In April 2023, A.S, a graduate student at UChicago’s Pritzker School of Medicine who asked to remain anonymous, discovered that her fetus had a significant health issue after 20 weeks of pregnancy. She then decided to terminate her pregnancy. Having U-SHIP (University Student Health Insurance Plan) coverage, she chose to undergo the abortion procedure at Northwestern Memorial Hospital, an in-network provider. After scheduling the procedure for her, the hospital called back: her insurance had refused to cover the procedure because it was deemed an elective surgery. However, the U-SHIP Certificate of Coverage asserts that abortion care is covered. It would cost $18,000 minimum out of pocket to get an abortion there, she recalled being told by the Northwestern medical staff.

Upset and confused, A.S. tried to find another in-network provider, but everywhere else the wait time was too significant. “I can’t wait. I don’t want to wait,” she recalled thinking, “it’s horrible to be pregnant and know that you’re not going to continue the pregnancy.” Finally, she got a spot at Family Planning Associates, an out-of-network provider, where she could afford the $3,000 required for the abortion.

At the time of the procedure, she remembered not understanding why UnitedHealthcare refused to cover her abortion when it was supposedly part of U-SHIP’s benefits (UnitedHealthcare has since “reprocessed A.S’s claim as in-network,” a UnitedHealthcare spokesperson wrote in an email to the Maroon.) Now, after a year, she is finally able to piece together what happened.

Choosing a health insurance provider is one of the many decisions admitted students face as they prepare for college. The University of Chicago, like most American universities, requires its students to have health insurance covering hospitalization, outpatient diagnostic, testing, and surgical procedures costs. However, it leaves them the choice of enrolling in U-SHIP or waiving it by demonstrating that they have comparable coverage. According to a 2024 survey by the American College Heath Association, 58% of American undergraduate students stay on their parents’ plan until they turn 26 years old because of the Affordable Care Act, while only 14.8% enroll in university-sponsored health insurance plans.

UChicago has offered a student health insurance plan since at least 1975, but U-SHIP first became an option in 2008 when the University contracted with United Healthcare Student Resources (UHCSR). According to a University spokesperson, “[the University] conducts competitive Request for Proposals for the student insurance program approximately every 3-4 years.” This process means that the University solicits proposals from health insurance providers for a student plan and chooses among the different offers that result from the bidding. This undertaking is managed by the Student Health Insurance Policy Oversight Committee (SHIPOC), a board composed of various UChicago officials and supervised by Student Wellness. During the last Request for Proposals in Autumn 2022, four insurances competed but “SHIPOC recommended to renew with UHCSR for multiple reasons, including plan pricing and UHCSR’s behavioral health benefits which include access to local area providers,” the University spokesperson wrote.

While U-SHIP costs $4,998 a year, it covers most of the costs of medical care and doctor visits, leaving the students responsible for a deductible of $400 worth of care for in-network providers before partially contributing to the costs of the eligible services. This means that if a specialist visit costs $420 and is covered by U-SHIP, the student will pay $400 and the plan $20. The out-of-pocket maximum, the total a student might have to pay for in-network medical care per year, is $2,000, after which all further expenses are fully covered by U-SHIP.

“On paper, U-SHIP is better than other insurances,” said Grace Hansen, a graduate student at the Pritzker School of Medicine, citing that most medical care is free for students under U-SHIP and that the out-of-pocket maximum is lower than other insurances. “If it worked the way it was supposed to, it would be wonderful,” she added.

A Year of Issues

In April 2023, Hansen was hit by a car when she was 16 weeks pregnant. Fortunately, except for a large lasting bruise on her upper thigh and hip, she was mostly unhurt and her pregnancy was still viable. She obtained the driver’s car insurance information and got a settlement from them to pay for the medical bills related to the accident. “That’s where I thought that was going to end,” she said. But Hansen explained that starting in July, Optum, a healthcare company that collects debt on behalf of United Healthcare, started sending her bills because they claimed that the costs of the medical care she had received as a result of the accident exceeded the amount she received from the settlement.

