UC Student Health Insurance (SHIP)
Health Plans with UC changing
The health plan we have now will not be offered by UC next year. It is Anthem Blue Cross Plus. I am wondering if anyone knows exactly why it will not be offered, and which plan is the most similar that will be offered. We have loved this plan and are not happy it is being discontinued. anon
You did not mention what your affiliation with UC Berkeley is (faculty, student, staff) so I do not know if this makes a difference. But I am a graduate student at UC Berkeley and all of our insurance changed as well. The Cal student health insurance plan (SHIP) for the past handful of years was part of a group plan that included all 10 UC campuses. Due to some financial and administrative mismanagement at the UC Office of the President, this past year a huge deficit was discovered. Through a pretty extensive process, UC Berkeley opted to return to a campus- only plan for its students. This has meant a change of medical, dental, and vision plans. Our new insurance is handled by Aetna and in my experience with a few non-campus providers (mental health, neurology, dental) it seems that all/most of the Anthem providers are covered by Aetna and the coverage is comparable. Again, I'm not sure if this change has affected faculty and staff in the same way, but if you are a student this would be the reason and I would double check with all of your doctors. I am happy to say that after an annoying day of phone calls checking on coverage, I've been able to stay with all of my providers. anon
Help! I need dental work and the list of dentists for the UCB dental insurance coverage is so long...does anyone have a dentist they use that takes our student insurance and they would recommend them? thanks michele
The UCB student dental insurance covers 80% of the costs of using dentists who aren't on their list, so if you can afford to pay the other 20% yourself, you have a LOT of choices. I use Dr. Clopton on Regent St. and really like him--I can get an appointment within a couple of weeks of when I call, he explains everything he does, and more than any dentist I've had before, carefully points out areas where I can do a better job of dental care myself to avoid having drilling done later. Elizabeth
I've been seeing Michael Young on Solano in Albany for almost 6 years now, and he definitely takes the UCB student insurance. I've never had anything but cleanings and x-rays but my daughter has had a couple of fillings done. I've always been pleased with his work; it is a small, friendly office and they schedule my daughter and I together so we only have to go in once. Kristen
I go to University Dental at Solano/San Pablo Ave in Albany. Their phone number is 510-528-7216. I have seen 3 different dentists over the last 5 years, and I think that all the dentists in the practice are excellent. The best part is that you just give them your student ID while making an appointment, and they get all the information directly from Tang center records and SHIP insurance. No filling out forms or hassles. It is very easy to get an appointment within 2-3 days and same day for emergencies. The front desk lady is wonderful. She would work patiently with you and maximize your benefit. For example, I needed 4 molars extracted last year. The maximum SHIP allows is $1000 for a calendar year. So she suggested to get two extractions done in December and two in January! That way it was all covered, leaving some for twice a year cleanings. I could even chew on one side while the other side was sore for a couple of days after extraction. There are coupons for extras, such as teeth whitening (not covered by SHIP) in the Guide to Good Life at Berkeley book. Overall, the office is very nice and makes you feel that they care about you, and do their best to accomodate your needs and budget as a student. They even pick you up from campus! happy teeth
University Health Services can help you learn about and get connected to the health insurance options available for dependents. We are knowledgeable about a variety of individual private insurance plans as well as community-based plans, both publicly supported and nonprofit. Please start by visiting our web site, http://www.uhs.berkeley.edu/students/insurance/families.shtml , which includes descriptions of the available plans and links to the plans' web sites. You can start the selection process by reviewing the plans and evaluating their benefit levels and prices. When you are ready for additional assistance, please call or stop by the Student Health Insurance Office on the third floor of the Tang Center, (510) 642-5700. Thanks,
Heather Pineda, MPH Health Plan Administrator University Health Services University of California, Berkeley
Does anyone have experience fighting with SHIP and Blue Cross for pregnancy and delivery issues?
After THREE DAYS of being induced at Alta Bates, I finally went into labor and didn't need a C-section. Nevertheless, my doctor practically ordered me to get an epidural since I was exhausted. The anesthesiologist on duty that morning is not part of the network and SHIP refused to pay any of the 80%. I complained because I didn't have any choice in the provider and Alta Bates is supposedly covered by SHIP. They reduced the $800 balence by $50, which is unacceptable to me.
In the meantime, the anesthesiologist was about to send a collection agency after me, so I have written another letter to SHIP demanding that they pay more of it or I will go to the State Board of Insurance. I will call Blue Cross directly again and the anesthesiologist may give me a discount.
