Medical and Mental Health Claim Costs

Student Health Insurance 2017 - 2018 Plan Year

To estimate your financial responsibility when seeking treatment, refer to the Premier Plan Certificate of Coverage  for the details of applicable deductibles, co-payments, co-insurance, limitations, and exclusions. In addition, refer to the Description of Benefits for details regarding the following features of managing your health care costs:

PRECERTIFICATION

To reduce your inpatient out-of-pocket costs, you must obtain an inpatient admissions pre-certification from AdvoCare.
Allergy testing is a Covered Expense when referred by the Student Health Center and pre-certified by AdvoCare.
To coordinate reimbursable maternity care expenses with your provider, obtain pre-certification with AdvoCare within the first three months of pregnancy.

EMERGENCY ROOM COVERAGE

To have Emergency Room services reimbursed, the condition must meet the Medical Emergency definition in the Premier Plan Description of Benefits. Consider urgent care clinics for after hours urgent care needs.

REIMBURSEMENT SCHEDULES 1, 2, AND 3

Plan reimbursement differs according to which provider bills for a service, not which provider refers you for a service. Any provider may order services from or refer you to another provider. For example, the Student Health Center may order labs or x-ray services from the Georgetown Univeristy Hospital and the services will be billed by the hospital and paid under Schedule 2 rather than the preferred Schedule 1. The responsibility for reducing and understanding your out-of-pocket expenses falls on you, the patient.

To reduce your out-of-pocket costs, access providers according to the following schedules:

The Student Health Center and the Counseling and Psychiatric Service, Schedule 1, first;
The United HealthCare Options PPO network, Schedule 2, second; and,
Other providers, worldwide, Schedule 3, last.

PPO PROVIDERS

If you obtain care from the United HealthCare Options PPO network, your provider has agreed to provide treatment at a discount and to bill the claims company directly. Most providers at GUH are United HealthCare Options PPO providers. If your provider is not a PPO provider, you may be required to pay for health care services when the service is rendered and then request reimbursement from United HealthCare StudentResources.

To identify a United HealthCare Options PPO provider, go to www.UHCSR.com. When you contact the Provider to schedule an appointment, confirm that the Provider continues to be a United HealthCare Options PPO provider.