“It was very confusing because it was numbers that didn’t make sense,” Hansen explained. Optum was charging her $4,800 while her medical bills related to the accident amounted to about $250 and the settlement to $1,500. After extensive research, she discovered that her prenatal care had been billed as related to the accident (UnitedHealthcare confirmed this detail to the Maroon in an email). Since she was pregnant when the car accident happened, the costs of her prenatal and accident-related care had been considered as linked. She deemed this billing “ridiculous” because the charges such as a routine OB-GYN appointment and first-trimester ultrasound were not care resulting from the car accident.

Hansen has also had other issues with U-SHIP. Coverage for her other routine prenatal care appointments were denied on the basis that her physician had not replied to mailed requests for the medical records needed to approve the claims, according to Hansen. But these requests were never received by the doctor. She said that she learned by calling UnitedHealthcare Customer Services that they had been mailing the records requests to her doctor’s outdated address.

Hansen has had over four different billing issues related to U-SHIP over the past year. “It is a lot of bureaucratic blunders, but it is a system in which United profits from every one of their bureaucratic blunders,” she said.

She categorically refuses to pay any unjustified charges and, while she has been able to solve some issues like with Optum, some are still pending. One of them is United’s denial of her newborn’s well-child appointment in October (well-child appointments are routine visits to monitor growth in newborns and children). Hansen explained that UnitedHealthcare had rejected coverage due to the CPT (Current Procedural Terminology) code, which indicates the type of care being provided. The original CPT code did not describe the appointment as preventative care, its normal categorization which would allow for coverage to be met. (UnitedHealthcare confirmed this in an email.) However, Hansen said that this CPT code had been regularly and successfully used by her provider in the past for well-child appointments. Hansen’s doctor then tried to resubmit the CPT code, but it was again denied. A UnitedHealthcare spokesperson stated that they “are working with Ms. Hansen’s provider to ensure the visit was appropriately coded so we can accurately process the claim.” While UChicago’s Billings Office is appealing this denial, Hansen gets constant text reminders about her unpaid bill.

The Student Insurance Advocates, an Imperfect Support System

When they first encountered difficulties with U-SHIP billing, both A.S. and Hansen turned to the Student Insurance Advocates to investigate what had happened. The Student Insurance Advocates, who are employed by UnitedHealthcare Student Resources, act as a liaison between the insurance and the University to help students navigate issues concerning U-SHIP. The University spokesperson defined their role as the following: “to answer students’ insurance questions, provide assistance navigating the insurance process, and assist students who have had insurance claims denied.” The University presents them as the main resource for students to resolve their U-SHIP issues, writing: “If a student believes that United Healthcare incorrectly denied a claim for a service that appears to be covered by the policy, the student should work with a campus advocate to investigate the problem.”

A.S. and Hansen did exactly that; however, they soon realized the difficulties of working with the Student Insurance Advocates. Hansen first reached out to the then-Student Insurance Advocates last year to solve her issue with Optum, but found them “unresponsive” to her difficulties and had to involve Student Health representatives and other University medical staff members to get help. (The current Student Health Insurance Advocates did not respond to our request for an interview.) Every time she had a billing issue, she tried to work it through with them. But she explained that the Student Insurance Advocates would reiterate the relevant benefits and details of the plan highlighted in the Certificate of Coverage, which she already knew because it was stated on her bills and letters from UnitedHealthcare. However, they would not call her doctor or UChicago’s Billing Office, which manages medical bills for patients at UChicago Medicine, where Hansen received all of her care.

“Honestly, the most stressful part about this is not the problems themselves, it’s how difficult it is to resolve anything between the student advocates and the Billing Office,” she said.

For A.S, the then-Student Insurance Advocates were not only unhelpful but “very gaslighting.” She first met with them in May 2023 and she recalls that their initial reaction to her story was that it was impossible since U-SHIP covers abortion. “Instead of being like ‘hey, you may have fallen into an error in the system so we’ll help you navigate it,’ they’re like ‘this thing should never happen so it must not have happened to you,’” she said regarding her interactions with them.

