Yale Health

Frequently Asked Questions

What if I have an illness or injury for which another party may be liable?

A member or enrolled dependent may be compensated for an illness or injury for which another party is liable to pay damages. In these cases that party has the primary payment responsibility and Yale Health has the legal right to be reimbursed for services covered or provided by Yale Health. If a Yale Health member brings legal action or otherwise makes a claim against a third party allegedly responsible for his or her condition that Yale Health member agrees to:

  • Notify the Yale Health Billing Department as soon as possible and to keep Billing informed at all times of subsequent developments.
  • Reimburse Yale Health for its costs and services out of any resulting settlement to the full extent permitted by law.
  • Cooperate in protecting the interests of Yale Health under this provision and execute and deliver to Yale Health or its nominees any and all documents (e.g. accident reports) requested by Yale Health that may be necessary to effectuate and protect its rights.
  • Yale Health will provide medical care upon a member’s request with the understanding that the member will reimburse Yale Health in full for any treatment rendered or expense incurred on his or her behalf without deductions of any nature, including attorney’s fees, to the full extent permitted by law.

Who should I contact with questions about the cost of my premiums or my bill?

Employees should contact the Employee Service Center.

Students should contact Member Services at 203-432-0246 or member.services@yale.edu.

I am retired and covered by Medicare. I received a bill from Yale Health and I have questions. Who should I contact?

Contact Billing at 203-436-8882.

Who do I call if I have questions regarding charges on student accounts and bursar billing transactions?

Please contact our staff at 203-436-8882.

Why did I receive a bill from Yale Health?

Member: Certain services are not covered under Yale Health basic coverage. For example, there may be a co-pay or deductible for certain items. See the Prescription/Supplemental Benefit Plan in the Member Coverage Booklet.

Student: If you waived Yale Health Hospitalization/Specialty Care coverage you may be billed for services not included in Basic Coverage. See the Student Handbook.

Who do I call if I have questions regarding a bill received for services rendered at Yale Health or have a question related to an alternate insurance carrier?

Please contact our staff at 203-436-8882.

I have Yale Health Hospitalization/Specialty Care coverage. I received a referral from a Yale Health clinician and obtained prior authorization to see a specialist outside 55 Lock Street. Why did I get a bill from the specialist?

There is a $20 copay for specialty services office visits outside of the Yale Health Center.  Different network providers have different policies. Some will bill Yale Health directly for prior-authorized services, while some will bill you. Bring or send the bill to the Claims Department and, if the service is covered, the claim will be paid.

I am a student and have Yale Health Hospitalization/Specialty Care coverage. I thought I was covered for absolutely everything, but I received a bill. Why?

Certain covered services and items will normally be billed to you. An example of this is durable medical equipment such as crutches or braces. You pay that bill and then submit it to the Claims Department. They will reimburse you, subject to the contract provisions.

I checked with my alternate insurance company. They said they have already paid a claim sent to them by Yale Health for services I received at Yale Health. But I see a charge on my bursar bill. What do I do?

Call the Billing Department at 203-436-8882 to verify that payment has been received by Yale Health. If it has been paid, you will receive credit on your bursar bill.

I thought that services and treatments in Inpatient Care were free for students. Why did I get a bill for my stay there?

Students receiving Yale Health Basic benefits who are admitted to Inpatient Care by a Yale Health clinician do receive room and board, nursing care and primary care at no charge. Those who have purchased Yale Health Hospitalization/Specialty Care coverage also receive approved specialty services at no charge. However, if you have alternate insurance, specialty care services ordered or rendered by a Yale Health clinician during an Inpatient Care stay will be billed to your other insurance. That company may or may not cover those services. If it does not, you will be billed directly via your bursar account.

How do I know if my alternate insurance is paying for services I receive at Yale Health as a student?

You will often receive an explanation of benefits with the payment information from your plan. If it indicates a partial payment or denial for services then you will be billed for the unpaid balance on your bursar account.

I am a student and have alternate hospitalization insurance. I received a service through Yale Health and received an explanation of benefits saying that they won’t pay. What should I do?

There are three possibilities:

  • The service or treatment you received may not be covered by your alternate insurance for any number of reasons.  The service may not covered at all, your insurance may require prior approval for some services and you did not obtain that approval or you may have received treatment at Yale Health for a condition that your plan thinks should have been treated in the plan’s network. If your plan doesn’t pay, Yale Health then bills your bursar account.
  • The service is covered, but is subject to a copayment or deductible for which you are being billed.
  • Incorrect information in your records may have caused the denial.

First you should call the Billing Department at 203-436-8882 to see if your information is correct. If it is incorrect, the corrections will be made and the claim will be sent again. However, if your information is accurate, the dispute over the claim is then between you and your insurance plan and you will have to follow through with them.

I am a student, if my alternate insurance receives a claim for services I received at Yale Health, does that mean that those services are not part of Yale Health Basic for students, are not free and are my responsibility?

Yes.  If you feel you were billed in error, call the Billing Department at 203-436-8882.

I am a student. What services do I get for free and what services involve billing either me or my insurance company?

To determine coverage for Yale Health Basic or Yale Health Hospitalization/Specialty Care coverage, please refer to the Student Handbook.