fact.

It is stating that you saw your PCP.

You need somebody that focuses on the type of treatment you require.

We cannot retroactively, we cannot predate any referrals, and neither can the doctor.

I will move into some common words.

I think I just threw a bunch of them at you.

But these are the primary words frequently used around Medical Services or on campus.

A premium is the amount that you pay in order to have access to your plan.

It is a fixed cost and whether you use that plan or not, that is what you are paying to be a member of that plan.

You do not get it back if you do not use it because you are paying to protect yourself for "what if."

A copayment is what you pay when you go to a specialist.

It is the charge when you walk in the door.

For a consult, you're going to pay a copayment of $30 at check-in.

If you are going to a mental health provider off-campus, you're going to pay $20.

Which in the grand scheme of things, if it seems like a lot I can tell you that mental health providers in New York do not often take insurance and when they do it is far more expensive.

These amounts apply to any visit that pertains to an off-campus situation.

If you have to have an outpatient medical procedure, a surgery or hospitalization, these procedures typically involve multiple individuals or specialists in the medical community.

You may have an anesthesiologist.

Coinsurance is the percentage you are required to pay for their total cost of that procedure.

It typically applies to hospitalizations as opposed to the copayment which is for the in-office visit.

If you are in-network, you would be on the hook for 10% of the total, whereas Aetna needs to take over 90% of that total cost.

So, even though it seems like a lot coming out of your pocket, it is actually a pretty rich plan.

A deductible, there is no deductible for the Aetna student health plan if you are in network.

If you decide that you want to go to your favorite doctor, but they are not a partner of Aetna, you would be on the hook for the out-of-network cost, which would be notably higher than the negotiated rate, as well as a deductible.

The deductible for out-of-network costs for Aetna is $600.

So, it does make more sense if you have the plan to find an Aetna doctor, which should not be difficult because they are a nationwide network.

And it is a vast network.

Moving on to more common words.

I mention PCP a lot.

It is a primary care physician.

All care belongs at Medical Services.

In simple terms it is your doctor.

It is your go to.

A referral is required by the plan.

If you have not heard the word I am guessing you have not had the plan.

Once they are written they are in your account.

Cynthia will go over that shortly, but a doctor or a student insurance, or anyone else is not allowed to backdate a referral if you forget to get one because insurance is highly regulated and it is prohibited.

So, make sure if you go to any care off-campus, except for maybe a routine gynecological, that you remembered to get the referral.

It is a written order that states from your doctor that you do need to see someone who specializes in what is going on with you.

If there is an emergency, absolutely go to the urgent care or ER for treatment, but if you are discharged and they say you need follow-up care, go to Medical Services, reach out via email to your primary care provider, get a referral from Columbia.

Do not rely upon the one from the ER because it is not going to count.

In-network and out-of-network, the difference is in-network you have a group of providers, doctors, hospitals, etc.

They are contracted with the carrier, in this case for as Aetna is the carrier.

So, the doctors have a contract with Aetna and they provide service at a discounted rate.

Depending upon the provider, you will have different networks.

Aetna student health is open choice.

They are a nationwide network and if you have to go overseas, if you see receipts and discharge papers and documentation, that can be followed as well as in network, because there is no in network internationally.

Out-of-network, you are going to pay more because there is no negotiated rate or partnerships with the providers that you are seeing.

So I know that is a lot of information, but I want to turn over to Cynthia now because she will put together how the information I just provided works with the basic student health plan.

Cynthia: Now we hope you have been introduced to this basic terminology and we will apply that to the plan.

If you still do not know how to use the plan, all of the plans that Karin just used are showing up here.

If you are in the Aetna student health plan, these are your co-pays and these are your coinsurances.

First and foremost, if you are seen by a physician at Medical Services, or someone at CPS, it is at no additional cost.

If you get a referral from either one of them to be seen off-campus, there will always be an associated cost.

For most services.

If you go to an in-network physician, that is a zero dollar deductible.

And what Karin went over is the deductible is an amount you will have to pay before the insurance kicks in.

If you go in-network, it is zero dollars, the insurance kicks in immediately.

For off-campus specialist visits, if you go to an allergist, cardiologist, anything of that nature, you will have a $30 co-pay.

Mental health visits are $20 for in network.

And with a referral.

It is a 10% coinsurance for most and Aetna picks up the other 90%.

There is a chart on our website.

This is a good time to tell you everything we are going through is on our website.

Click on the insurance page.

There is a detail on there that will tell you the differences between your coinsurance and your co-pays, and what they will be in-network compared to out-of-network.

There is a $60 co-pay for urgent care visits, those are actual urgent care facilities, not just if you think that you are urgent.

You actually have to go to an urgent care facility in order for it to be $60 and for you do not have a referral.

You also do not need a referral if you go to the emergency room, however that is a $150 co-pay.

Our next term is, what is a claim?

On the next page, you will see that a claim is the bill, basically.

You'll get charged your co-pay.

They will file the claims themselves.

If it is a service, you will owe a coinsurance.

They will usually bill you.

They will send the claim to Aetna.

And they will get their 90% of that.

Then they will charge you the rest of that, 10%.

If you go out-of-network, meaning that doctor is not in, or the facility or hospital is not in the Aetna PPO network, that requires a claim form to be submitted to Aetna directly.

And it is usually done by the student.

So, that is obviously a little more documentation that you have to get.

But it is a fairly simple process as well.

So when you file a claim or when the claim is filed by the doctor's office, it will get paid by Aetna, however your benefit -- you will receive an email from Aetna detailing your claim and how much they paid.

It is called an explanation of benefits, it is not a bill.

We get emails from students who believe they have received a bill from Aetna and they are not sure why.

We will tell them, and it is usually written at the top, this is not a bill.

It's Aetna saying that somebody filed a claim in your name for this service and this is how much we paid, and this is how much you may owe.

You do not need to pay anything until you get a bill from the provider or whoever performed the services.

What we have done for you this year, we created a quick guide card, a little wallet sized card that has useful resources and phone numbers.

It has emails.

And definitely things at that you want to keep so that way you know how to properly use your insurance.

As you can see, this is the information on the front and back.

These little cards, we have distributed them across campus.

We have tried to go to many of the schools.

We have put them up in Medical Services, CPS has them, Disability Services has them.

So, if you see them lying around, grab one.

They are really handy.

I have been telling people to take a picture of them front and back, so that way if they lose them they can refer to them.

And it tells you everything that we have talked about today.

Our website is on there.

The phone number is there for counseling.

It will remind you that referrals are required for off-campus appointments, in case you forget.

It also tells you how to access your insurance card, which is at Aetna student health dot com.

That is our most common basic question that we get is how do you get your insurance card.

And how do you get your ID number.

Your ID number will be on the insurance card.

And when you go to the doctor's office, which I forgot to tell you, they will either when you call for your appointment or you are there, they will ask you for a copy of your ID card.

And they will get the information from the card and it they will do the verification of those benefits.

So, definitely have that on hand.

You can use the app.

It is digital, so you can store it there on your phone.

There is also phone numbers that are very important.

If you are off-campus, call 911.

If you are on campus, you can call Public Safety, who will also dispatch an ambulance if you need it.

That phone number is right there.

That is all that is on the card.

There is a lot of information packed on the little cards.

They are floating around, so if you find one, grab one.

That way you have that information handy.

Our email addresses also there.

And you can, if you have specific questions, personal health, private health information that you do not want to share in a webinar such as this, we are here.

We can answer your questions.

And that will be throughout the year.

We are also here available on campus.