How to Fight for the Care You Need Through Your Student Health Plan

Rachel Madley

Columbia University

Rachel Madley, a Ph.D. student at Columbia University Medical Center, is a student board member of the New York chapter of Physicians for a National Health Program. She was a part of the University of Michigan chapter of The Diabetes Link during her undergrad. She wrote an Op-Ed in the New York Times called “Does Anyone Really ‘Love’ Private Health Insurance?”.

For non-diabetics, a huge milestone on the path to adulthood is calling to make your own doctor’s appointment. For type 1 diabetics, that milestone is calling your health insurance company to battle for coverage of your life-saving care.  Being a T1D for my entire adult life, I have had the unfortunate experience of navigating student health insurance plans. While daunting at first, years of practice have taught me crucial skills to win these battles for the healthcare I need as a T1D. So how do you, a young adult, square off with a multi-billion-dollar health insurance company? Try these tactics:

1. Gear up for battle

Almost all colleges and universities offer a health insurance plan for students. The first thing you should do is research this plan online. Details about what the plan does and does not cover are usually found on the school’s student health services website. While researching the plan, T1Ds need to think about more than just basic care. You should find out if your brand of insulin is covered, if durable medical equipment coverage is included (insulin pumps, CGMs, and supplies fall into this category), if an annual eye exam is covered, and if laboratory tests are covered.  Take note of the level of coverage too. Are your prescriptions fully covered or do you pay a portion of the cost (a co-pay)? Get to know your plan details and arm yourself with this knowledge before enrolling in your student health plan.

2. Fight for yourself fiercely

You will likely encounter obstacles to getting the care you need while on your student health insurance plan. These may be denials of prescriptions, requirements for pre-authorization, or large bills for care that your plan is supposed to cover. When these obstacles occur, you need to confidently and assertively advocate for yourself. You know your body and what it needs better than anyone else in the world and you are the only one who can stand up for it.

Every student health plan will have a customer support number or, in some cases, an administrative office on campus. Find this number or office and don’t hesitate to use it. Always be sure to clearly explain your situation, your knowledge of your plan, and details that demonstrate that your care should be covered. It may take multiple phone calls and requests to speak to a supervisor to get your issue resolved. Always remember to be persistent and do not take no for an answer. At first it may be intimidating to have to fight for yourself but you DESERVE to get the healthcare you need, do not let anyone tell you otherwise.

3. Prepare for Emergencies

During your time on a student health insurance plan, you will likely encounter an emergency situation. Emergencies can be delayed prescription refills, changes in the medication type or amount you are approved for, or drastic increases in cost that make your care unaffordable. It helps to tactically prepare for these situations to avoid emergencies, such as running out of medication or supplies.

You can prepare for these scenarios by refilling your prescriptions as soon as you are able to and can afford it. If you still have some insulin left but are eligible for your refill, take the refill early! This way you can have a little extra if you are ever unable to get a refill but are dangerously close to running out. This applies to other prescriptions and supplies too.

Get to know your student health service providers, endocrinologists, and pharmacists. Keep their contact information handy and don’t hesitate to reach out if you ever run out of any medication or have a medical emergency. The Diabetes Link chapter on your campus is another great emergency resource. You can connect with other T1Ds who can offer support or extra medication in case of emergencies.

With these lines of defense in mind, you will be able to win the battles you may face with your student health insurance plan. But, as T1Ds, we shouldn’t have to live in a world where we are constantly battling to get the care we need from our health insurance companies. These battles are part of a much larger war, a war to live our lives free of the burden of high costs for our life-saving healthcare. The advice above will help you survive in our dangerous, for-profit health insurance system in the U.S. until we can win the change we really need.

What does that change look like? It looks like a world without sky-high insulin prices that bankrupt, or worse, kill patients. A world that removes for-profit insurance companies that deny care based on arbitrary protocols, not medical advice. A world where all T1Ds, and everyone else, get the care and medication they need without worrying about costs or surprise bills. This is the change we really need in order to live without fear of being denied the care we depend on.