Several USM students can expect a refund from a very unlikely source.

After a long battle between University Health Services and one of the nation’s largest health insurers, AETNA will reimburse nearly $3,500 to students who fell victim to a contract misinterpretation.

The conflict developed when students insured through the University were forced to pay deductibles they shouldn’t have.

Problems began when, on the advice of its insurance broker, the University decided to change its insurance provider from Acadia to AETNA during the summer of 1998.

The new contract with AETNA began in the 1999 fall semester.

AETNA had agreed that the contract switch would be on a no loss/no gain basis. This was interpreted by University officials to mean that all aspects of the previous contract with Acadia would be honored. It was nearly a year later when Jane Young, the director of University Health Services, realized there were discrepancies.

With Acadia, students were only required to pay deductibles for emergency room visits. Under the new contract with AETNA, deductibles were charged after all regular hospital visits.

Some students began questioning why they were required to pay a deductible and brought it to the attention of University Health Services.

Young first contacted AETNA about the deductible policy last August. AETNA replied to her in September denying the request to wave the deductible in cases of regular hospital visits. Young went one step further and sought the assistance of Associate University Counsel Todd Cabelka, who sent a letter in January reminding AETNA of the no loss/no gain basis that had been agreed to.

Cabelka also stated in the letter that students being forced to pay the deductible were those least able to afford it.

On Feb. 23 AETNA responded, saying the company would delete the outpatient deductible and reimburse the students who had paid it over the last year. After a year and a half, AETNA is now providing USM students with coverage that was intended to be part of the original contract.

“The students win here,” said Young. “We were really excited to be able to work with AETNA to get this resolved.”

AETNA officials say they are also pleased with the agreement. “We’re in the business of insuring students, not taking it away from them,” said Mark Jardin, the general manager of student plans for AETNA.

A deductible still exists for emergency room visits. This deductible, according to Young, is there to make students realize how costly emergency room visits are. Students insured through the University plan are encouraged to call University Health Services before making a trip to the emergency room. This way students might not waste a trip to the hospital for an illness that could be treated in the University’s clinic.

Students contacting University Health Services before heading to the emergency room will have their deductible waived if an emergency room visit is necessary.

The University plan costs $556 for a full year of coverage and $330 for a half year. For more information on the University Health Services Insurance Plan call 780-5411.

Staff Writer Tyler Stanley can be contacted at: [email protected]


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