Any advice? Irene
SHIP refused to pay for my week-long hospitalization when I went into labor at seven months, stating that my labor was not an emergency and I did not need to be hospitalized. My doctor wrote an angry letter to the insurance office, and the bill was paid. Have your doctor write a letter stating that your epidural was necessary. That should do it. The guy over at the Tang Center seems to authorize as little as possible. I am still trying to get them to pay for lab bills from over a year ago! Mary
I had Blue Cross PPO and delivered at Alta Bates last year, and the epidural wasn't covered. None of their anesthesiologists are covered. I mentioned this problem to my OB/GYN who suggested that my only recourse was to negotiate with the Anesthesiologist: ''send a letter, a check, and say 'this is how much I'm willing to pay'''. I asked Blue Cross what their adjusted/allowable amount was for the epidural and I paid a little more than that as a reasonable basis for compensation. It was about half of the invoice. I never heard from the anesthesiologist again. Of course, I handled this matter within 2-3 weeks of receiving the invoice.
The anesthesiologist's billing service suggested that I write a letter to the doctor pleading a hardship case. I think you should try your hardest to negotiate with the doctor to forestall your account going to collections in order to save your credit rating. A token partial payment might help get a dialog going. It will at least buy you time to complete your efforts with insurance. By the way, last I heard, the only Pediatricians in the East Bay accepting Blue Cross was Summit Pediatrics in Orinda. Good luck. Kim
To the person who had trouble with her insurance paying for her delivery bills. I missed your letter, but here is some useful info. of organizations that may be able to help you.
Office of the Patient Advocate 1-866-466-8900 www.opa.ca.gov HMO Help Center : 1-888-HMO-2219 www.hmohelp.ca.gov California Patient's Guide : www.calpatientguide.org Department of Insurance 1-800-927-4357 www.insurance.ca.gov
You can also request an Independent Medical Review to settle the issue. Call the HMO Help Center and they should be able to help you start the process. Good luck Gladys
DHIP rates just went up another 20% !! Can anyone recommend an alternative to the university's DHIP program? (they sell Blue Cross California Care HMO to students w/ dependents) The current rate for 3-party family is $1278 (that's $142 per person, per month). Seems like a lot... What are other people doing for health care coverage for their spouse/kids if they don't receive it from their employer? Recs for other plans or agents would be greatly appreciated... also, some figures regarding what people are paying monthly for their coverage. Thanks, Holly.
I got a flyer in the mail the other day that addresses this topic. Seems that Kaiser offers a personal advantage plan to individuals and families. $15 office visits, $10 copay for Rx. Assuming one spouse is under 40 yrs, a family plan would be $338/mo for both parents and all children. For just one parent and one child it would be $194/mo, and for one child only it would be $69/mo. There are many more options. The flyer said: To obtain a no obligation enrollment kit, call 1-800-325-6662. Applicants are subject to a medial review. Good luck! Dawn
I know what you mean! We bailed out of DHIP long ago for a private insurer (Frankel Ins.?) whose rates were cheaper than DHIP -- the way it was explained to us, DHIP is higher because of the pregnancy coverage -- the California Care HMO we got through Frankel Ins. was exactly the same as the DHIP coverage, but with an additional $1,000 co-pay in case of pregnancy. But eventually even that got out of hand -- we were billed monthly, and it got to be close to $400/mo. I struggled with whether to get on the Healthy Families program (which is a very good program, if you haven't already checked them out), but I couldn't bear to give up my pediatrician. Finally I decided to go directly to Blue Cross and change our coverage from a $10/co-pay to a $40/co-pay. This reduced our monthly premium to $156. It works for us -- good luck! MMRivas
If you haven't already, check out http://www.ehealthinsurance.com. You can browse a variety of plans and experiment with different copayments/deductibles to determine your costs. Good Luck! Rachel
SHIP and mental health benefits
Those people interested in seeing a marriage counselor or undergoing other therapy should know that SHIP (Student Health Insurance Plan) covers up to 600$ of outpatient psychotherapy per calender year. The maximum reimbursement per visit is $40. Since the coverage is per calender year, you can see a therapist for sessions spanning Nov-March, for instance, and get $1200 paid for through your insurance! I'm not sure whether or not staff are covered in a similar way, but this is certainly worth pursuing for grad students.