A.S. then had to prove that her incident with U-SHIP happened, a difficult process as she soon discovered that there was no paper trail. On the phone, both UnitedHealthcare and Northwestern Memorial Hospital would give confirmation, but they would not send records to her because there was no standard bill nor prior authorization form. This latter document, which informs the insurance before the procedure so it can verify whether it is covered, represents a lot of paperwork for the hospital. As Northwestern Memorial Hospital had conducted a pre-prior authorization by calling UnitedHealthcare and learnt that the abortion would not be covered, they chose to save time and did not fill it, she said she learned by calling the hospital. The only record she had access to was the bill Family Planning Associates sent to UnitedHealthcare after she insisted.

However, she said that the student insurance advocates repeatedly blamed the denial of abortion care on the fact that she went to an out-of-network medical provider. After multiple exchanges with the student advocates about resolving her bill, she stopped enquiring what happened.

“Instead of paying in money, I pay in time”: Hours of Calls to Uncover the Truth

Hansen estimated that she has spent roughly sixty hours since July 2023 solving her billing issues. “I feel like I’m trapped with this plan and essentially instead of paying in money, I pay in time,” she said.

Despite her numerous calls with UnitedHealthcare Customer Services, the Billing Office, and her doctors among others, the two billing issues she had while pregnant, including the one with Optum, were not resolved until September 2023. Concerning Optum, she remembered that “it was just so difficult to unsnarl.” The denials of her newborn’s well-child appointment and her postpartum depression screening questionnaire, which both happened in October 2023, are still unresolved.

A.S. also spent hours calling UnitedHealthcare Customer Services to understand why her abortion coverage had been denied. She explained that UnitedHealthcare used the fact that they do not cover elective surgeries, which is stated in the Certificate of Coverage, as justification. However, this same document mentions that abortion is covered.

In the process of calling UnitedHealthcare and Northwestern Memorial Hospital, she finally discovered that the staff member at UnitedHealthcare who answered Northwestern’s call had made a mistake in saying that her abortion was not covered.

“It was just this crazy bureaucratic failure that there were no double-checks on,” she said.

After the incident, A.S. also received a bill from Northwestern Memorial Hospital for the medical diagnosis of her fetus’s health issues. She then called UnitedHealthcare Customer Services and they told her that they had not received the bill. After spending a full day calling back and forth between the insurance and the hospital, she realized that Northwestern had not sent the bill to UnitedHealthcare, which they then did.

A.S. initially started enquiring in May 2023 as she visited the student insurance advocates, but stopped after a few months until early February.

“This has been on my list of things that I still haven’t let go of, but I also have enough time and emotional space finally to figure out what happened,” she said, to explain her recent decision to pursue the truth.

I’m a UChicago student Dealing with U-SHIP Issues. What Should I Do?

The 2022-2023 Report from UChicago’s Student Ombuds Office noted that the number of cases related to billing surprises and errors from health services or UChicago Medicine that year was “concerning.”

The Student Ombuds Office, created in 1968, aims to “help students when they’re running into issues on campus,” said Max Willner-Giwerc, a second-year student at the Law School and one of the two Student Ombuds. He mentioned that during the 2022-2023 academic year, the Office handled about ten cases related to medical and insurance billing issues. The issues were often surprise billings, which means that a student was either told that a procedure was fully covered but then received its bill or was not in control and discovered that they were financially responsible for more than expected. This academic year, he noted that the number of these cases decreased to about three.

“The issues seem to be a little broader than just U-SHIP for us,” Willner-Giwerc explained as some cases involve other insurance plans that are not U-SHIP. Beyond UChicago, health insurance in the United States is hard to navigate. It can be complex to obtain, as it is tied to employment for about 153 million of Americans in 2023, leaving those unemployed and ineligible for Medicaid or whose employer does not sponsor coverage having additional financial burdens to enroll in a plan. Health insurance access was the third-ranking response in a Harris Poll about the biggest obstacles Americans face regarding healthcare, followed by the opacity of insurance coverage, as 28% of respondents stated that they had difficulty understanding what was covered or not.

