Non Reportable Insurance Appeal Process
An appeal or review may be used for students who feel they are eligible to waive the Brandeis Student Health Plan (SHP) for a comparable alternate provider but have been denied.
It is the students responsibility to assure that their alternate insurance plan is comparable to the Brandeis SHP plan and meets Massachusetts Division of Health Care Finance and Policy Regulations 114.6 CMR 3.00 and PPACA guidelines. The following list of key points of coverage should be reviewed with your insurance agent or broker to determine if you need to purchase additional coverage or the SHP to assure adequate coverage while at school. It is important for you to consider that plans with high deductibles and co insuracnes place you at risk for incurring significant out of pocket expenses well beyond the cost of the SHP.
Please complete the following form and submit with any supporting documentation to the Insurance Coordinator at the Health Center as directed below. You should hear back within 10 business days of receipt of the review request. If the appeals process occurs after the start of the QSHIP insurance year (August 15th) you will be billed for the QSHIP during the appeals process. You should hear back within 10 business days of the receipt of your appeal. You will be billed for the QSHIP during the review/appeal process. If the student's request for a waiver is successful, the bill will be credited or refunded unless the plan has been utilized. Any uncovered medical expenses incurred before, during, or after the appeals process are the responsibility of the student and neither Brandeis, BIDMC, GallagherKoster, nor the Insurers HPHC or BCBS can be held liable. If the waiver is not granted and the student must purchase the QSHIP they can submit to the QSHIP claim department for reimbursement for expenses after August 15th as allowed under the plan.
The Brandeis Health Center Insurance Coordinator, Health Center Management, representatives from the students program and others with interest and knowledge on the QSHIP and MA Regulations may be part of an appeals review as needed.
Please fill in the Health Insurance Denial of Waiver Appeal form and submit it to the insurance coordinator at email@example.com (non encrypted, non secure), fax to 1-781-736-3675 attn Insurance Coordinator, or mail it to Brandeis Health Center, 415 South Street MS034, Waltham MA 02454 Attn.: Insurance Coordinator.