UC Berkeley University Health Services' headquarters, the Tang Center at 2222 Bancroft Way. (Chloe Veltman/KQED)
Psychotherapist Orit Weksler operates out of a bright office in Berkeley outfitted with a big, yellow couch, a box filled with sand and shelves stocked with small plastic figurines for patients to play with.
"Take whatever speaks to you, put it in the sand, and it creates a kind of picture, kind of like a dream scene," Weksler said. "It's just a way to start a conversation."
UC Berkeley students make up about a third of Weksler's practice. Navigating things like the red-tape imposed by insurance companies and erratic student schedules makes the job tough. "It's a very big commitment on our part," Weksler said. "We do this because we love working with students."
Now, Berkeley's decision to change up its health insurance provider — for the third time in six years — is putting that love to the test.
The main issue is the choice of insurance provider: Blue Shield.
Weksler is one of five mental health professionals interviewed for this story in person, on the phone or via email. All of them complained about the company's low reimbursement rates and slow, bureaucratic processes.
"Anthem and Aetna before them only pay us about 50 percent of our regular full fee," Weksler said of UC Berkeley's current and previous two student medical insurance partners. "Blue Shield will offer even less, which will make it impossible for most of us to offer more than one or two slots per week for students, due to the cost of living."
Weksler said many of her colleagues have voiced their concerns on a community listserv about what the switch to Blue Shield might mean for students' access to services going forward, in a climate where there are more students seeking therapy than there are therapists to provide it.
"People are going to get on the Blue Shield list to be able to continue to provide care for students who are currently on their caseload," Weksler says. "But they're not going to open any slots for new students."
The new plan will serve around 20,000 students and is scheduled to begin Aug. 1.
Blue Shield spokeswoman Amanda Wardell said her company plans to make the transition as easy as possible and provide a high level of care.
"As a nonprofit health plan, Blue Shield of California is dedicated to meeting the healthcare needs of UC Berkeley students with our extensive network of providers," Wardell said in a statement. "We are committed to working with UC Berkeley Student Health Insurance Plan (SHIP) to make this transition easy and ensuring access to high-quality care that is worthy of our family and friends."
UC Berkeley University Health Services’ (UHS) associate director of insurance and business development, Bahar Navab, defended the switch as being necessary in the face of ever-escalating healthcare costs.
"We have to find the right balance of let's reimburse our providers a livable wage, while also not having the cost of the plan be unsustainable," Navab said.
Navab said UHS considered bids from 10 insurance providers, and engaged students, the Berkeley administration and other campus stakeholders during the five-month-long bidding and evaluation process, before settling on Blue Shield. (The California-based provider is offering its services in collaboration with Wellfleet, a Massachusetts-based insurance firm that specializes in student insurance plans.)
Navab said her department has been working closely with Blue Shield to advocate for reimbursement rates on par with what the current insurer, Anthem, paid healthcare providers. She also said the new plan will not require doctors and other specialists to join the standard Blue Shield network. Instead, UHS has negotiated a special "carve out" for healthcare providers to work with UC Berkeley students.
"The carve out will offer providers more consistent rates," Navab said. "Additionally, we have been working with Blue Shield to reduce administrative barriers, figure out how to streamline the transition and make it as seamless and painless as possible."
Weksler is skeptical of phrases like "carve out": "It's just words," she said.
She wants UHS leaders to engage health practitioners in more conversations about policy and best practices in order to serve students' healthcare needs in a way that makes financial sense for the university, students and providers.
"I want to see that they understand what the actual problems are and that they're committed to helping us," Weksler said.
UC Berkeley student Nuha Khalfay, who studies public health, said she’s confident the university has students’ best interests at heart and is happy about some aspects of the new plan — such as the coverage of facial feminization surgery for transgender students for the first time.
Mental Health Care in California
But Khalfay said some of her friends on campus have had to travel far to find in-network providers willing to see them in recent months, and worries about the situation getting worse.
"If providers can't be reimbursed at the rates that they need to take students who go to UC Berkeley, then UC Berkeley students will lose out on the diversity of providers that they could have access to," Khalfay said.
According to Didi Wu, president of Student-to-Student Peer Counseling, a network of Berkeley students offering counseling services to their fellow students, the need for mental health care on campus has never been greater. "There has definitely been increasing demand for counseling among students," Wu said.
A UC system spokeswoman said Berkeley was the only campus in the system to offer Blue Shield as a primary provider.