While medical and insurance situations are outside the Student Ombuds Office’s purview, Willner-Giwerc states that for students running into those issues: “being proactive is very important and the sooner you come to us, the more options we can give you.” In those cases, one recurring solution has been the Emergency Grant Program, which is funded by the Undergraduate Student Government (USG) and covers emergency medical care that the student cannot afford and is not covered by their insurance.

Hansen and A.S are aware that their background in medicine helped them navigate the healthcare system and find answers to their issues. Both encourage students to cautiously verify their bills for any errors.

“Don’t assume that if you have a bill, it’s real,” Hansen said. She explained that she now compares the charges (after insurance) on her bills from UChicago Medicine to the explanation of benefits, which states the charges and what her plan covers, sent via email by UnitedHealthcare. She said that more often than not, she notices an error.

A.S added that “if anyone ever gets a bill, they should first check that their insurance even got it.” When there is a billing inconsistency, Hansen advises to “prepare yourself for a rat’s nest of calling.” That is what it takes for a student to avoid paying a bill that they should not be responsible for, she explained.

Students can also file an appeal if they disagree with UnitedHealthcare’s denial of coverage for a procedure within 180 days of having been notified that it would not be covered. The steps, which are outlined in the Certificate of Coverage, include sending personal information, records of the procedure, and statements about why UnitedHealthcare’s decision should be reconsidered. A University spokesperson specified in an email that the Student Insurance Advocates can help students with this process.

The University’s Role in Preparing Students to Navigate Healthcare

The 2022-2023 Report from the Student Ombuds Office states that even though most students were able to resolve their medical and billing issues, they “still voiced concern that this process lacked transparency.” Willner-Giwerc elaborated on this observation by explaining that “people are often unsure where their bill is coming from or what the charges are for.” However, he considers this lack of information not to be unique to UChicago but representative of the American healthcare system as a whole. Concerning potential steps the University might take to improve student’s knowledge of the healthcare system, he believes that “the University is willing to listen to students and their concerns and potentially make changes. But it is difficult to change the entire healthcare system.”

It is fair to say that the American healthcare system is difficult to navigate and the multiple cases of unjustified denials of coverage and inconsistent billing at UChicago, especially in the last year, might reflect a nationwide trend. However, college students are often managing their health insurance and seeking care on their own for the first time. Students say that facing an inconsistent or surprise bill when they have neither the time nor the financial means to resolve it independently can be overwhelming.

“There are many holes to fall through and people act like I’m making stuff up all the time,” said A.S. about her experience of resolving her issue with U-SHIP as a UChicago student.

The Lasting Consequences of U-SHIP Denials of Coverage

As a graduate student with healthcare knowledge and the University’s insurance plan, A.S. never expected to have such problems with U-SHIP and abortion coverage. “It was this whole set of issues which I thought would never affect someone like me, but it totally does,” she said. She looks back on her experience as “very humbling,” now knowing that despite her expertise and her student health insurance at a secular university in a state where abortion is legal, such incidents can happen.

“I’m pissed about it, but I’m also worried for other people. I want to make it so that maybe someone else doesn’t have to go through this,” she said, explaining why she wanted to share her story.

Hansen still bears the burden of her unresolved issues and their psychological consequences. These experiences “have honestly made me apprehensive to seek care,” she said, explaining that what worries her the most is “the uncertainty of whether they will deny care that they are supposed to cover.” She has changed her health insurance plan and is no longer covered by U-SHIP.

While UChicago prides itself on the rigorous vita mentis or “life of the mind,” a student’s health is also important and necessary to their critical thinking: mens sana in corpore sano (“a healthy mind in a healthy body”). Can there then be a life of the mind if staying physically and mentally healthy is a challenge?