Delaney Miller, a sixth-year Ph.D. student in mechanical engineering, received a call on Sept. 25 from her medical supply company notifying her of a $674 charge. The fee was for durable medical equipment (DME) — everyday medical supplies she requires to treat her diabetes.

25 days earlier, Stanford had switched from HealthNet to Aetna as the designated healthcare provider for Cardinal Care, the University-sponsored health insurance plan. Nearly 72% of graduate students and 34% of undergraduate students are enrolled in Cardinal Care, according to Johanna Infantine, who manages student health insurance programs at Vaden.

Miller said she was shocked that Aetna was billing her for DME — like insulin pumps, sensors and infusion sets — which HealthNet previously covered entirely. 

“When we switched from HealthNet to Aetna, I reached out to my diabetes suppliers that I had been working with, who were covered under HealthNet,” Miller said. “I was told that the suppliers I was using were also covered with Aetna.”

Miller assumed the suppliers were the same, only to receive “some very sizable bills from my diabetes supply companies.”

Instead of receiving full coverage, Miller was now asked to foot 30% of the cost. Miller said she thought she had signed up for a Tier 1 supplier, the highest benefit level for insurance, but was instead charged in accordance with the Tier 2 rate that covers less. According to documents reviewed by The Daily, her initial bill was $3,560, and Aetna’s negotiated price with Advanced Diabetes Supply (ADS), her supplier, was $1,080. Miller’s responsibility was $674.

Yet, based on her Aetna plan, Miller should not have owed anything.

Miller spent the next month and a half communicating with Aetna, her medical supply company and Vaden, who administers Cardinal Care. Miller learned on Nov. 28 that a Cardinal Care system-wide error had affected DME coverage and that the charge was a mistake.

Miller was not alone — many other Stanford students who use DME also received an inaccurate bill. 

The Vaden Insurance and Referral Office released a public statement on Feb. 12 — two days after The Daily reached out to them for comment — over student concerns about DME-related charging errors. The office wrote they are “aware that some DME and diagnostic laboratory benefits have been adjudicated at the incorrect tier,” amid the Aetna transition in September.

According to the statement, it is the office’s “understanding” that all incorrect adjudications were corrected. 

The University declined to provide a separate statement and referred The Daily to the public statement. 

Miller’s bill was eventually corrected to $0. However, she expressed concern that other students were paying medical fees they did not owe. If she did not personally reach out to Vaden, Aetna and ADS representatives, she would likely have swallowed the $674 bill for her essential DME, Miller said.

Representatives told Miller the issue was a system-wide mistake. The strange part, she said, was that it fell to her to reach out to them.

Miller urged Vaden to issue a notice about the error to prevent students fulfilling inaccurate charges. According to her, Vaden wrote in response that they had no way of identifying all students who may need DME.

Vaden has not directly communicated with everyone covered by Cardinal Care about the system-wide error, beyond the public statement posted to the Vaden website. 

Miller was not the only student affected. Jacqueline Bendrick, a second-year Ph.D. student in neuroscience, also faced difficulties with DME bills in the transition from HealthNet to Aetna.

Before the transition, Bendrick said she contacted Aetna to ensure the supplies and medications she needs for her diabetes would be covered under the new plan.

According to Bendrick, Aetna told her 100% of her supplies would be covered, and that her current DME supplier would remain Tier 1 with zero out-of-pocket fees. But when she made her first supply order through Aetna, Bendrick received a $680.75 bill, according to documents reviewed by The Daily.

“As a graduate student making very little money, that was extremely shocking,” Bendrick said. “A large chunk of my monthly income would have gone to this.”

Bendrick said she submitted the incorrect bill to Vaden on Oct. 17, and Aetna corrected the mistake on Dec. 5. During this nearly two-month period, her supplier, Byram Healthcare, refused to send refills until the $680.75 was paid.

By California law, health insurance providers are required to provide a grievance process to address enrollee complaints within 30 days. In Bendrick’s case, it took 49 days to resolve the complaints.

“I almost ran out of multiple life-saving DME equipment,” Bendrick said. “It’s not an option to stop using it. I had to get my manager and the director of my program involved to get more clout behind me because the insurance office was telling me to be patient. It took a ton of time away from work and school, and there’s a tremendous amount of anxiety that comes from not knowing if you’re going to have medical supplies you need to be able to live.”

Like Miller and Bendrick, Brenda Velasco, a seventh-year Ph.D. immunology student, has faced challenges with Cardinal Care’s transition to Aetna. Velasco has type 2 diabetes and reactive hypoglycemia, which she described as “life-threatening” because she could pass out or fall into a coma if she had too much sugar, became too stressed or exercised.

Aetna no longer covers Velasco’s DME. Velasco uses a continuous glucose monitor for her diabetes, which was fully covered under HealthNet. Under Aetna, Velasco said she no longer qualifies for full coverage of her DME because she is not a type 1 diabetic and does not use an insulin pump.

Velasco said she had to switch to a different continuous glucose monitor that she gets through a pharmacy benefit, for which her copay is $87.59 a month, per documents reviewed by The Daily.

“I had a baby in 2022,” Velasco said. “I’ve still been paying those bills from HealthNet. Having multiple chronic health conditions and all the copays and all my medications, which aren’t fully covered — it’s too expensive.”

Expressing frustration at Vaden’s communication with her, Velasco questioned, “Why couldn’t they reach out and say some of the contracts are changing, make sure you’re with the right company?”

Amid similar student questions and concerns, the Vaden Student Health Advisory Committee (VSHAC) was formed in August to solicit student voices. This fall, much of their work has been geared toward student issues with the Aetna transition, according to co-leaders Elizabeth Park, a fourth-year Ph.D. student in chemistry, and Perry Nielsen Jr., a second-year master’s student in health policy.

Over the past few months, VSHAC collected over a hundred individual complaints from students to inform Vaden of mis-adjudication issues like those experienced by Miller and Bendrick.

“At VSHAC, we’re trying to give Stanford students the ability to have a voice in the care they’re receiving on campus,” Nielsen said. 

According to Park, Vaden and Aetna said they are in the process of fixing the mis-adjudication issues. Vaden solicited comments from VSHAC on how to improve transparency with students, Park said.

Despite attempts to respond to student complaints, Miller said the DME mis-adjudication issues are far from over. Although the insulin pumps she is currently ordering from a Tier 1 DME supplier are supposed to be fully covered, she said the supplier reported they could not come to an agreement with her insurance company and would be unable to provide a pump at all. Miller said the next Tier 1 supplier she tried quoted her more than $1000, claiming Miller was only covered at 70%. 

She asked the DME supplier “to call Aetna back to ask about Tier 1 coverage — but this indicates the issue is still not resolved.”